Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: A meta-analysis

Abstract

Background: To compare the efficacy and safety of K-wire tension band fixation (KTB) with other alternative approaches (cannulated screws, cable pin, and ring pin) for treatment of patella fractures by performing a meta-analysis. Methods: PubMed and EMBASE databases were searched for all relevant studies. Standardized mean difference (SMD) or relative risk (RR) and their corresponding 95% confidence intervals (CIs) were calculated for continuous or dichotomous outcomes via either a fixed- or random-effect model using Stata 13.0 software. Results: Nine literatures involving 949 patients (581 in the KTB group and 368 in the control group) were included. Pooled analysis showed there were no differences in the success rate, operative time, healing time, and number of infections between patients undergoing KTB and others. However, the incidence of complications (RR=8.04, 95% CI=4.45-14.53; p<0.001) and VAS (SMD=0.642, 95% CI=0.22-1.06; p=0.003) were lower, while flexion degree (SMD=-0.70 95% CI=-1.04--0.36; p<0.001), Böstman joint function score (SMD=-0.68, 95% CI=-1.10--0.27; p=0.001), Iowa knee score (RR=0.88, 95% CI=0.81-0.96; p=0.004), and Lysholm score (SMD=-0.71, 95% CI=-1.10--0.32; p<0.001) were significantly higher in patients undergoing alternative approaches than the KTB. Subgroup analysis also demonstrated the cannulated screw fixation was superior to KTB in reducing the incidence of complications. Conclusions: Alternative treatments may be effective for management of patella fractures and should be attempted to be popularized in clinic.