Single-Stage Tension Band Wiring with Circumferential Cerclage for a Transverse Patellar Fracture Neglected for One Month after Traditional Bone-Setting: A Case Report

Abstract

Background: Displaced transverse patellar fractures disrupt the knee extensor mechanism. When treatment is delayed, for example by traditional bone-setting, fibrous tissue fills the gap and the proximal fragment retracts, complicating fixation in fragile bone.

Objective: To describe single-stage fibrous curettage and fixation with parallel Kirschner-wire tension band wiring (TBW) plus a circumferential cerclage wire for a transverse patellar fracture neglected for one month, and the six-week outcome.

Methods: We report a 66-year-old postmenopausal woman (body mass index 26.3 kg/m²; 25-hydroxyvitamin D 21.0 ng/mL) who presented 30 days after a fall and traditional bone-setter manipulation with an AO/OTA 34-C1 fracture (gap 10 mm; step-off 3 mm) and Kellgren–Lawrence grade II osteoarthritis. Open curettage of the fibrous interposition, two parallel 1.8-mm Kirschner wires with a 1.0-mm figure-of-eight wire, and a 1.0-mm circumferential cerclage wire were used. Outcomes to postoperative day 42 (day 72 after injury) are reported descriptively (CARE guideline).

Results: Reduction closed the gap and the step-off (both 0 mm), and fixation was stable through 0°–90° of passive flexion. An active straight-leg raise returned and the 20° extension lag resolved by postoperative day 21. Active flexion increased from 20° to 30° at week 4 (+50%) and to 45° at week 6 (+125%); resting pain fell from 7/10 to 1/10 (−85.7%), and early cortical callus was reported at week 4. No complication occurred.

Conclusion: In this patient, TBW with an additional circumferential cerclage allowed single-stage fixation one month after injury without quadricepsplasty or bone grafting, with early functional recovery at six weeks. Longer follow-up is needed.