To determine whether any of the commonly used wiring techniques are
rigid enough to allow early motion in the treatment of transverse fracture
of the patella, the patellae of twenty-five fresh cadaver knees were
fractured transversely and fixed using the following techniques:
circumferential wiring, tension-band wiring, Magnusson wiring, and a
modification of tension-band wiring. The knees were mounted in a machine
capable of measuring quadriceps force, flexion angle, and fracture
separation simultaneously. The knees were extended from 90 to zero degrees
by applying tension to the quadriceps tendon with the force of gravity as
the only resistance, and separation of the fracture fragments was measured
first with the retinaculum unrepaired and then again with the retinaculum
repaired. Separation of the fracture fragments was much less with the
Magnusson wiring and modified tension-band wiring than with circumferential
wiring or standard tension-band wiring. The retinacular repair was found to
contribute to stability; however, this seemed most important in the less
rigid repairs. We concluded that if early motion is to be used in treating
transverse fractures of the patella, techniques in which the wire is
anchored directly in bone should be used and the retinaculum should be
repaired.