A Case Report of the Complete Union of an Impending Failure of Patellar Fracture Treated with Cannulated Cancellous Screws and Tension Band Wiring for Failed Modified Tension Band Wiring Technique

INTRODUCTION: Modified tension band wiring (MTBW) using two cannulated cancellous screws which also achieve a horizontal figure of eight patterns of tension band is established as a superior fixation to using Kirschner wires for type 34-C1 fracture of the patella. We are describing a case where this method was used for failed MTBW using two Kirschner wires where an impending failure in the early post-operative period proceeded to complete bony union without any implant failure or functional deficit following a period of conservative management. CASE PRESENTATION: We are describing a 67-year-old man with type 34-C1 fracture of patella treated by MTBW using Kirschner wires and a stainless steel (SS) wire, with fixation failure after around 6 weeks, which was revised by MTBW using two vertically placed cannulated partially threaded cancellous screws and SS wire as a tension band. In the early post-operative period, a routine X-ray of the operated part showed fracture fragment separation with a slight sack in the tension band wire without any signs of implant failure. To our surprise, the fracture proceeded to complete bony union while continuing gradually increased active knee range of motion exercises. CONCLUSION: This case report presents how an impending failure proceeded to complete fracture healing because of dynamic compression of the fracture provided by the tension band construct.