Technical TrickRevisiting Tension Band Fixation for Difficult Patellar FracturesHambright, Dustin S. MD*; Walley, Kempland C. BcS*; Hall, Amber BS†; Appleton, Paul T. MD*; Rodriguez, Edward K. MD, PhD*Author Information *Department of Orthopaedics, Beth Israel Deaconess Medical Center, Boston, MA; and †Boston Children's Hospital, Boston, MA. Reprints: Edward K. Rodriguez, MD, PhD, Department of Orthopaedics, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Stoneman 10, Boston, MA 02215-5400 (e-mail: email@example.com). The authors report no conflict of interest. Presented as a poster at the Annual Meeting of the Orthopaedic Trauma Association, October 7–10, 2015, San Diego, CA. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jorthotrauma.com). Journal of Orthopaedic Trauma: February 2017 - Volume 31 - Issue 2 - p e66-e72 doi: 10.1097/BOT.0000000000000686 Buy SDC Metrics Abstract Summary: Patella fractures with comminution, osteoporotic bone, and/or previously failed fixation are exceedingly difficult to reduce and fix. Moreover, the risk of symptomatic constructs and patients who are poorly compliant with postoperative activity restrictions can make these complex fracture patterns an even more challenging scenario. Although there is an array of techniques described for comminuted patella fractures, there lacks an accepted surgical technique for these difficult cases. In this clinical series, we describe an enhancement to the traditional tension band construct that uses additional wires and multiple tension bands to gather and fix comminuted fracture patterns in nontransverse planes, bolster osteoporotic bone, and secure fractures in patients undergoing a revision and/or have potential to be poorly compliant with postoperative activity restrictions. The clinical outcomes of 27 patients demonstrate high rates of bony union, functional range of motion, and low rates of both infection and failure. In conclusion, using the basic principles of tension band wiring remains highly versatile, useful, and economical in approaching difficult patella fractures. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.