INTRODUCTION: Patella fractures account for almost about 1% of all 1musculoskeletal system fractures. The treatment of patella fractures may sometimes damage the underlying articular surface and lead to traumatic arthritis and cause long-term problems like Joint stiffness, muscle weakness and reduction of function. The most common surgery performed is open reduction & internal xation with K wire and tension band wiring. However, the incision utilised for the surgery is extensive and the extent of damage to the surrounding soft tissue including retinaculum is massive and can lead to tissue adhesions. There is always a concern about the occurrence of infection and cosmesis. In today's era of Minimally invasive surgery, the technique of using percutaneous cannulated screws promises to be fast, offering early Functional recovery and reduced occurrence of traumatic arthritis. We orchestrated the study with the aim of studying the effectiveness of percutaneous cannulated screw method of xation of transverse patella fractures. MATERIAL & METHODS This was a retrospective study conducted in the Department of Orthopaedics at our institute from August 2017 & July 2018 that analysed 12 patients (7 males & 5 females) with transverse patella fracture operated between by the minimally invasive technique of 2 percutaneous cannulated screws. The average follow-up period was 9 months (12-14 months). The average age was 49 years (38-69 years). The cause of the fracture was noted in all cases. We analysed the radiologic union, knee ROM and postoperative Lysholm score. In all cases the surgical technique involved application of pneumatic tourniquet to the patient in supine position under spinal or general anaesthesia, reduction of the fracture using towel clip under uoroscopic guidance and insertion of guidewires of 4mm cannulated cancellous screw through a small incision of about 0.5-1 cm in the proximal patella. After accepting the position of guidewire drilling and subsequent insertion of nal screw was done. Final reduction was conrmed on image intensier (FIGURE 1). FIGURE 1: Final reduction was conrmed on image intensier After routine closure, knee extension cylinder splint was applied with knee held in complete extension. The next day after surgery bedside knee mobilisation upto 90° was started. Isometric exercises for the quadriceps were taught and weight bearing mobilisation as per pain tolerance was advised. About 6 weeks post-surgery, knee bending beyond 90° was allowed. Lateral radiographs of the knee were analysed for articular surface damage & evidence of arthritis. Lysholm score for each patient was calculated. RESULTS The most common cause of trauma was road trafc accident. Radiological evaluation revealed that all fractures healed uneventfully. There were no reports of broken screw or non union in any patient. Normal range of motion upto 120° of exion was achieved in 11 knees (91.66%). One patient recovered upto 90° of knee exion due to non-compliance to physiotherapy. There were no cases of stiffness. The Average Lysholm score was 93.7 (85-100 points) at nal follow-up. This implied minimal loss of function for the patients post- operatively. There were no reports of wound complication and cosmetically healing was perfectly acceptable to the patient. There were no incidence of infection in our patients. OUTCOME OF PERCUTANEOUS CANNULATED SCREW FIXATION IN PATELLAR FRACTURES Original Research Paper Abhinav Jogani Senior Registrar, Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai. Orthopaedics Purpose: To assess the outcome of percutaneous cannulated screw xation in transverse patellar fractures Materials and Methods: This was a retrospective study conducted in the Department of Orthopaedics at our institute from August 2017 & July 2018 that analysed 12 patients (7 males & 5 females) with transverse patella fracture operated between by the minimally invasive technique of 2 percutaneous cannulated screws. The average follow-up period was 9 months (12-14 months). The average age was 49 years (38-69 years). The cause of the fracture was noted in all cases. We analysed the radiologic union, knee ROM and postoperative Lysholm score. Results: There were no reports of broken screw or non-union in any patient. Normal range of motion upto 120° of exion was achieved in 11 knees (91.66%). One patient recovered upto 90° of knee exion due to non-compliance to physiotherapy. There were no cases of stiffness. The Average Lysholm score was 93.7 (85-100 points) at nal follow-up. This implied minimal loss of function for the patients post-operatively. There were no reports of wound complication and cosmetically healing was perfectly acceptable to the patient. There were no incidence of infection in our patients. All fractures healed uneventfully. Normal range of motion was achieved in 11 knees (92.9%). Average Lysholm score was 95.9 at nal follow-up. Conclusion: Screw xation seemed to be useful for treatment of transverse patellar fracture except in comminuted fractures. The advantage of this technique was the preservation of extensor mechanism, simplicity, short operation time and good cosmesis. ABSTRACT KEYWORDS : Tushar Rathod* Associate Professor, Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai. *Corresponding Author VOLUME-8, ISSUE-9, SEPTEMBER-2019 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 82 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS DISCUSSION The patella provides a lever arm to the femoral quadriceps and extensor apparatus. It plays an important role in increasing the power of the knee joint extension. The aim of fracture treatment is to ensure continuity of the extensor mechanism and to ensure that the incidence of complications related to the articular surface of the patella are reduced. Since the patella happens to be subcutaneously placed in the lower limb, traditionally any and every xation modality that has been utilised for fracture xation like K wire or tension band/cerclage wires are often responsible for soft tissue irritation of the anterior knee region. Literature reports the incidence of complications related to wire cerclage to be as 2high as 47%. These complications prolonged recovery and necessitated additional surgery. Various modalities of treatment used to x patella fractures include K wire tension band wiring or encirclage or percutaneous cannulated screws. Many attempts have been made to perform minimally invasive surgery using 3,4arthroscopy assisted reduction. Proposed advantages include short surgical time, smaller incision, less risk of infection and more satisfaction of patients who desired cosmesis, decompression of intra-articular hematomas, removal of loose bodies or fracture pieces and direct visualization of the articular surface for reduction. Even while performing open approach, arthroscopy has the distinct advantage of offering a clearer evaluation of articular 4congruity with magnied visual eld. 3Tandogan studied Arthroscopic-assisted percutaneous screw xation of select patellar fractures and achieved decent results. The soft tissue disturbance was less than that of a routine open xation. Yet it is difcult to apply on a regular basis because of limitations of setup requirement and expertise of arthroscopic techniques which may have a learning curve. 5Edwards et al in their landmark study of 30 years follow-up of patella fractures laid down the guidelines for recommended 6 treatment. Whittle states that a disruption of the extensor mechanism or 2 to 3 mm of displacement is an indication for 7surgical treatment. Benjamin et a is stated in biomechanical cadaveric experiments recommended that screw xation should be utilised for transverse patellar fractures in patients who have good bone quality. In patients who sustain patellar fractures with comminution and/or osteopenia, choice of xation is modied tension band xation. Simple wiring techniques alone may not provide sufcient xation to allow immediate range of motion a single bone would be useful for pipe screw xation. The patella provides attachment to the quadriceps mechanism. This group of muscles extend along the borders of the patella as retinaculum which is an accessory knee extensor. Sometimes in cases of patella fractures this accessory extensor group can provide some degree of knee extension. But if there is complete detachment of extensor mechanism with patella and retinacular damage no active knee extension will be possible. The advantage of open technique of patellar xation involves that retinacular tears can be visualised and repaired if required according to Weber 8 9et al . Carpenter noted that there is a disadvantage of K wire and tension band wiring method of xation that it cannot be used in complex or comminuted fractures. The vascular supply of the patella is through a branch of the upper, middle, and lower patellar arteries. Open reduction may damage the patellar peripheral vascular plexus and can cause a non-union or avascular necrosis of the patella. In our study there was an advantage of being able to preserve the blood supply well and hence minimise the chances of vascular damage. Routinely reported postoperative complications of patella fractures include infection, xation failure, knee stiffness and posttraumatic osteoarthritis. Such complications have not been reported in our study. In recent years, early joint movement has become critical for optimising results. In some cases we had to use passive or active assisted range up to 90 degrees immediately post- surgery for ensuring early joint movement. Allowing light exercise and enforcing early weight bearing led to enhanced functional recovery and shortened the rehabilitation time. However, our limitation was smaller sample size and short follow-up. Future studies can be targeted at larger sample sizes and longer follow-up to achieve higher level of evidence. CONCLUSION Hence we conclude that Cannulated cancellous screw xation can be safely used in the treatment of transverse patella fractures except comminuted type. It is relatively simple and minimally invasive, does not affect the overall function, the operation time is relatively short, associated complication rate is lesser and is considered to be cosmetically satisfactory to the patients. REFERENCES 1. Lotke PA, Ecker ML. Transverse fractures of the patella. Clin Orthop Relat Res. 1981;(158):180-4 2. Hung LK, Chan KM, Chow YN, Leung PC. Fractured patella: operative treatment using the tension band principle.Injury. 1985;16:343-7 3. Tandogan RN, Demirors H, Tuncay CI, Cesur N, Hersekli M: Arthroscopic- assisted percutaneous screw xation of select patellar fractures. Arthroscopy, 18: 156-162, 2002. 4. Turgut A, Gunal I, Acar S, Seber S, Gokturk E: Arthroscopic-assisted percutaneous stabilization of patellar fractures.Clin Orthop Relat Res, 389: 57-61, 2001. 5. Edwards B, Johnell O, Redlund-Johnell I: Patellar fractures: a 30-year follow- up. Acta Orthop Scand, 60: 712-714, 1989 6. Whittle AP: Fractures of lower extremity. Campbell's operative orthopaedics. 10th ed. St. Louis, Mosby: 2796-2804, 2003 7. Benjamin J, Bried J, Dohm M, McMurthy M: Biomechanical evaluation of various forms of xation of transverse patellar fractures. J Orthop Trauma, 1: 219-222, 1987 8. Weber MJ, Janecki CJ, McLeod P, Nelson CL, Thompson JA: Efcacy of various forms of xation of transverse fracture of the patella. J Bone Joint Surg Am, 62: 215-220, 1980 9. Carpenter EJ, Kasman R, Matthews LS: Fractures of the patella. 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