Purpose: Tension band fixation (TBF) using screws or wires is the widely accepted standard of care for patellar fractures. This meta-analysis aims to quantitatively compare postoperative outcomes between Kirschner wire tension band fixation (KWTB) and cannulated screw tension band fixation (CSTB) to determine the optimal fixation method. Methods: A systematic review and meta-analysis were conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for comparative studies on KWTB vs. CSTB. Primary outcomes included union rate, time to union, infection, reoperation rate and pain. Secondary outcomes included range of motion, time to weight bearing, implant complications, and functional scores. Results: This meta-analysis included 10 studies with 1,272 patients. KWTB was associated with a significantly longer time to union (p = 0.02), greater pain scores (p < 0.0001), and higher infection rates (p = 0.04). However, union and reoperation rates were comparable. For secondary outcomes, CSTB had significantly improved time to full weight bearing (p < 0.00001). In addition, KWTB had higher complication rates, including implant migration/loosening (p < 0.00001), implant prominence, skin irritation (p = 0.003), and implant removal (p < 0.00001). The Lysholm score (p < 0.00001) and range of motion (p = 0.03) were significantly higher in the CSTB group. Conclusion: While union rates are comparable, CSTB for TBF in patellar fractures is associated with improved functional outcomes and a reduced complication rate compared with KWTB. Level of Evidence: Level III , systematic review and meta-analysis. See Instructions for Authors for a complete description of levels of evidence.

Introduction: Venous thromboembolism (VTE) remains a major complication following orthopedic trauma and fracture surgery. Low-molecular-weight heparin (LMWH) is widely used for prophylaxis; however, aspirin (ASA) has emerged as a potential alternative due to its ease of administration and cost-effectiveness. This study aimed to compare the efficacy and safety of aspirin (ASA) versus low-molecular-weight heparin (LMWH) in orthopedic trauma patients. Methods: A systematic review and meta-analysis was conducted by searching PubMed, Cochrane Library, and Google Scholar. Randomized controlled trials and comparative observational studies evaluating aspirin (ASA) versus low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis in orthopedic trauma patients were included. Outcomes assessed included overall venous thromboembolism (VTE), deep-vein thrombosis (DVT), pulmonary embolism (PE), fatal PE, mortality, bleeding complications, wound site infection, and hematoma formation. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed using the I(2) statistic. Results: Five studies comprising a heterogeneous orthopedic trauma population were included. No statistically significant difference between aspirin (ASA) and low-molecular-weight heparin (LMWH) in the incidence of venous thromboembolism (VTE) was noted (OR 0.52, 95% CI 0.02–12.25, p = 0.68). No significant differences were observed in the incidence of DVT between aspirin (ASA) and low-molecular-weight heparin (LMWH) (OR 1.00, 95% CI 0.46–2.16, p = 1.00). Pulmonary embolism (PE) (OR 0.96, 95% CI 0.72–1.28, p = 0.80), fatal PE (OR 0.55, 95% CI 0.18–1.65, p = 0.28), and mortality (OR 1.02, 95% CI 0.68–1.54, p = 0.91) were comparable between the two groups. Similarly, no significant differences were observed in bleeding complications (OR 0.95, 95% CI 0.86–1.05, p = 0.33) or wound complications (OR 1.05, 95% CI 0.81–1.37, p = 0.70). Hematoma formation showed a trend favoring aspirin (ASA) (OR 0.36, 95% CI 0.13–1.02, p = 0.05), although this did not reach statistical significance. Conclusions: Aspirin (ASA) may be a reasonable alternative to low-molecular-weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis in selected orthopedic trauma patients, with comparable outcomes for pulmonary embolism (PE), mortality, bleeding and wound complications. Larger high-quality randomized trials with standardized protocols in clearly defined orthopedic trauma populations are warranted to confirm these findings and guide clinical decision-making.