• Jill M Martin, Dylan T Applin, Linda M McGrady, Mei Wang, and Gregory J Schmeling.
• Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI.
• J Orthop Trauma. 2019 Jun 1; 33 (6): e240-e245.

ObjectiveThis study aimed to investigate the stability and strength of tension band wire fixation using headless compression screws versus headed screws for transverse patella fractures.MethodsSix matched pairs of fresh-frozen cadaveric knees with transverse osteotomies created at the midpoint of the patella were surgically fixed, with one knee randomly receiving fixation with headless screws (Acumed Acutrak 4/5) and the other with headed screws (Synthes 4.0 partially threaded cannulated screws). The specimens were mounted onto a servohydraulic load frame in a 45-degree flexed position and loaded through the quadriceps tendon. Interfragmentary movement was recorded with a motion analysis system. The initial fixation stiffness, range of interfragmentary motion, and strength of the headless screw construct were compared with the headed screw construct. Failure was defined as either a sudden drop in applied tendon force or 2 mm of separation on the anterior surface of the patella (ie, clinical failure), whichever occurred first.ResultsMean primary interfragmentary motion was 0.31 ± 0.28 degrees for the headed screws and 0.10 ± 0.06 degrees for headless screws under 150 N load (P = 0.03). Mean construct stiffness was 277 ± 243 N/degrees for the headed screws and 510 ± 362 N/degrees for the headless screws (P = 0.03). None of the constructs from either group displayed structural failure before reaching the clinical failure gap of 2 mm. The mean clinical failure strength was 808 ± 183 N for the headless screws construct and 520 ± 241 N for the headed screws construct (P = 0.03).ConclusionsHeadless screw tension band fixation demonstrated superior biomechanical behaviors over standard headed screw fixation with higher construct rigidity, smaller interfragmentary motion, and greater fixation strength.

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