Objective To evaluate the therapeutic effect of Kirschner wire tension band combined with cobweb-like suturing in the management of comminuted patellar fractures.Methods A total of 82 patients with comminuted patellar fractures treated from January 2022 to December 2023 were included. They were randomly assigned into an observation group (41 cases) and a control group (41 cases). The control group underwent conventional Kirschner wire tension band fixation, while the observation group received additional cobweb-like suturing. Surgical parameters, fracture healing, postoperative knee joint function, inflammatory markers, and complication rates were compared between the two groups.Results There were no significant differences in operative time, intraoperative blood loss, hospital stay, or fracture healing time between the two groups (P>0.05). At 1 and 3 days after surgery, pain scores in the observation group were lower than those in the control group (P<0.05), while no difference was found at 5 and 7 days (P>0.05). The observation group showed greater knee flexion at 1 and 3 months postoperatively (P<0.05), whereas no differences were observed at 6 months and 1 year (P>0.05). One week after surgery, the levels of interleukin-6, C-reactive protein and procalcitonin in the observation group were lower than those in the control group (P<0.05).One week after surgery, the levels of interleukin-6, and C-reactive protein in the observation group were lower than those in the control group (P<0.05).The overall complication rates showed no significant difference between groups (P>0.05).Conclusion Compared with conventional Kirschner wire tension band internal fixation, the combination of Kirschner wire tension band and arachnoid sutures demonstrates distinct advantages in treating comminuted patellar fractures. This approach effectively reduces early pain, enhances patellar stability, accelerates early joint function recovery, and improves postoperative inflammation response. Particularly for elderly osteoporosis patients, it provides a balanced approach that prioritizes both bone and tendon preservation while ensuring excellent safety.