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Poh JW, Li Z, Koh DTS, Tay KXK, Goh SK, Woo YL, Xia Z. Cannulated compression screws with cable technique leads to a dramatic reduction in patella fracture fixation complications compared to tension band wiring. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05533-w. [PMID: 39261327 DOI: 10.1007/s00402-024-05533-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/31/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION The aim of this study was to compare the clinical, radiological and functional outcomes between cannulated compression screw with cable construct (CS) and tension band wiring (TBW) in transverse patella fractures. MATERIALS AND METHODS A retrospective study was conducted on patients surgically treated for AO/OTA 34C1 or 34C2 transverse patella fractures with CS or TBW technique between January 2019 and January 2023. Clinical outcomes included complications related to the implant, wound and fracture at 6 months and 1 year, time to achieving full weight bearing status and early perioperative clinical outcomes. Radiological outcomes included the time to fracture heals and delayed union. Functional outcome measures using the Oxford Knee Scale, 36-short form questionnaire and the Bartlett Anterior Knee Score were assessed. RESULTS 73 patients were treated with CS (n = 33) or TBW (n = 40). TBW had higher complication rates: 25.0% (n = 10) required implant removal, 12.5% (n = 5) had wire breakage, 12.5% (n = 5) experienced fracture displacement while 52.5% (n = 21) experienced implant migration. In contrast, no CS patients had implant removals, wire breakage or fracture displacement and 3.0% (n = 1) experienced implant migration. At 1 day post-operatively, 87.9% (n = 29) CS group patients were able to ambulate as compared to the 55.0% (n = 22) of TBW patients. Furthermore, CS patients ambulated further distances at 11.8 ± 10.6 m than the TBW group (6.4 ± 7.4 m). The CS group (25.9 ± 24.6 days) also achieved full weight bearing status faster than the TBW group (43.6 ± 39.4 days). The time taken for the fracture to heal and functional outcomes were comparable among the two groups. CONCLUSIONS The CS technique demonstrated lower complications, in particular, no CS patient had implant removals, wire migration or fracture displacement. Additionally, CS technique showed a faster return to ambulation and time to achieving full weight bearing status.
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Affiliation(s)
- Jane Wenjin Poh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Zongxian Li
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Don Thong Siang Koh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore.
| | - Kenny Xian Khing Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Seo Kiat Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Yew Lok Woo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Zhan Xia
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
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Yurteri A, Mercan N, Uğur L. Comparison of the use of biocompatible materials and titanium in the treatment of midshaft clavicle fractures with a patient-specific plate: a finite element analysis study. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05449-5. [PMID: 39008077 DOI: 10.1007/s00402-024-05449-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 06/30/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Clavicular midshaft fractures treated with titanium plates may encounter complications like implant failure. We assess if alternative biocompatible materials suchs as PLA, PLA/HA, PEEK offer comparable stability. Our study evaluates the biomechanical performance of these materials in surgical management of midshaft clavicle fractures. METHODS We simulated a personalized fixation implant with four different materials and conducted finite element analysis in ANSYS to assess maximum von Mises stress (MvMs). RESULTS The MvMs occurring on the plates, screws, clavicle, and fracture site were recorded. MvMs on titanium material at the 6th hole level (764.79 MPa) and the 6th screw level (503.38 MPa), with the highest stresses observed at 48.52 MPa on the lateral clavicle at the 1st hole level and 182.27 MPa on the medial clavicle at the 6th hole level. In PLA material analyses, the highest MvMs were observed at the 3rd hole level (340.6 MPa) and the 3rd screw level (157.83 MPa), with peak stresses at 379.63 MPa on the lateral clavicle fracture line and 505.44 MPa on the medial clavicle fracture line. In PLA/HA material analyses, the highest MvMs were at the 3rd hole (295.99 MPa) and 3rd screw (128.27 MPa), with peak stresses at 220.33 MPa on the lateral clavicle and 229.63 MPa on the medial clavicle fracture line. In PEEK material analyses, the highest MvMs were at the 3rd hole (234.74 MPa) and 6th screw (114.48 MPa), with peak stresses at 184.36 MPa on the lateral clavicle and 180.1 MPa on the medial clavicle. CONCLUSION Our findings indicate that titanium material shows significantly higher stresses on plates and screws compared to those on the clavicle, suggesting a risk of implant failure. PLA and PLA/HA were inadequate for fixation. Although stress on the plate with PEEK material is higher than on the clavicle, it remains lower than titanium, indicating potential stability at fracture site. Further research is needed to confirm these findings.
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Affiliation(s)
- Ahmet Yurteri
- Department of Orthopaedics and Traumatology, Konya City Hospital, Konya, 42020, Türkiye
| | - Numan Mercan
- Department of Orthopaedics and Traumatology, Kahramanmaraş Necip Fazıl City Hospital, Kahramanmaraş, 46050, Türkiye.
| | - Levent Uğur
- Mechanical Engineering Department, Amasya University, Amasya, 05100, Türkiye
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Bel JC, Lefèvre C. Reconstruction of patella fractures with the tension band technique: A review on clinical results and tips and tricks. Injury 2024; 55 Suppl 1:111401. [PMID: 39069346 DOI: 10.1016/j.injury.2024.111401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION The goals of surgical treatment of patellar fractures are a biomechanically stable joint and congruent restoration of the retro patellar joint surface. Surgical treatment strategies for patellar fractures have evolved from tension band in combination with wire cerclages to new devices. METHODS The modified anterior tension band (MATB) technique for fixation of patellar fractures consists of two longitudinal 1.8 mm Kirschner wires (K-wires) and an 18-gauge stainless steel wire looped in a figure-of-8 pattern over the anterior aspect of the patella. The K-wires should be inserted 5 mm from the anterior cortical surface of the patella, parallel in the coronal and sagittal planes. For mechanical reasons, the wire should be the closest to the anterior aspect of the bone. This construct converts the anterior tensile forces generated by the extensor mechanism and knee flexion into compressive forces on the anterior aspect of the fracture site. The MATB is the most widely accepted method of internal fixation for transverse and comminuted patellar fractures. Only a careful implementation of the MATB in all its phases will provide the best mechanical construct and the least aggressive construct for the soft tissues, allowing early re-education without complications. RESULTS Good to excellent clinical results (64-100 %) have been reported with MATB for fixation of patellar fractures. Good to excellent range of knee motion and satisfactory results have been reported despite a high percentage (up to 60 %) of secondary procedures, mainly for removal of symptomatic hardware. CONCLUSION This article provides an overview of the use and results of the MATB technique for patellar fractures and the means to improve results with this technique.
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Affiliation(s)
- Jean-Christophe Bel
- CHU Lyon HCL E. Herriot Hospital, Pavilion T, Orthopaedic & Trauma Department, 5 place D'Arsonval, 69003 Lyon, France.
| | - Christian Lefèvre
- CHRU Brest Cavale Blanche Hospital, Orthopaedic & Trauma Department, boulevard T. Prigent, 29609 Brest Cedex, France
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Garner MR, Homcha B, Cowman T, Goss M, Reid JS, Lewis GS. Transverse patella fracture fixation: A cadaveric biomechanical comparison of cannulated screws and anterior tension band versus low-profile, multiplanar mesh plating. Injury 2024; 55:111574. [PMID: 38669892 PMCID: PMC11111345 DOI: 10.1016/j.injury.2024.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Multiplanar mesh plating of patella fractures has become more popular in recent years. It was the goal of this study to compare the biomechanical stability of cannulated screw with anterior tension band to multiplanar mesh plating for fixation of transverse patella fractures in cadaver specimens. MATERIALS AND METHODS Eight matched pairs of fresh frozen cadaveric knees were obtained and soft tissues dissected leaving the extensor mechanism, joint capsule, and retinaculum intact. Transverse fractures were created at the mid-portion of the patella. For each pair, one specimen was repaired using cannulated screws with anterior tension band, and the second was repaired using multiplanar mesh plating. Each specimen underwent cyclic extension loading with loads increasing by 1.1 kg after every 50 cycles. Interfragmentary displacement was measured at the end of each interval at both 5° and 45° of knee flexion angle, with fixation failure defined by >2 mm displacement. RESULTS The specimens fixed with multiplanar mesh plating survived more cycles and higher loads than the specimens fixed with cannulated screws with anterior tension band (p = 0.011 comparing survival plots). After 150 cycles of extension loading, 3 of 8 of the specimens fixed with screws/tension band had failed, whereas none of the mesh plated specimens had failed. After 400 cycles, 7 of 8 of the screws/tension band had failed, whereas half of the mesh plated specimens had failed. CONCLUSIONS While a more technically challenging and expensive technique, mesh plating for patella fractures appears to offer greater durability than traditional cannulated screw with tension banding.
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Affiliation(s)
- Matthew R Garner
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA.
| | - Brittany Homcha
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Trevin Cowman
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Madison Goss
- Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - J Spence Reid
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Gregory S Lewis
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
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Warner S, Sommer C, Zderic I, Woodburn W, Castle R, Penman J, Saura-Sanchez E, Helfet DL, Gueorguiev B, Stoffel K. Lateral rim variable angle locked plating versus tension band wiring of simple and complex patella fractures: a biomechanical study. Arch Orthop Trauma Surg 2024; 144:2131-2140. [PMID: 38520547 DOI: 10.1007/s00402-024-05266-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 03/03/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION Treatment of both simple and complex patella fractures is a challenging clinical problem. Although tension band wiring has been the standard of care, it can be associated with high complication rates. The aim of this study was to investigate the biomechanical performance of recently developed lateral rim variable angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures. MATERIALS AND METHODS Sixteen pairs of human anatomical knees were used to simulate either two-part transverse simple AO/OTA 34-C1 or five-part complex AO/OTA 34-C3 patella fractures by means of osteotomies, with each fracture model created in eight pairs. The complex fracture pattern was characterized by a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral, and an inferior (central distal) fragment mimicking comminution around the distal patellar pole. The specimens with simple fractures were pairwise assigned for fixation with either tension band wiring through two parallel cannulated screws or a lateral rim variable angle locking plate. The knees with complex fractures were pairwise treated with either tension band wiring through two parallel cannulated screws plus circumferential cerclage wiring or a lateral rim variable angle locking plate. Each specimen was tested over 5000 cycles by pulling on the quadriceps tendon, simulating active knee extension and passive knee flexion within the range of 90° flexion to full extension. Interfragmentary movements were captured via motion tracking. RESULTS For both fracture types, the articular displacements measured between the proximal and distal fragments at the central patella aspect between 1000 and 5000 cycles, together with the relative rotations of these fragments around the mediolateral axis were all significantly smaller following the lateral rim variable angle locked plating compared with tension band wiring, p ≤ 0.01. CONCLUSIONS From a biomechanical perspective, lateral rim variable angle locked plating of both simple and complex patella fractures provides superior construct stability versus tension band wiring under dynamic loading.
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Affiliation(s)
- Stephen Warner
- University of Texas Health Science Center, Houston, TX, USA
| | | | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland.
| | | | | | | | | | - David L Helfet
- New York Presbyterian Hospital, New York Weill Cornell Center, New York, NYC, USA
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Hua YF, Zhang YR, Guo L. Retrospective study of patellar fractures and damage of accessory soft tissue based on MRI. PLoS One 2024; 19:e0295671. [PMID: 38466690 PMCID: PMC10927098 DOI: 10.1371/journal.pone.0295671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/28/2023] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND To better understand the pathophysiological mechanisms of patellar fractures, MRI was utilized to identify the imaging signs of various types of patellar fractures. METHODS A retrospective study was performed using MRI images of 52 patients with patellar fractures. Observing the development of patellar and femoral morphology and the imaging manifestations of different fracture types, such as fracture displacement, and damage to accessory ligaments, tendons, and meniscus, type of joint cavity effusion, and damage to surrounding accessory bones were identified. RESULTS There were 21 tangential fractures (40.4%), 8 transverse fractures (15.4%), 8 longitudinal fractures (15.4%), 4 oblique fractures (7.7%), and 11 comminuted fractures (21.2%) among the 52 patients with patellar fracture. Tangential fractures begin at a younger age than the other four forms of fractures. When tangential fractures were compared to other types of fractures, medial patellar retinaculum and anterior and posterior cruciate ligament injuries were statistically significant (P< 0.05). The detection rate of trochlear dysplasia, type II and type III patellar was higher in patients with tangential fractures than in other fractures. CONCLUSIONS Tangential fractures are less common to cause anterior and posterior cruciate ligament injuries than other types of fractures, but they are more likely to cause medial patellar retinaculum injuries.
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Affiliation(s)
- Yi-Fan Hua
- Department of Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
- Department of School Infirmary, Yunnan Minzu University, Kunming, Yunnan, P.R. China
| | - Yu-Rou Zhang
- Department of Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
| | - Li Guo
- Department of Radiology, Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, P.R. China
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Liu CD, Hu SJ, Chang SM, Du SC, Chu YQ. Morphological characteristics and a new classification system of the inferior pole fracture of the patella: A computer-tomography-based study. Injury 2024; 55:111256. [PMID: 38049367 DOI: 10.1016/j.injury.2023.111256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE The objective of this study was to measure the morphological characteristics of inferior pole fracture of the patella (IPFP) and develop a practical classification system to determine the corresponding treatment protocols for different IPFPs with specific patterns. METHODS A retrospective radiographic review was performed on a series of 71 patients with IPFP. The preoperative CT data were collected and measured using image processing software. The number of fragments, maximum fracture fragment anteroposterior length (MFFAL), maximum fracture fragment transverse length (MFFTL), fracture fragment coronal angle (FFCA), fracture fragment sagittal angle (FFSA), maximum fracture fragment height (MFFH) and maximum transverse sectional area (MTSA) were analysed. RESULTS The mean number of fracture fragments was 3.8. The average MFFAL was 14.9 mm, the average MFFTL was 23.5 mm, the average FFCA was 92.1°, the average FFSA was 93.0°, the average MFFH was 13.6 mm, and the average MTSA was 299.3 mm2. A new classification system was introduced to describe the varied patterns of IPFP, summarized as (I) simple IPFP; (II) comminuted IPFP; (III) simple IPFP with simple patellar body fracture; and (IV) comminuted patellar fracture involving the inferior pole. With the four-type classification system, 12 type I, 22 type II, 21 type III, and 16 type IV lesions were observed, each with specific morphological characteristics. CONCLUSION Most IPFPs exhibited a diversiform pattern, demonstrating that coverage fixation was likely needed. The four-type classification system might offer a valuable approach to help orthopaedic surgeons make individual treatment plans.
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Affiliation(s)
- Chen-Dong Liu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China
| | - Sun-Jun Hu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China.
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China
| | - Shou-Chao Du
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China
| | - Yong-Qian Chu
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai 200090, Republic of China
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Baid M, Narula S, Manara JR, Blakeney W. Evolution in the Management of Patella Fractures. J Clin Med 2024; 13:1426. [PMID: 38592262 PMCID: PMC10934211 DOI: 10.3390/jcm13051426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of the knee, where large forces are transmitted, and its subcutaneous nature has made treatment of patella fractures a challenge. In this review article, we evaluate how the management of these fractures has evolved over time and the advantages associated with the various treatment techniques. There are few comparative studies looking at the different treatment types for fractures of the patella, with the goal of achieving a functional extensor mechanism with low rates of post-traumatic arthritis and metal-work irritation.
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Affiliation(s)
- Mahak Baid
- Aneurin Bevan University Health Board, Wales NP20 2UB, UK; (M.B.); (J.R.M.)
| | - Sid Narula
- Royal Perth Hospital, Perth, WA 6000, Australia
| | - Jonathan R. Manara
- Aneurin Bevan University Health Board, Wales NP20 2UB, UK; (M.B.); (J.R.M.)
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Kim S, Mungalpara N, Wangikar R, Tarabichi M, Karam J, Bedi A, Koh J, Amirouche F. Comparative study of locking neutralization plate construct versus tension band wiring with a cannulated screw for patella fractures: experimental and finite element analysis. J Orthop Surg Res 2024; 19:77. [PMID: 38233950 PMCID: PMC10795423 DOI: 10.1186/s13018-024-04538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
Transverse patella fractures, accounting for approximately 1% of Orthopedic injuries, pose intricate challenges due to their vital role in knee mechanics. This study aimed to compare the biomechanical performance of a construct, integrating cannulated screws and an anterior locking neutralization plate, with the conventional tension band wiring technique for treating these fractures. Experimental testing and Finite Element Analysis were employed to evaluate the constructs and gain profound insights into their mechanical behavior. Sixteen cadaveric knees were prepared, and transverse patella fractures were induced at the midpoints using a saw. The plate construct and tension band wire fixation were randomly assigned to the specimens. A cyclic test evaluated the implants' durability and stability, simulating knee movement during extension and flexion. Tensile testing assessed the implants' maximum failure force after cyclic testing, while Finite Element Analysis provided detailed insights into stress distribution and deformation patterns. Statistical analysis was exclusively performed for the experimental data. Results showed the plate enhanced stability with significantly lower deformation (0.09 ± 0.12 mm) compared to wire fixation (0.77 ± 0.54 mm) after 500 cycles (p = 0.004). In tensile testing, the construct also demonstrated higher failure resistance (1359 ± 21.53 N) than wire fixation (780.1 ± 22.62N) (p = 0.007). Finite Element Analysis highlighted distinct stress patterns, validating the construct's superiority. This research presents a promising treatment approach for transverse patella fractures with potential clinical impact and future research prospects. This study presents a promising advancement in addressing the intricate challenges of transverse patella fractures, with implications for refining clinical practice. The construct's improved stability and resistance to failure offer potential benefits in postoperative management and patient outcomes.
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Affiliation(s)
- Sunjung Kim
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Nirav Mungalpara
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Rohan Wangikar
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Majd Tarabichi
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Joseph Karam
- Department of Orthopedic Surgery, Orthopedic and Spine Institute, Northshore University Health System, An Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL, 60076, USA
| | - Asheesh Bedi
- Department of Orthopedic Surgery, Orthopedic and Spine Institute, Northshore University Health System, An Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL, 60076, USA
| | - Jason Koh
- Department of Orthopedic Surgery, Orthopedic and Spine Institute, Northshore University Health System, An Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL, 60076, USA
| | - Farid Amirouche
- Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA.
- Department of Orthopedic Surgery, Orthopedic and Spine Institute, Northshore University Health System, An Affiliate of the University of Chicago Pritzker School of Medicine, 9669 Kenton Avenue, Skokie, IL, 60076, USA.
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Tsotsolis S, Ha J, Fernandes ARC, Park JY, Dewhurst M, Walker T, Ilo K, Park SR, Patel A, Hester T, Poutoglidou F. To plate, or not to plate? A systematic review of functional outcomes and complications of plate fixation in patellar fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3287-3297. [PMID: 37286819 DOI: 10.1007/s00590-023-03597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Poor outcomes and high complication and reoperation rates have been reported with tension-band wiring (TBW) in the management of patellar fractures and particularly the comminuted ones. The purpose of this study was to investigate the functional outcomes and complication rates of patellar fractures managed with open reduction and internal fixation (ORIF) with a plate. METHODS MEDLINE, EMCare, CINAHL, AMED and HMIC were searched, and the PRISMA guidelines were followed. Two independent reviewers extracted the data from the included studies and assessed them for the risk of bias. RESULTS Plating of patellar fractures is associated with satisfactory range of movement (ROM) and postoperative function and low pain levels. We found a 10.44% complication rate and a low reoperation rate. Reoperations were mainly performed for metalwork removal. CONCLUSION ORIF with plating of patellar fractures is a safe alternative in the management of patellar fractures and may be associated with a lower complication and reoperation rate compared to TBW. Future randomized prospective studies are needed to validated the results of the present systematic review.
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Affiliation(s)
- Stavros Tsotsolis
- Department of Trauma and Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joon Ha
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | | | - Jae Yong Park
- Faculty of Medicine, Imperial College London, London, UK
| | - Maximilian Dewhurst
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Thomas Walker
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Kevin Ilo
- University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
| | - Se Ri Park
- Faculty of Medicine, Imperial College London, London, UK
| | - Amit Patel
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Thomas Hester
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Freideriki Poutoglidou
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK.
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Neumann-Langen MV, Sontheimer V, Näscher J, Izadpanah K, Schmal H, Kubosch EJ. Incidence of postoperative complications in patellar fractures related to different methods of osteosynthesis procedures - a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:871. [PMID: 37946171 PMCID: PMC10634146 DOI: 10.1186/s12891-023-06998-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Patellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management. METHODS In a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines. RESULTS A total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p < 0.043). The incidence of posttraumatic infection was significantly higher following the hybrid fixation technique with cannulated screws and tension wire than following the other analysed techniques (p = 0.024). No postoperative wound infection was observed after screw fixation or locking plate fixation. Symptomatic hardware was most frequently seen after tension-band fixation. Onset of posttraumatic osteoarthritis was most often found after the hybrid fixation technique (55%). CONCLUSION Surgical management of patellar fractures remains crucial but fracture fixation using plating systems or small fragment screws is least associated with postoperative complications. TRIAL REGISTRATION Trial registration number (DRKS):00027894.
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Affiliation(s)
- M V Neumann-Langen
- Department of Orthopaedic and Trauma Surgery, Klinikum Konstanz, Mainaustrasse 35, 78464, Konstanz, Germany.
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - V Sontheimer
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - J Näscher
- Department of Mathematics and Statistics, University of Konstanz, Eggerthaldestrasse D, 78457, Konstanz, Germany
| | - K Izadpanah
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - H Schmal
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
- Department of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - E J Kubosch
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
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Cancio-Bello AM, Owen AR, Kuttner NP, Hidden KA, Cross WW, Yuan BJ, Sems SA. Patella Fracture Fixation With Novel Wagon Wheel Construct Versus Tension-Band Construct: A Technical Trick. J Orthop Trauma 2023; 37:e452-e458. [PMID: 36788110 DOI: 10.1097/bot.0000000000002579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
SUMMARY Internal fixation of patella fractures remains technically challenging. Cannulated screws with an anterior tension band have been associated with high rates of implant prominence, and fracture comminution can make appropriate application of a tension band impractical. We present the results of a novel technique using a transtendinous/transligamentous mini-fragment plate positioned peripherally around the patella with radially directed screws: termed the wagon-wheel (WW) construct. Compared with a cohort of fractures treated with cannulated screws with an anterior tension band, there was no difference in final range of motion and rate of nonunion. The WW construct had a significantly decreased incidence of symptomatic implants (5% vs. 32%, P = 0.02), rate of reoperation (9% vs. 38%, P = 0.018), dependency on gait aids (10% vs. 38%, P = 0.031), and a faster time to union (HR: 2.2; 95% CI, 1.28-3.95, P = 0.005). In summary, the WW was designed with the goal of obtaining peripheral plate fixation to maximize fragment-specific fixation while minimizing implant prominence. Patients treated with the WW demonstrated reduced rates of implant prominence and reoperation.
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13
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Liu S, Liu S, Gu F, Wei X, Liang Y. Novel screw-cable integrated system(SCIS) for minimally invasive treatment of patella transverse fractures: a finite element analysis. J Orthop Surg Res 2023; 18:818. [PMID: 37907986 PMCID: PMC10619249 DOI: 10.1186/s13018-023-04306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/20/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The most recommended method for treating transverse patella fractures is modified tension band wiring (MTBW). However, the optimal instrument for use with MTBW is still undetermined. Hence, we aimed to design a novel screw-cable integrated system (SCIS) and compare its biomechanical characteristics with Kirschner-wire, SCIS, and Cable-Pin systems in treating transverse patellar fracture. METHODS A finite-element (FE) model of transverse patella fracture was created. The fracture model was fixed with either K-wire, SCIS, or Cable-pin. Different tension force loading (400 N and 800 N), direction(0° and 45°), and screw or K-wire depth(5 mm and 10 mm) were set. The maximum displacement of the fragment and maximum gap opening were measured by using FE analysis. RESULTS Compared with the K-wire and Cable-pin system, SCIS increased the stability of the fractured patella by reducing fragment displacement and gap opening. Under 400 N loading in the direction 45°, SCIS with screw placing at 5-mm depth reduced the maximum fragment displacement (0.43 mm) by 49.62% and 26%, respectively, compared with the K-wire (0.22 mm) and Cable-pin (0. 22 mm) group. Meanwhile, the gap opening in SCIS (0.05 mm) was reduced by 83% and 59.8% (0.05 to 0.18) compared with the K-wire (0.30 mm) and Cable-pin (0.18 mm) group. CONCLUSION SCIS demonstrated improved biomechanical stability for treating transverse patellar fractures compared to MTBW with Kirschner wire and the Cable-Pin system. Finite element analysis showed SCIS substantially reduced fracture fragment displacement and gap opening under various loading conditions.
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Affiliation(s)
| | - Shen Liu
- Aerospace Center Hospital, Beijing, China
| | - Feng Gu
- Aerospace Center Hospital, Beijing, China
| | - Xing Wei
- Aerospace Center Hospital, Beijing, China
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Yao LW, Mao HJ, Dong WW, Wu ZT, Liu Q. Comparison of a minimally invasive osteosynthesis technique with conventional open surgery for transverse patellar fractures. Chin J Traumatol 2023; 26:261-266. [PMID: 37198050 PMCID: PMC10533542 DOI: 10.1016/j.cjtee.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/31/2023] [Accepted: 03/19/2023] [Indexed: 05/19/2023] Open
Abstract
PURPOSE The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures. METHODS It was a retrospective study. Adult patients with closed transverse patellar fracture were included, and with open comminuted patellar fracture were excluded. These patients were divided into minimally invasive osteosynthesis technique (MIOT) group and open reduction and internal fixation (ORIF) group. Surgical time, frequency of intraoperative fluoroscopy, visual analogue scale score, flexion, extension, Lysholm knee score, infection, malreduction, implant migration and implant irritation in two groups were recorded and compared. Statistical analysis was performed by the SPSS software package (version 19). A p < 0.05 indicated statistical significance. RESULTS A total of 55 patients with transverse patellar fractures enrolled in this study, the minimally invasive technique was performed in 27 cases, and open reduction was performed in 28 cases. The surgical time in the ORIF group was shorter than that in the MIOT group (p = 0.033). The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery (p = 0.015). Flexion was restored faster in the MIOT group than that in the ORIF group at one month (p = 0.001) and three months (p = 0.015). Extension was recovered faster in the MIOT group than that in the ORIF group at one month (p = 0.031) and three months (p = 0.023). The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group. Complications, such as infection, malreduction, implant migration, and implant irritation, occurred more frequently in the ORIF group. CONCLUSION Compared with the ORIF group, the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation. Although it requires a long operation time, MIOT may be a wise choice for transverse patellar fractures.
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Affiliation(s)
- Li-Wei Yao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China
| | - Hai-Jiao Mao
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China
| | - Wen-Wei Dong
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China
| | - Ze-Ting Wu
- Department of Orthopaedic Surgery, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China
| | - Qing Liu
- Department of General Practice, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, 315020, Zhejiang province, China.
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15
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Demirtaş Y, Katı YA. A novel patella fracture fixation technique: finite element analysis. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04910-1. [PMID: 37233796 DOI: 10.1007/s00402-023-04910-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Patella fractures account for approximately 1% of all bone fractures. The tension band wiring technique has been used in surgical treatment. However, there is no clear information about the location of the K-wires in sagittal plane. Thus, a transverse fracture line was created in the patella finite element model and fixed with Kirchner (k) wires and cerclage at different angles and compared with two different standard tension band models. MATERIALS AND METHODS A total of 10 finite element models were created to study AO/OTA 34-C1 patella fractures. Two models used the classical tension band method with either circumferential or 8-shaped cerclage wire. The other 8 models used K-wires placed at 45° or 60°, either alone or combination with cerclage wire. A force of 200 N, 400 N, and 800 N were applied at 45° knee angle and the resulting data fracture line opening, surface pressure and stress in the implants were analyzed through finite element analysis. RESULTS When all the results are considered, it was determined that the K-wires 60° crossing at the fracture line and with cerclage modeling was superior to the other models. The diagonal placement of the K-wires with cerclage (could be 45° or 60° medium) was superior to the reference models. CONCLUSIONS This study has shown that the new fixation method we propose could come to the fore as an alternative method to be used successfully in transverse patella fractures and lower complications. In transverse patellar fractures, the use of K-wires crossed at 60° may be a good alternative to the standard method.
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Affiliation(s)
- Yunus Demirtaş
- Department of Orthopedics and Traumatology, Faculty of Medicine, Private Liv Hospital Ankara, Yüksek İhtisas University, Kavaklıdere, Bestekar Cd No: 8, 06680, Çankaya, Ankara, Türkiye.
| | - Yusuf Alper Katı
- Antalya Training and Research Hospital Orthopedics and Traumatology Department, Antalya, Türkiye
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16
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Li L, Zhang Q, Tao F, Wang D, Dong J, Zhou D, Song W. Management and Outcome of Elderly Patients With Patellar Fracture Treated With Novel Modified Cerclage Wiring. Geriatr Orthop Surg Rehabil 2023; 14:21514593231177983. [PMID: 37250018 PMCID: PMC10214090 DOI: 10.1177/21514593231177983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction The purpose of this study is to assess the efficacy and security of a fixation method for fixing patellar fractures in elderly patients utilizing modified cerclage wire. Methods From January 2015 to December 2020, 31 cases (age≥65 years old) of closed patellar fracture were treated by modified cerclage wiring. Patients in these instances ranged in age from 65 to 87 (73.7 ± 7.2 years), with 15 men and 16 women. 4 instances were type 34-C1 (transverse fracture) according to the AO/OTA classification, 27 cases (87%) were comminuted fractures, including 11 cases that were type 34-C2 (3 fragments), and 16 cases that were type 34-C3 (more than 3 fragments). Postoperative problems such as fragment re-displacement, nonunion, internal fixation loosening, infection, and internal fixation rupture were evaluated. The clinical grading systems of Böstman were used to assess the postoperative clinical outcomes. Results Thirty one patients in all were monitored for 14 to 31 months (22.2 ± 4.5 months). After the procedure, the fracture took 2.5-3.5 months (2.92 ± .25 months) to heal. There were no postoperative issues like infection, dislocation, implant breakage, uncomfortable hardware, or post-traumatic osteoarthritis. According to the clinical grading scales of Böstman, the average score of the final follow-up was 28.6 ± 1.1 (range 26-30). 29 (94%) of the patients had excellent results, whereas just 2 (6%) had good results. The patient's knee flexion activity ranged from 110 to 140°, making for a favorable prognosis. Conclusion Most patella fractures in the elderly are comminuted. Elderly patients with patellar fractures may be successfully treated with modified cerclage wire, with good results and no noticeable side effects.
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Affiliation(s)
- Lin Li
- Department of Orthopedic Surgery,
Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopedic Surgery, Tengzhou Central People’s Hospital
Affiliated to Jining Medical University, Tengzhou, Shandong, China
| | - Qing Zhang
- Department of Orthopedic Surgery,
Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopedic Surgery, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fulin Tao
- Department of Orthopedic Surgery, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dawei Wang
- Department of Orthopedic Surgery,
Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopedic Surgery, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jinlei Dong
- Department of Orthopedic Surgery,
Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopedic Surgery, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopedic Surgery,
Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Department of Orthopedic Surgery, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Wenhao Song
- Department of Orthopedic Surgery, Shandong Provincial Hospital
Affiliated to Shandong First Medical University, Jinan, Shandong, China
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17
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Li SJ, Tiwari SR, Chang SM, Du SC, Zhang YQ. Separate vertical wiring plus bilateral anchor girdle suturing fixation for the fractures of the inferior pole of the patella. J Orthop Surg Res 2023; 18:176. [PMID: 36890520 PMCID: PMC9997027 DOI: 10.1186/s13018-023-03649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 02/25/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The fixation of inferior pole fractures of the patella (IPFPs) is still a great challenge for surgeons. MATERIALS AND METHODS We introduced a new fixation method for IPFP fixation, that is, separate vertical wiring plus bilateral anchor girdle suturing fixation (SVW-BSAG). Three finite element models including the anterior tension band wiring (ATBW) model, separate vertical wiring (SVW) model and SVW-BSAG model, were built to evaluate the fixation strength of different fixation methods. A total of 41 consecutive patients with IPFP injury were enrolled in this retrospective study, including 23 patients in the ATBW group and 18 patients in the SVW-BSAG group. The operation time, radiation exposure, full weight-bearing time, Bostman score, extension lag versus contralateral healthy leg, Insall-Salvati ratio, and radiograph outcomes were employed to assess and compare the ATBW group and SVW-BSAG group. RESULTS The finite element analysis confirmed that the SVW-BSAG fixation method was as reliable as the ATBW fixation method in terms of fixed strength. Through retrospective analysis, we found that there was no significant difference between the SVW-BSAG and ATBW groups in age, sex, BMI, fracture side, fracture type, or follow-up time. There were no significant differences between the two groups in the Insall-Salvati ratio, 6-month Bostman score, and fixation failure. Compared with the ATBW group, the SVW-BSAG group showed advantages in intraoperative radiation exposure, full weight-bearing time, and extension lag versus the contralateral healthy leg. CONCLUSION The finite element analysis and clinical results showed that SVW-BSAG fixation methods are a reliable and valuable for IPFP treatment.
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Affiliation(s)
- Shi-Jie Li
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090, China
| | - Shashi Ranjan Tiwari
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shi-Min Chang
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090, China.
| | - Shou-Chao Du
- Department of Orthopaedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090, China
| | - Ying-Qi Zhang
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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18
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Gumaste A, Baindoor P, Jeevannavar S, Shenoy K, Gurudev R. Modified tension band wiring of transverse patella fractures through cannulated cancellous screws: An analysis of functional outcomes and complications. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2023. [DOI: 10.4103/jodp.jodp_58_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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19
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Seggewiss J, Nicolini LF, Lichte P, Greven J, Ribeiro M, Prescher A, Michalik R, Herren C, Kobbe P, Hildebrand F, Pishnamaz M. Transosseous suture versus suture anchor fixation for inferior pole fractures of the patella in osteoporotic bone: a biomechanical study. Eur J Med Res 2022; 27:270. [PMID: 36463220 PMCID: PMC9719228 DOI: 10.1186/s40001-022-00903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The surgical treatment of inferior patellar pole fractures can be a challenge, especially in geriatric patients, who are particularly frequently affected by osteoporosis. The objective of this biomechanical study was to compare the performance of suture anchor and transosseous suture fixation in fractures of the inferior patellar pole in context of bone mineral density. METHODS Twelve fresh-frozen human cadaveric knees received a transverse osteotomy, simulating an AO/OTA 34C1.3 inferior pole fracture of the patella. These fractures were fixated with either suture anchors (SA; Corkscrew® FT 4.5 mm) or transosseous suture (TS; #2 FiberWire®). Cyclic loading tests were performed by pulling the quadriceps tendon against gravity from 90° flexion to almost full extension (5°) for 1000 cycles. Motion and fracture gap displacement were tracked until failure occurred. Subsequently, loading to failure tests followed. Differences between groups were compared using unpaired t-tests, and correlations were calculated with Pearson's correlation coefficient. RESULTS The suture anchor group showed significantly fewer cycles to failure than the transosseous suture group (SA: 539.0 ± 465.6 cycles, TS: 1000 ± 0 cycles, P = 0.04). Bone mineral density correlated positively with cycles to failure in the suture anchor group (Pearson's r = 0.60, P = 0.02). No differences in fracture gap displacement could be proven after 100 cycles (SA: 4.1 ± 2.6 mm, TS: 6.5 ± 2.6 mm, P = 0.19); 500 cycles (SA: 6.4 ± 6.1 mm, TS: 9.6 ± 3.8 mm, P = 0.39); and 1000 cycles (SA: 4.0 ± 0.4 mm, TS: 11.0 ± 4.5 mm, P = 0.08). Furthermore, the mean destructive load to failure in the suture anchor group was also significantly lower than in the transosseous suture group (SA: 422.4 ± 212.2 N, TS: 825.7 ± 189.3 N, P = 0.04). CONCLUSIONS Suture anchors may be a viable alternative to transosseous suture in younger patients for clinical advantages, but in osteoporotic bone, the more stable osteosynthesis with transosseous suture continues to prove superior. Therefore, trauma surgeons might consider the use of transosseous suture in elderly patients, especially in those presenting with low bone mineral density values.
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Affiliation(s)
- Jana Seggewiss
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
- Fontanestr. 57, 47877 Willich, Germany
| | - Luis Fernando Nicolini
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
- Institute of General Mechanics (IAM), RWTH Aachen University, Eilfschornsteinstr. 18, 52062 Aachen, Germany
| | - Philipp Lichte
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Johannes Greven
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Marx Ribeiro
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Andreas Prescher
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Roman Michalik
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Christian Herren
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Philipp Kobbe
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
| | - Miguel Pishnamaz
- Department of Orthopaedics, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstr. 30, 52074 Aachen, Germany
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Buschbeck S, Götz K, Barzen S, Hoffmann R. [Patalla Fractures]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:687-702. [PMID: 35259771 DOI: 10.1055/a-1623-6906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patella fractures are rare injuries, accounting for 0.5 - 1.5% of all fractures, but they can lead to severe functional limitations if they do not heal properly. In addition to a prompt diagnosis, surgical treatment is usually necessary for multi-fragment fractures. The goals of every treatment are a biomechanically stable joint as well as a congruent restoration of the retropatellar joint surface. These results often remain a challenge, especially in multiple fragment fractures. The surgical treatment strategies have steadily evolved from tension band and screw osteosyntheses in combination with wire cerclages. Currently, angular stable plate systems are increasingly being used. This article gives an overview of the fracture anatomy, the classification and diagnosis of patella fractures and the currently used surgical treatment options.
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21
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Lenihan J, Ramos-Pascual S, Silvestros P, Beak P, Miles AW, Trompeter A. Author reply to letter to the editor. Injury 2022; 53:3564. [PMID: 35660102 DOI: 10.1016/j.injury.2022.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J Lenihan
- Department of Trauma and Orthopaedic Surgery edith cacell campus peterborough, cambridgeshire PE39GZ, UK.
| | - S Ramos-Pascual
- Department of Trauma and Orthopaedic Surgery edith cacell campus peterborough, cambridgeshire PE39GZ, UK
| | - P Silvestros
- Department of Trauma and Orthopaedic Surgery edith cacell campus peterborough, cambridgeshire PE39GZ, UK
| | - P Beak
- Department of Trauma and Orthopaedic Surgery edith cacell campus peterborough, cambridgeshire PE39GZ, UK
| | - A W Miles
- Department of Trauma and Orthopaedic Surgery edith cacell campus peterborough, cambridgeshire PE39GZ, UK
| | - A Trompeter
- Department of Trauma and Orthopaedic Surgery edith cacell campus peterborough, cambridgeshire PE39GZ, UK
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22
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Suture tension band fixation vs. metallic tension band wiring for patella fractures - A biomechanical study on 19 human cadaveric patellae. Injury 2022; 53:2749-2753. [PMID: 35701245 DOI: 10.1016/j.injury.2022.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/26/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Traditional tension band fixation of patella fracture is associated with high reoperation rates. The purpose of the study was to assess strength of fixation in patella fractures treated with either a non-metallic all suture-based technique or traditional metallic tension band wiring. METHODS Ten paired human cadaveric specimens were included. A transverse fracture was created, reduced and fixated with a non-metallic or metallic approach. Non-metallic fixation was done according to a previously published technique, metallic fixation was done according to AO description. Specimens were fixed in 90° of flexion and underwent 200 cycles of loading by pulling the Quadriceps tendon to 300 Newton. Fracture displacement was optically monitored. Primary outcome was fracture displacement after 200 cycles compared to the first cycle. Subsequently, load-to-failure was assessed by a monotonic pull to 1000 N. RESULTS For cyclic loading analysis, one specimen from each group was excluded due to machine synchronization, resulting in a total population of 18 specimens. Median (min-max) fracture displacement was 0.65 mm (0.06-1.3) in the non-metallic group and 0.68 mm (0-1.23), (p=0.931) in the metallic group. No difference in displacement was found between the two groups in the repeated measures analysis of variance (p=0.5524). For load-to-failure analysis one specimen was excluded due to machine synchronization, resulting a total population of 19 specimens. 2/9 specimens failed in the non-metallic group (at 979 and 635 N) and 2/10 failed in the metallic group (745 and 654 N). CONCLUSION Non-metallic technique is a biomechanically viable alternative to traditional tension band fixation and it can hopefully lead to fewer implant-related complications.
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23
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Clinical Outcomes of Cannulated Screws versus Ring Pin versus K-Wire with Tension Band Fixation Techniques in the Treatment of Transverse Patellar Fractures: A Case-Control Study with Minimum 2-Year Follow-Up. BIOMED RESEARCH INTERNATIONAL 2022; 2022:5610627. [PMID: 35782082 PMCID: PMC9240961 DOI: 10.1155/2022/5610627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 05/16/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022]
Abstract
Purpose. K-wire with tension band (KTB) technique has long been the primary surgical method for transverse patella fractures; however, it also has shortcomings. This study is aimed at evaluating the three different techniques to see whether the cannulated screw tension band (CSTB) or ring pin tension band (RPTB) techniques could decrease complications and achieve better knee function compared with KTB. Methods. We conducted a retrospective comparison of the KTB, CSTB, and RPTB fixation techniques. We selected and reviewed 90 patients (30 patients in each fixation group) with follow-up at least 2 years. Duration of operation, intraoperative blood loss, mean healing time, visual analog scale score, range of motion, Böstman score, Iowa knee score, modified Lysholm rating scale, and postoperative complications were compared. Multivariate analyses were performed to identify the independent risk factors for fracture healing time, postoperative complications, and knee function recovery. Results. After adjusting for confounding factors, multivariate regression analysis revealed that CSTB was 0.26 times (95% CI: 0.08-0.86,
) less likely to prolong fracture healing time, 0.20 times (95% CI: 0.06-0.64,
) lesser risk of postoperative complications, and more than four times (95% CI: 1.41-13.56,
) as likely to improve the knee function score compared with KTB. Besides, RPTB were also superior to KTB in reducing the incidence of postoperative complications (OR: 0.21, 95% CI: 0.07-0.64,
) and improved knee function score (OR: 3.96, 95% CI: 1.30-12.08,
); however, the CSTB group being more superior. In addition, AO/OTA C2 fractures (OR, odds ratio: 10.68, 95% CI: 1.30-87.70,
) and high-energy fracture (OR: 8.78, 95% CI: 1.57-49.17,
) were also associated with prolonged fracture healing time but not with postoperative complications and knee function. No significant differences in related indicators such as gender, age, BMI, AO/OTA classification, fracture side, injury mechanism, duration of operation, and intraoperative blood loss were detected among the three groups. Conclusion. This study demonstrated that the CSTB technique is superior to KTB and RPTB techniques in reducing the incidence of postoperative complications, and it also has advantages in accelerating fracture healing, achieving better VAS, ROM, and functional recovery. Further long-term large-sized prospective randomized trials are needed to evaluate the efficacy of the KTB in treating transverse patellar fractures.
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Wagner FC, Hamann A, Maier D, Ophoven C, Yilmaz T, Südkamp NP, Jaeger M, Reising K. Lag screw osteosynthesis of simple olecranon fractures: A biomechanical comparative study. Proc Inst Mech Eng H 2022; 236:841-847. [DOI: 10.1177/09544119221090341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Olecranon fractures are most frequently stabilized by tension band wiring (TBW), which unfortunately leads to relevant implant removal rates due to K-wire migration and soft tissue irritation. As lag screw osteosynthesis (LSO) might be a gentle and effective alternative in simple fracture patterns, the goal of the present study was to biomechanically compare LSO with TBW in simple olecranon fractures at a cadaver model. A simple olecranon fracture (Mayo type IIA) was created in eight pairs of human cadaver elbows, which were pairwise fixed by either TBW or two transcortical 4.0 mm lag screws. Biomechanical testing was conducted as a pulling force, applied to the triceps tendon in a 90° position. First, cyclic loading between 10 and 300 N was performed for 50,000 cycles. Afterward, maximum load was raised by 0.02 N/cycle until construct failure, what was defined as displacement >2 mm. Besides fracture displacement, failure cycle and failure load, the modes of failure were analyzed. Within the first five cycles, there was no significant difference in displacement (median TBW: 0.2 mm; LSO: 0.5 mm; p = 0.091). Both after 2000 (median TBW: 0.2 mm; LSO: 0.6 mm; p = 0.042) and after 20,000 cycles (median TBW: 0.4 mm; LSO: 0.9 mm; p = 0.027), the difference was significant. Failure cycle (median TBW: 72,639 cycles; LSO: 43,429 cycles; p = 0.017) and failure load (median TBW: 702 N; LSO: 303 N; p = 0.025) differed significantly as well. TBW mostly (6/8) failed at the lock of the cerclage wire, whereas most LSO constructs (5/8) failed as a pullout of the proximal fragment. In conclusion, to our biomechanical findings at human cadaver specimens, simple olecranon fractures treated by LSO show higher dislocation rates and lower failure loads compared to conventional TBW and mostly fail by pullout of the proximal fragment.
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Affiliation(s)
- Ferdinand C Wagner
- Department of Orthopedics and Trauma Surgery, Medical Centre, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Alexander Hamann
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Dirk Maier
- Department of Orthopedics and Trauma Surgery, Medical Centre, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Christian Ophoven
- Department of Orthopedics and Trauma Surgery, Medical Centre, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Tayfun Yilmaz
- Department of Orthopedics and Trauma Surgery, Medical Centre, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopedics and Trauma Surgery, Medical Centre, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- G.E.R.N. Tissue Replacement, Regeneration & Neogenesis, Department of Orthopedics and Trauma Surgery, Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Jaeger
- Department of Orthopedics and Trauma Surgery, Medical Centre, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Kilian Reising
- Department of Orthopedics and Trauma Surgery, Medical Centre, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
- Department of Trauma Surgery, Asklepios Klinikum Hamburg, Hamburg, Germany
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26
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Berninger MT, Frosch KH. Wandel in der Behandlung der Patellafrakturen. Unfallchirurg 2022; 125:518-526. [DOI: 10.1007/s00113-022-01167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
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27
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Comminuted AO-C3 fractures of the patella: good outcome using anatomically contoured locking plate fixation. INTERNATIONAL ORTHOPAEDICS 2022; 46:1395-1403. [DOI: 10.1007/s00264-022-05374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
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28
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Kotelnikov GP, Kim YD, Shitikov DS, Knyazev NA, Likholatov NE. [Postoperative outcomes in patients with closed patellar fractures]. Khirurgiia (Mosk) 2022:89-96. [PMID: 35289554 DOI: 10.17116/hirurgia202203189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To improve postoperative outcomes in patients with closed patellar fractures using a new method of surgical treatment. MATERIAL AND METHODS The authors proposed a new method of patellar osteosynthesis. Technique of osteosynthesis is described, and surgical scheme is presented. Treatment outcomes were analyzed in 68 patients with closed patellar fractures. The control group consisted of 34 patients who underwent Weber osteosynthesis. The authors assessed clinical and radiological data. Moreover, clinical example of a patient with traumatic closed patellar fracture and illustrations of surgical treatment are presented. RESULTS Clinical data indicate the advantage of treatment in the main group.
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Affiliation(s)
| | - Yu D Kim
- Samara State Medical University, Samara, Russia
| | | | - N A Knyazev
- Samara State Medical University, Samara, Russia
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29
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Zhan Y, Zhang Y, Xie X, Luo C. Three-dimensional fracture mapping of multi-fragmentary patella fractures (AO/OTA 34C3). ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1364. [PMID: 34733916 PMCID: PMC8506535 DOI: 10.21037/atm-21-1814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/14/2021] [Indexed: 01/13/2023]
Abstract
Background Multi-fragmentary patella fractures (MFPFs) are common patella fracture type. Low-profile plate fixation seems to be promising advancement in the treatment of such difficult fractures. There is no systematic morphologic study specifically for MFPFs to provide objective reference for the improvement of future implants and biomechanical models. This study aimed to delineate and quantify the location and spatial frequency of fracture lines, comminution zones, and coronal plane fragments in MFPFs using three-dimensional (3D) CT mapping technique. Methods A total of 187 MFPFs were retrospectively reviewed and analyzed. Fractures were digitally reconstructed from CT data, and fracture lines, comminution zones, and coronal fragments were graphically overlaid onto a 3D patella template. Fracture characteristics were summarized qualitatively based on the fracture maps and quantitatively on the counts and volume of each fragment. Furthermore, according to the classic fracture patterns concerning MFPFs, subgroup analysis was conducted. Results On average, we observed 7 fragments in each fracture, 3 of which were <1 cm3. Most fractures (81.2%) had coronal fragments on the anterior and/or posterior patella surfaces. We identified three classic patella fracture patterns: transverse with comminution, stellate, and “displaced comminuted” in 104, 54, and 29 knees, respectively. 3D maps demonstrated distinct distribution fracture patterns of fracture lines, comminution zones, and coronal fragments. Conclusions Supero-medial corner of the patella was seldomly involved, and might be used as the cornerstone for fixation. Coronal fragments were common on both anterior and posterior patella surfaces, justifying the application of anterior plate osteosynthesis characterized by multi-planar fixation. Comminution areas mainly concentrated in the lower half of the patella, potentially suitable for an implant in combination with sutures or circumferential cerclage wiring. The described 3D features of MFPFs could provide reference for the design of future implants and biomechanical models.
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Affiliation(s)
- Yu Zhan
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yingqi Zhang
- Department of Orthopaedic Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xuetao Xie
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Congfeng Luo
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Lifka S, Baumgartner W. A Novel Screw Drive for Allogenic Headless Position Screws for Use in Osteosynthesis-A Finite-Element Analysis. Bioengineering (Basel) 2021; 8:136. [PMID: 34677209 PMCID: PMC8533393 DOI: 10.3390/bioengineering8100136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 11/25/2022] Open
Abstract
Due to their osteoconductive properties, allogenic bone screws made of human cortical bone have advantages regarding rehabilitation compared to other materials such as stainless steel or titanium. Since conventional screw drives like hexagonal or hexalobular drives are difficult to manufacture in headless allogenic screws, an easy-to-manufacture screw drive is needed. In this paper, we present a simple drive for headless allogenic bone screws that allows the screw to be fully inserted. Since the screw drive is completely internal, no threads are removed. In order to prove the mechanical strength, we performed simulations of the new drive using the Finite-Element method (FEM), validated the simulations with a prototype screw, tested the novel screw drive experimentally and compared the simulations with conventional drives. The validation with the prototype showed that our simulations provided valid results. Furthermore, the simulations of the new screw drive showed good performance in terms of mechanical strength in allogenic screws compared to conventional screw drives. The presented screw drive is simple and easy to manufacture and is therefore suitable for headless allogenic bone screws where conventional drives are difficult to manufacture.
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Affiliation(s)
- Sebastian Lifka
- Institute of Biomedical Mechatronics, Johannes Kepler University Linz, 4040 Linz, Austria;
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31
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Howatt J, Liew AS, Wilkin G. Patellar Fractures: Anatomy, Mechanics, and Surgical Management. J Bone Joint Surg Am 2021; 103:00004623-990000000-00350. [PMID: 34570740 DOI: 10.2106/jbjs.20.01478] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ A preoperative computed tomography scan may be considered to improve surgical planning, as secondary fracture lines are poorly visualized on radiographs. ➤ Oblique internal and external rotation fluoroscopic views may be used intraoperatively to fully evaluate the medial and lateral facet articular reduction if direct assessment by visualization or palpation is not completed. ➤ Partial patellectomy for inferior pole fractures should be avoided, and bone-preserving procedures are recommended. ➤ A lateral arthrotomy may be used for direct visualization of the articular reduction for multifragmentary fractures. An inferomedial arthrotomy should be avoided to protect the dominant blood supply of the patella. ➤ Tension band fixation with cannulated screws yields a lower reoperation rate, improved functional outcome scores, and better performance in biomechanical studies than Kirschner wire-based tension band fixation. ➤ Preliminary studies of novel plate and screw constructs for osteosynthesis have shown promising results.
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Affiliation(s)
- Jonathan Howatt
- Division of Orthopaedic Surgery, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
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Kim Y, Kwon M, Ryu JY, Moon SW. Biomechanical Analysis of the Kirschner-Wire Depth of the Modified Tension Band Wiring Technique in Transverse Patellar Fractures: An Experimental Study Using the Finite-Element Method. Clin Orthop Surg 2021; 13:315-319. [PMID: 34484623 PMCID: PMC8380525 DOI: 10.4055/cios20253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Backgroud Modified tension band wiring is one of the most preferred surgical methods for transverse patellar fractures. However, the optimal depth or sagittal position of a Kirschner wire (K-wire) in modified tension band wiring has yet to be determined. The purpose of this study was to evaluate whether the depth of a K-wire affects the biomechanical characteristics of modified tension band wiring using the finite-element method. Methods A patella model was designed with a cuboid shape (length, 34.3 mm; width, 44.8 mm; and thickness, 22.4 mm) and divided into the cortical and cancellous bone parts. A transverse fracture line was formed on the midline of the cuboid shape model. The cuboidal model was applied to modified tension band wiring. The depth or sagittal position of the K-wire was divided into superficial, center, and deep. With the Abaqus v2017 program (Dassault System Inc.), the distal part of the model was fixed, and a tensile load of 850 N was applied to the proximal part of the model at an angle of 45°. The maximum pressures of the cortical and cancellous bones at the fracture plane were measured. The largest von Mises values of the K-wire and stainless steel wire were also measured. The fracture gap on the distracted or anterior side was measured. Results In deep K-wire placement, the highest peak von Mises values of the cortical and cancellous bones were observed. The K-wire and stainless steel wire showed the highest von Mises values in deep K-wire placement. The fracture gap was also largest in deep K-wire placement. Conclusions The depth of the K-wire affects the biomechanical characteristics of modified tension band wiring. Deep placement of the K-wire will be more favorable for bone union than the empirically known 5-mm anterior or center placement of the K-wire.
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Affiliation(s)
- Youngbok Kim
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Minsung Kwon
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Ji Young Ryu
- Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Sang Won Moon
- Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
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Comparison of Functional and Radiological Outcomes of Transverse Patellar Fractures Fixed with Tension Band Fixation Using Cannulated Screws and Kirschner Wires: A Prospective Randomized Study. Indian J Orthop 2021; 56:369-376. [PMID: 35251499 PMCID: PMC8854533 DOI: 10.1007/s43465-021-00498-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/20/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To compare functional and radiological outcomes of transverse patella fractures treated with tension band wiring using either two 4.5 mm cannulated screws or Kirshner wire. METHODS This is a non-blinded prospective randomized study comprising of two groups (n = 30 each) with closed transverse patella fractures treated with tension band wiring using Kirschner wire (K wire group) and two 4.5 mm cannulated screws (CCS group). Outcomes measured were radiological union, Knee Society score, range of motion and post-operative complications. RESULTS The CCS group showed a statistically significant higher range of motion than K wire group for each follow up (p < 0.001 in flexion and p < 0.005 in extension). A statistically significant higher percentage of patients in the CCS group showed signs of union at 6th and 12th post-operative week (p = 0.001 and 0.011 respectively) but no difference at 24th post-operative week (p = 0.313). The rate of hardware complications was significantly higher in K wire group (p = 0.001). No significant difference was noted in in the Knee society score and post-operative complications between the groups. CONCLUSION This study concludes that the fixation of closed transverse patella fractures using two 4.5 mm cannulated screws is allows a faster rate of union, a better knee range of motion and lesser hardware complications as compared to Kirschner wires. However more studies with larger sample sizes and longer follow up are required.
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34
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李 广, 刘 平. [Progress in the surgical treatment of the patellar fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1057-1062. [PMID: 34387438 PMCID: PMC8403998 DOI: 10.7507/1002-1892.202104068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To review research progress of surgical treatment of patellar fractures. METHODS The domestic and foreign literature about patellar fracture treatment in recent years was extensively consulted, and the advantages, disadvantages, and indications of various surgical treatments were summarized. RESULTS The patella plays an important role in knee flexion and extension activities, and the fracture significantly affects the patient's quality of life. At present, the surgical methods include open reduction and internal fixation and patella resection. The internal fixation methods include ring/binding patella fixation, tension band wiring and improved technology, tension band wiring combined with other methods, screw fixation (including absorbable screws), steel plate fixation, and patella fixator fixation. Each surgical method has different indications, advantages, and disadvantages. Choosing an appropriate treatment plan plays a crucial role in clinical prognosis. CONCLUSION There are many surgical treatments for patellar fractures. In order to improve the effectiveness and reduce postoperative complications, it is necessary to choose the most appropriate treatment strategy for the type of fracture.
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Affiliation(s)
- 广磊 李
- 华中科技大学同济医学院附属梨园医院骨科(武汉 430077)Department of Orthopedics, Liyuan Hospital Affiliated to Tongji Medical School of Huazhong University of Science and Technology, Wuhan Hubei, 430077, P.R.China
| | - 平 刘
- 华中科技大学同济医学院附属梨园医院骨科(武汉 430077)Department of Orthopedics, Liyuan Hospital Affiliated to Tongji Medical School of Huazhong University of Science and Technology, Wuhan Hubei, 430077, P.R.China
- 华中科技大学同济医学院附属梨园医院体检中心(武汉 430077)Physical Examination Center, Liyuan Hospital Affiliated to Tongji Medical School of Huazhong University of Science and Technology, Wuhan Hubei, 430077, P.R.China
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35
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Wang Y, Xia D, Luo X, Zhang H, Wu J, Zhou P, Xu S. Comparison of the Kirschner Wire Tension Band with a Novel Nickel-Titanium Arched Shape-Memory Alloy Connector in Transverse Patellar Fractures: A Retrospective Study. J Knee Surg 2021; 34:987-996. [PMID: 31896140 DOI: 10.1055/s-0039-3402802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study aims to compare the clinical outcomes of the nickel-titanium arched shape-memory alloy connector (hereafter referred to as the ASC) and tension band fixation for the treatment of transverse patellar fractures. We retrospectively analyzed a total of 257 patients with transverse patellar fractures who were treated at our emergency orthopaedics department from March 2010 to March 2017. Either an ASC or the Kirschner wire (K-wire) tension band had been used to treat these fractures according to surgeons' experience and preference. We compared operative details, postoperative recovery, and postoperative knee function at 6 months. In terms of surgical duration, blood loss, incision length, length of hospital stay, and postoperative complications, patients in the ASC group showed significantly better results than patients in the K-wire group (p < 0.05). There were no significant differences between the two groups in terms of fracture healing time, knee mobility, and the Boström score at the postoperative 6-month evaluation (p > 0.05). Though, there were similar functional outcomes between two groups whose transverse patellar fractures were different methods, we found that the ASC method was a more reliable, more minimally invasive, and safer treatment option than the tension band wiring method using K-wires, resulting in less tissue damage, shorter surgical duration, shorter length of hospital stay, and fewer complications.
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Affiliation(s)
- Yang Wang
- Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China.,Department of Orthopedics, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
| | - Demeng Xia
- Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
| | - Xi Luo
- Department of Spine Surgery II, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Hongyue Zhang
- Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
| | - Jianghong Wu
- Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
| | - Panyu Zhou
- Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China.,Department of Orthopedics, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
| | - Shuogui Xu
- Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China.,Department of Orthopedics, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
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36
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Huang PH, Hsu CH, Hsu SL, Liu HC. Treatment of displaced fractures of the patella: Tension band wiring technique with the one-end or both-ends K-wire bending fixation method. J Orthop Surg (Hong Kong) 2021; 29:2309499020988179. [PMID: 33550932 DOI: 10.1177/2309499020988179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Tension band wiring technique has been widely used for treating patellar fracture. Conventional techniques are associated with some complications and several modifications have been introduced to increase stabilization. The purpose of this study was to compare two different fixation techniques, the one-end and both-ends Kirschner wire bending fixation methods. METHODS We retrospectively reviewed patient data from 2013 to 2017, including the age, sex, body height, body weight, BMI, lesion of injury, trauma mechanism, fracture displacement and classification, type of fixation, fracture healing duration, length of follow-up, clinical results and complications. The surgical outcome was assessed using the pain score (VAS), Lysholm knee score, and knee joint ROM. Plain radiographs were used to evaluate radiographic outcomes and assess the fracture union duration and hardware complications. We performed statistical analysis to compare these two different fixation techniques. RESULTS There were no significant differences between the two groups in terms of demographic data, fracture healing duration, level of the K-wires, distance between the K-wires, or length of the K-wires over the patella length (all p > 0.05). There were significant differences in the VAS score, K-wire migration, flexion degree, ROM, and Lysholm score (all p < 0.001) between the two different fixation methods. CONCLUSION The both-ends K-wire bending fixation method has a lower complication rate and results in a better clinical outcome than the one-end K-wire bending fixation method. This revised technique can effectively control both ends of the K-wires, thus eliminating the possibility of K-wire migration and improving the fixation stability.
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Affiliation(s)
- Po-Hua Huang
- Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Chi-Hsiang Hsu
- Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Shan-Ling Hsu
- Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
| | - Hao-Chen Liu
- Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
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Yao SH, Lin SF, Lin CH, Chen CH. Loop Anchor Tension Band Technique for Patella Fractures Lowers the Rate of Kirschner Migration. Injury 2021; 52:1556-1562. [PMID: 33243524 DOI: 10.1016/j.injury.2020.11.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/17/2020] [Accepted: 11/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the complications of patella fracture after open reduction and internal fixation using our innovative, loop-based modification of the tension band wiring technique and the traditional tension band wiring technique. METHODS Fifty-eight patients with patella fracture (AO/OTA: 34-C) were enrolled in this retrospective case-control study during the study period. We treated 36 patients with the traditional tension band wiring and 22 patients with our loop anchor tension band technique. Lysholm knee scoring scale, sex, numbers of wire dislodge, number of implants removal between two groups were compared. RESULTS The number of cases of wire dislodgement was zero in the loop anchor tension band group and seven in the traditional tension band group. There was statistically significant difference (P = 0.037). Lysholm knee score (P = 0.685) and operation time (P = 0.395) were not significantly different between the two groups CONCLUSIONS: The loop anchor tension band technique is safe and effective for treating patella fractures. The rates of implant loosening and wire pull-out were significantly lower in the loop anchor tension band group than those in the traditional technique group.
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Affiliation(s)
- Shu-Hsin Yao
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Shu-Fan Lin
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - Chang-Hao Lin
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chun-Ho Chen
- Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan;; School of Medicine, National Taiwan University, Taipei, Taiwan..
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Sayum Filho J, Lenza M, Tamaoki MJ, Matsunaga FT, Belloti JC. Interventions for treating fractures of the patella in adults. Cochrane Database Syst Rev 2021; 2:CD009651. [PMID: 33625743 PMCID: PMC8095054 DOI: 10.1002/14651858.cd009651.pub3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Fractures of the patella (kneecap) account for around 1% of all human fractures. The treatment of these fractures can be surgical or conservative (such as immobilisation with a cast or brace). There are many different surgical and conservative interventions for treating fractures of the patella in adults. This is an update of a Cochrane Review first published in 2015. OBJECTIVES To assess the effects (benefits and harms) of interventions (surgical and conservative) for treating fractures of the patella in adults. SEARCH METHODS We searched CENTRAL (2020, Issue 1), MEDLINE, Embase, LILACS, trial registers and references lists of articles to January 2020. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs that evaluated any surgical or conservative intervention for treating adults with fractures of the patella. The primary outcomes were patient-rated knee function, knee pain and major adverse outcomes. DATA COLLECTION AND ANALYSIS At least two review authors independently selected eligible trials, assessed risk of bias and cross-checked data extraction. Where appropriate, we pooled results of comparable trials. MAIN RESULTS We included 11 small trials involving 564 adults (aged 16 to 76 years) with patella fractures. There were 340 men and 212 women; the gender of 12 participants was not reported. Seven trials were conducted in China and one each in Finland, Mexico, Pakistan and Turkey. All 11 trials compared different surgical interventions for patella fractures. All trials had design flaws, such as lack of assessor blinding, which put them at high risk of bias, potentially limiting the reliability of their findings. No trial reported on health-related quality of life, return to previous activity or cosmetic appearance. The trials tested one of seven comparisons. In the following, we report those of the main outcomes for which evidence was available for the three most important comparisons. Four trials (174 participants) compared percutaneous osteosynthesis versus open surgery. Very low-quality evidence means that we are uncertain of the findings of no clinically important difference between the two interventions in patient-rated knee function at 12 months (1 study, 50 participants) or in knee pain at intermediate-term follow-up at eight weeks to three months. Furthermore, very low-quality evidence means we are uncertain whether, compared with open surgery, percutaneous fixation surgery reduces the incidence of major adverse outcomes, such as loss of reduction and hardware complications, or results in better observer-rated knee function scores. Two trials (112 participants) compared cable pin system (open or percutaneous surgery) versus tension band technique. The very low-quality evidence means we are uncertain of the findings at one year in favour of the cable pin system of slightly better patient-rated knee function, fewer adverse events and slightly better observer-rated measures of knee function. There was very low-quality evidence of little clinically important between-group difference in knee pain at three months. Very low-quality evidence from two small trials (47 participants) means that we are uncertain of the findings of little difference between biodegradable versus metallic implants at two-year follow-up in the numbers of participants with occasional knee pain, incurring adverse events or with reduced knee motion. There was very low-quality and incomplete evidence from single trials for four other comparisons. This means we are uncertain of the results of one trial (28 participants) that compared patellectomy with advancement of vastus medialis obliquus surgery with simple patellectomy; of one quasi-RCT (56 participants) that compared a new intraoperative reduction technique compared with a standard technique; of one quasi-RCT (65 participants) that compared a modified tension band technique versus the conventional AO tension band wiring (TBW) technique; and of one trial (57 participants) that compared adjustable patella claws and absorbable suture versus Kirschner wire tension band. AUTHORS' CONCLUSIONS There is very limited evidence from nine RCTs and two quasi-RCTs on the relative effects of different surgical interventions for treating fractures of the patella in adults. There is no evidence from trials evaluating the relative effects of surgical versus conservative treatment or different types of conservative interventions. Given the very low-quality evidence, we are uncertain whether methods of percutaneous osteosynthesis give better results than conventional open surgery; whether cable pin system (open or percutaneous surgery) gives better results than the tension band technique; and whether biodegradable implants are better than metallic implants for displaced patellar fractures. Further randomised trials are needed, but, to optimise research effort, these should be preceded by research that aims to identify priority questions.
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Affiliation(s)
- Jorge Sayum Filho
- Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Mário Lenza
- Orthopaedic Department and School of Medicine, Faculdade Israelita de Ciencias da Saude Albert Einstein and Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Marcel Js Tamaoki
- Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fabio T Matsunaga
- Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil
| | - João Carlos Belloti
- Department of Orthopaedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil
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Zhu XZ, Huang TL, Zhu HY, Bao BB, Gao T, Li XW, Lin JQ, Zheng XY. A retrospective cohort study on prevalence of postoperative complications in comminuted patellar fractures: comparisons among stabilized with Cannulated-Screw, Kirschner-Wire, or Ring-Pin Tension Bands. BMC Musculoskelet Disord 2021; 22:60. [PMID: 33430847 PMCID: PMC7798242 DOI: 10.1186/s12891-020-03936-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/28/2020] [Indexed: 11/10/2022] Open
Abstract
Background Displaced patellar fractures are commonly treated with open reduction and fixation with several different types of tension-band (TB) constructs. The main objective of this study was to compare the prevalence of postoperative complications after surgical stabilization of comminuted patellar fractures with either a modified Kirschner-wire tension band (MKTB), a cannulated-screw tension band (CSTB), or a ring-pin tension band (RPTB). Methods We conducted a retrospective and consecutive cohort study of comminuted patellar fractures (n = 334) stabilized using a TB construct. Postoperative premature loss of reduction, infection, and skin breakdown were compared according to the type of TB constructs received (MKTB, CSTB, or RPTB). The rate of implant removal due to symptomatic hardware was also evaluated. Results Fixation failure rate was significantly different among the groups (P = 0.013), with failure rates of 4.7% observed in the MKTB group,14.5% in the CSTB group, and 4.9% in the RPTB group. Skin breakdown and infection were not significantly different among the groups (Ps > 0.05). Due to symptomatic hardware, 40.5% of the patients in the MKTB group, 22.9% in the CSTB group, and 24.3% in the RPTB group underwent implant removal (P = 0.004). After adjusting for age, gender, comorbidities, number of supplementary screws/K-wires, and use of cerclage cables, multivariate regression analysis revealed that CSTB contributed to a 2.08-times greater risk of fixation failure compared to RPTB, while MKTB and RPTB were similar in risk of failure. In addition, it was found that patients who underwent MKTB fixation were more than twice as likely to undergo implant removal for symptomatic hardware compared with RPTB (odds ratio = 2.11, 95% CI = 1.20 to 3.72; P = 0.010). Conclusions RPTB have advantage over MKTB and CSTB fixation in terms of symptomatic hardware and premature failure, respectively. Level of evidence Therapeutic Level III
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Affiliation(s)
- Xiao-Zhong Zhu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China
| | - Teng-Li Huang
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China
| | - Hong-Yi Zhu
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China
| | - Bing-Bo Bao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China
| | - Tao Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China
| | - Xing-Wei Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China
| | - Jun-Qing Lin
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China
| | - Xian-You Zheng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University affiliated Sixth People's Hospital, 200233, Shanghai, China.
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Fehske K, Berninger MT, Alm L, Hoffmann R, Zellner J, Kösters C, Barzen S, Raschke MJ, Izadpanah K, Herbst E, Domnick C, Schüttrumpf JP, Krause M. [Current treatment standard for patella fractures in Germany]. Unfallchirurg 2020; 124:832-838. [PMID: 33331976 PMCID: PMC8460507 DOI: 10.1007/s00113-020-00939-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of patella fractures is technically demanding. Although the radiological results are mostly satisfactory, this often does not correspond to the subjective assessment of the patients. The classical treatment with tension band wiring with K‑wires has several complications. Fixed-angle plate osteosynthesis seems to be biomechanically advantageous. OBJECTIVE Who is treating patella fractures in Germany? What is the current standard of treatment? Have modern forms of osteosynthesis become established? What are the most important complications? MATERIAL AND METHODS The members of the German Society for Orthopedics and Trauma Surgery and the German Knee Society were asked to participate in an online survey. RESULTS A total of 511 completed questionnaires were evaluated. Most of the respondents are specialized in trauma surgery (51.5%), have many years of professional experience and work in trauma centers. Of the surgeons 50% treat ≤5 patella fractures annually. In almost 40% of the cases preoperative imaging is supplemented by computed tomography. The classical tension band wiring with K‑wires is still the preferred form of osteosynthesis for all types of fractures (transverse fractures 52%, comminuted fractures 40%). In the case of comminuted fractures 30% of the surgeons choose fixed-angle plate osteosynthesis. If the inferior pole is involved a McLaughlin cerclage is used for additional protection in 60% of the cases. DISCUSSION The standard of care for patella fractures in Germany largely corresponds to the updated S2e guidelines. Tension band wiring is still the treatment of choice. Further (long-term) clinical studies are needed to verify the advantages of fixed-angle plates.
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Affiliation(s)
- Kai Fehske
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
| | - Markus T Berninger
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Lena Alm
- Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Unfallkrankenhaus Hamburg, Hamburg, Deutschland
| | | | - Johannes Zellner
- Klinik für Unfallchirurgie, Caritas-Krankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - Clemens Kösters
- Klinik für Orthopädie, Unfall- und Handchirurgie, Maria-Josef-Hospital Greven, Greven, Deutschland
| | - Stefan Barzen
- BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt, Deutschland
| | - Michael J Raschke
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Kaywan Izadpanah
- Klinik für Orthopädie und Unfallchirurgie, Department für Chirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Elmar Herbst
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | | | | | - Matthias Krause
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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Kfuri M, Escalante I, Schopper C, Zderic I, Stoffel K, Sommer C, Qawasmi F, Knobe M, Richards G, Gueorguiev B. Comminuted patellar fractures: The role of biplanar fixed angle plate constructs. J Orthop Translat 2020; 27:17-24. [PMID: 33344168 PMCID: PMC7732873 DOI: 10.1016/j.jot.2020.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/02/2020] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
Background Comminuted patellar fractures represent a challenging clinical problem. Treatment aims to restore the integrity of the extensor mechanism and the congruity of patellofemoral joint. Controversy exists regarding the ideal fixation method. Metallic constructs aiming to convert pulling forces on the anterior aspect of the patella into compression forces across the fracture site are the standard of care. More recently, low profile plates have been described in the management of comminuted patellar fractures. The aims of this study were to (1) develop a novel unstable patellar fracture model and (2) to compare biomechanically three different constructs for fixation comminuted patellar fractures. We hypothesized that an orthogonal biplanar disposition of the screws within an anteriorly placed locking plate provides the best biomechanical properties in the management of comminuted fractures. Methods Six-part complex AO 34–C3 patella fractures were simulated in 18 human cadaveric knees by means of osteotomies including comminution around the distal patellar pole. The specimens were randomly assigned to 3 fixation techniques (n = 6) for either anterior plating, antero-lateral plating, or tension band wiring (TBW). Biomechanical testing was performed over 5000 cycles in active extension and passive flexion, followed by ultimate destructive quasi-static testing. Interfragmentary movements were captured by means of optical motion tracking. Results Displacement between the proximal and distal medial patella fragments was lower after anterior plating compared to both antero-lateral plating (P = 0.084) and TBW (P < 0.001). Moreover, displacement between the proximal and distal lateral fragments was significantly lower after anterior plating compared to both other techniques (P ≤ 0.032). In addition, it was significantly lower for antero-lateral plating versus TBW (P < 0.001). Rotation around the medio-lateral axis between the proximal and distal medial fragments was significantly lower after anterior plating compared to TBW (P = 0.017). Conclusions Anterior mesh plating with biplanar placement of locking screws provides superior stability for fixation of comminuted patellar fractures when compared to both antero-lateral mesh plating and TBW. The latter is associated with considerably inferior performance.
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Affiliation(s)
- Mauricio Kfuri
- Department of Orthopaedic Surgery, University of Missouri, Columbia, MO, United States
| | | | - Clemens Schopper
- AO Research Institute Davos, Davos, Switzerland.,Department for Orthopaedics and Traumatology, Kepler University Hospital GmbH, Johannes Kepler University Linz, Austria
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | | | - Christoph Sommer
- Department of Surgery, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Feras Qawasmi
- AO Research Institute Davos, Davos, Switzerland.,Department of Trauma Surgery, Hadassah Medical Center Jerusalem, Israel
| | - Matthias Knobe
- Department of Trauma Surgery, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Vicenti G, Bizzoca D, Solarino G, Carrozzo M, Belluati A, D'Arienzo A, De Carolis O, Moretti B. Periprosthetic femoral re-fractures pathogenesis, classification, and surgical implications. Injury 2020; 54 Suppl 1:S24-S30. [PMID: 33218615 DOI: 10.1016/j.injury.2020.11.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/10/2020] [Indexed: 02/02/2023]
Abstract
Periprosthetic femoral re-fractures (PFRFs) represent an emerging challenge for orthopaedic surgeons, since their incidence is growing in the last years, but very few experiences about their management have been currently published. The present study aims to (1) introduce, for the first time, an etiologic classification for PRFRs and (2) to provide surgical and pharmacological tips for the correct management of these injuries. Periprosthetic femoral re-fractures (PFRFs) could be classified into traumatic-PFRFs (T-PFRFs) and pathological-PFRFs (P-PFRFs). T-PFRFs, i.e. the "true" periprosthetic re-fractures, present as new fracture lines occurring proximally or distally to a previous periprosthetic fracture, that has correctly healed. They are generally unpredictable injuries but, in selected cases, it is possible to predict them by analyzing the construct used in the treatment of the previous periprosthetic fracture. P-PFRFs, on the other hand, define re-fractures occurring on a previous periprosthetic non-union or delayed union: the new fracture line appears in the same district of the old one. According to the etiologic factors influencing the P-PFRFs pathogenesis, it is possible to define re-fractures caused by mechanical failures, biological failures, septic failures and multifactorial failures, i.e., a combination of the previously mentioned concerns. A successful postoperative outcome, following the surgical management of PFRFs, requires the correct identification of all the underlying causes, which should be promptly and appropriately managed.
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Affiliation(s)
- Giovanni Vicenti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy.
| | - Davide Bizzoca
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Giuseppe Solarino
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Massimiliano Carrozzo
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
| | - Alberto Belluati
- Ospedale "Santa Maria delle Croci", Ravenna, AUSL Romagna, Italy
| | | | - Oronzo De Carolis
- Orthopaedic and Traumatology Unit, "Di Venere" Hospital, Bari, Italy
| | - Biagio Moretti
- School of Medicine, University of Bari Aldo Moro, AOU Consorziale "Policlinico", Department of Basic Medical Sciences, Neuroscience and Sense Organs, Orthopaedic & Trauma Unit, Bari, Italy
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Comparison of the Therapeutic Effects of Tension Band with Cannulated Screw and Tension Band with Kirschner Wire on Patella Fracture. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2020; 2020:4065978. [PMID: 32908578 PMCID: PMC7468626 DOI: 10.1155/2020/4065978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/01/2020] [Accepted: 07/04/2020] [Indexed: 11/17/2022]
Abstract
Background Patella fracture accounts for 1% of bone injury, of which anatomical reduction is of great significance to the recovery. Tension band with cannulated screw and Kirschner wire is commonly used methods for the treatment of displaced patella fracture. However, there is still some controversy on the clinical efficacy of the two treatment methods. Objective This study aimed at comparing the therapeutic effects of the cannulated screw and Kirschner wire tension bands on patella fracture and at providing more data basis for clinical selection of treatment methods for patella fracture. Methods Altogether, 146 patients with displaced patella fracture admitted to our hospital from March 2016 to February 2018 were selected and divided into two groups according to the different treatment methods. Among them, 71 patients received tension band with a cannulated screw (TBWCS group) and 75 patients received tension band with Kirschner wire (TBWKW group). Two groups of patients were compared in terms of surgical treatment effect after one year of treatment, complications within six months after the operation and operation-related indexes. The pain visual analogue scale (VAS) score, knee flexion degree, Lysholm score, and Bostman score were recorded at 1, 3, 6, and 12 months after operation, and the activity of daily living scale (ADL) score was evaluated at the last follow-up. Results During the operation of patella fracture patients, the intraoperative blood loss, hospitalization time, and knee flexion loss of patients in TBWCS group were less than those in the TBWKW group (P < 0.05), the starting time of postoperative functional exercise was earlier than that of patients in TBWKW group (P < 0.05), and the incidence rate of secondary operation was lower than that of patients in the TBWKW group (P < 0.05), but there was no statistical difference in the operation time, incision length, and postoperative fracture gap between the two groups. The results of curative effect analysis showed that the knee flexion, Lysholm score, and Bostman score of patients treated with tension band with cannulated screw were higher than those treated with Kirschner wire (P < 0.05), and VAS score was lower. Tension band with cannulated screw had a better curative effect on patella fracture (P < 0.05), lower complication rate (P < 0.05), and higher quality of life of patients (P < 0.05). Conclusion Tension band with cannulated screw has a good curative effect on patella fracture, low incidence of complications, early start of postoperative functional exercise, and high quality of life.
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Vicenti G, Bizzoca D, Nappi VM, Carrozzo M, Miolla MP, Ottaviani G, Solarino G, Moretti B. Minimally invasive osteosynthesis technique in the treatment of transverse patellar fractures in the elderly. Injury 2020; 51 Suppl 3:S50-S55. [PMID: 31948780 DOI: 10.1016/j.injury.2020.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 11/17/2019] [Accepted: 01/05/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This prospective study aims to describe our experience in the management of transverse patellar fractures in elderly patients with minimally invasive osteosynthesis technique (MIOT), at 12-months follow-up. METHODS Patients older than 60, with transverse patellar fracture, type 34-C1 according to the AO/OTA classification system, referred to our trauma centre, between January 2014 and December 2017 were prospectively recruited. All the patients were managed using MIOT surgical procedure and underwent a clinical and radiological follow-up at 2 weeks, 6 weeks and at 3, 6, 12 and 15 months postoperatively. The clinical evaluation was performed using the Lysholm Knee Scoring System (LKSS) and the Visual Analogue Scale (VAS) for pain. The hardware removal was planned at 12-months follow-up. The paired t-test was performed. The test was two-tailed with a confidence level of 5%. RESULTS 61 patients were recruited. The mean VAS was significantly lower in MIOT group until the 3-months follow-up (p = 0.001). ROM in flexion and LKSS score were significantly better in MIOT-group at all follow-ups, whereas ROM in extension showed no differences, between the two groups, starting from the 6-months follow-up. In the open surgery group, a significantly higher rate of delayed wound healing (p = 0.014), broken wires (p = 0.001) and non-cosmetic scar (p = 0.0221) was observed. CONCLUSIONS This prospective study shows that MIOT is a safe option for treatment of patellar transverse fractures in elderly patients, since it reduces the intra-operative blood loss, shortens the operating time, and is endowed with lower rates of postoperative complications.
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Affiliation(s)
- Giovanni Vicenti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Davide Bizzoca
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Vittorio Maria Nappi
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Massimiliano Carrozzo
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy.
| | - Maria Paola Miolla
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Guglielmo Ottaviani
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Giuseppe Solarino
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
| | - Biagio Moretti
- Orthopedic & Trauma Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs, School of Medicine, University of Bari "Aldo Moro" - AOU Consorziale "Policlinico", Piazza Giulio Cesare 11, 70100 Bari, Italy
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Yao C, Sun J, Wu J, Zhou Z, Liu F, Tao R, Zhang Y. Clinical outcomes of Ti-Ni shape-memory patella concentrator combined with cannulated compression screws in the treatment of C2 and C3 patella fracture: a retrospective study of 54 cases. BMC Musculoskelet Disord 2020; 21:506. [PMID: 32736553 PMCID: PMC7395425 DOI: 10.1186/s12891-020-03536-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 07/23/2020] [Indexed: 12/04/2022] Open
Abstract
Background Ti-Ni shape-memory patella concentrator (TNSMPC) has been designed as an alternative approach for fixation of patella fracture, which has some advantages like higher hardness, higher tenacity, better wearing resistance, excellent corrosion resistance and desired histocompatibility. The present study was to investigate the efficiency of TNSMPC combined with cannulated compression screws in the treatment of comminuted patella fractures. Methods Between January 2014 and December 2017, 54 patients of C2 and C3 patella fractures underwent open reduction and internal fixation with TNSMPC combined with cannulated compression screws. All the patients got standard postoperative rehabilitation programs and were regularly followed up for at least 12 months after the operation. X-rays, knee functions and life quality were evaluated during the follow-up. Results All the patients achieved bone healing and recovery of knee function with low incidence of complications according to outcomes of X-rays and questionnaires. The average operation time and blood loss during surgery were 77.5 ± 25.12 min and 24.25 ± 4.70 ml respectively. The Knee Outcome Survey Activities of Daily Living Scale, the range of motion and the 36-item short-form heath survey after the operation were all improved. According to the Bostman’s criteria, the excellent to good rate was 92.6%. Conclusion TNSMPC combined with cannulated compression screws is an effective internal fixation method for C2 and C3 patella fracture with excellent clinical outcomes. In addition, the operation does not increase extra technique difficulty or tissue damage relatively, which is worth promotion.
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Affiliation(s)
- Chen Yao
- Department of Orthopaedics, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China
| | - Jie Sun
- Department of Orthopaedics, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China
| | - Jiancheng Wu
- Department of Orthopaedics, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China
| | - Zhenyu Zhou
- Department of Orthopaedics, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China
| | - Fan Liu
- Department of Orthopaedics, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China
| | - Ran Tao
- Department of Orthopaedics, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China
| | - Yafeng Zhang
- Department of Orthopaedics, The Affiliated Hospital of Nantong University, Nantong City, Jiangsu Province, PR China.
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Lenihan J, Ramos-Pascual S, Silvestros P, Beak P, Miles AW, Trompeter A. Novel techniques demonstrate superior fixation of simple transverse patella fractures - A biomechanical study. Injury 2020; 51:1288-1293. [PMID: 32276726 DOI: 10.1016/j.injury.2020.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 02/18/2020] [Accepted: 03/03/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Traditional tension band wiring (TBW) remains the gold standard treatment for simple transverse patella fractures. Challenges include appropriately siting and bending Kirschner wires without damaging surrounding soft tissues. Damage to soft tissues and malposition of metalwork can lead to complications. We propose three novel techniques for fixation of simple transverse patella fractures to ease application without additional resources to traditional TBW. We tested their biomechanical integrity against traditional TBW. METHOD Four configurations were tested; two with longitudinal Kirschner Wires (LKW) and two with cross Kirschner Wires (CKW) fixed with either standard figure-of-eight (AO) or side TBW (STBW). An initial proof of concept human cadaveric study was conducted to ensure real world application of the constructs was feasible. The fracture fixations were tested in a biomechanical study using porcine knees. The knees were cyclically loaded in a specially designed test rig through flexion from 90 to 45 degrees. Fracture gap displacement was measured and data blindly analyzed for all tests reaching 100 cycles. RESULTS 17/22 specimens reached 100 cycles with peak loading ranging from 75 to 80 N. CKW with STBW performed best with average fracture displacement of 0.43 mm. LKW with STBW performed worst with average fracture displacement of 1.93 mm. The incremental displacement/cycle for both CKW configurations was 0.27 mm compared to 0.41 & 0.60 mm for both LKW constructs showing that the CKW configuration conferred greater fixation stiffness under cyclic loading. DISCUSSION Previous studies have compared alternative methods of patella fracture fixation to TBW through biomechanical superiority often requiring new resources. The methods tested here utilize the same resources as those for standard AO TBW. Reorientating the plane of the wires and position of the cerclage TBW may reduce iatrogenic soft tissue injury; reduce operating time and the risk of complications. CONCLUSION This study shows biomechanical superiority for CKW with either AO or STBW compared to LKW.
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Affiliation(s)
| | | | | | | | - Anthony W Miles
- Department of Mechanical Engineering, University of Bath, UK
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Abstract
OBJECTIVES To characterize the fracture patterns and comminution zones for complete articular (OTA/AO 34C type) patellar fractures, using a computed tomography mapping technique. METHODS Eighty-three OTA/AO 34C type patellar fractures were included. Images of patellar fractures were superimposed on a coronal template of the patella, created from a healthy right knee, to identify fracture patterns and comminution zones. RESULTS Our analysis was based on 83 computed tomography images of patellar fractures, contributed by 69 male and 14 female patients (mean age, 52 years; range, 18-79 years), and included 13 type C1, 26 type C2 and 44 type C3 fractures. A transverse fracture, including both the medial and lateral facets, was the most common fracture pattern, identified in 92.8% of cases. In the C1 and C2 types, the fracture line affecting the medial and lateral joint surface was either transverse or oblique. In the C3 type, the transverse and vertical fracture line of the medial articular surface extended to the inferior pole of the patella, with transverse and oblique fractures lines on the lateral joint surface. In addition, a concentration of the fracture lines around the vertical ridge was observed. CONCLUSIONS The patterns of fracture lines and comminution zones OTA/AO 34C type fractures were repeatable on the constructed maps. A transverse fracture line on the inferior pole which was observed in the C2 and C3 type fractures may be used for the modification of current classification systems to direct treatment.
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Jiang W, Li Y, Kotian RN, Lin B, Zhang X. A novel three-dimensional strapping reduction for the treatment of patellar fractures. J Orthop Surg Res 2019; 14:249. [PMID: 31387615 PMCID: PMC6683372 DOI: 10.1186/s13018-019-1294-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to investigate the effectiveness of a three-dimensional strapping reduction in the treatment of patellar fractures. Methods Between January 2015 and June 2017, a total of 56 patients were randomly allocated to the three-dimensional strapping reduction group (trial group) and towel clamp reduction group (control group). There were no significant differences in age, gender, injury side, the interval time from injury to surgery, fracture pattern, and cause of injury (P > 0.05). The operation time, fluoroscopy time, bone union time, postoperative Hospital for Special Surgery (HSS) scores, and complications were recorded and analyzed. Results All incisions achieved primary union. All patients in both groups completed a follow-up with an average of 12.5 months (range 11–15 months). Both operation time and fluoroscopy time in the trial group were significantly shorter than those in the control group (P < 0.001). All patellar fractures achieved bone union, and there was no significant difference in bone union time between the two groups (P > 0.05). Bone nonunion, infection, and fixation failure were not found in both groups. HSS scores of the trial group (90.9 ± 4.2) were higher than those of the control group (86.6 ± 5.2) (P < 0.01). Conclusion Compared with towel clamp reduction, the three-dimensional strapping reduction in the treatment of patellar fractures has advantages of shorter operation time and fluoroscopy time, better knee function after surgery, and satisfactory fracture healing.
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Affiliation(s)
- Wei Jiang
- Department of Bone and Joint, Shenzhen People's Hospital, The First Affiliated Hospital of Nanfan University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, People's Republic of China
| | - Yusheng Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, People's Republic of China.
| | - Ronak Naveenchandra Kotian
- Department of Orthopaedic Surgery, Victoria Hospital, Bangalore Medical College and Research Institute, Bangalore, India
| | - Bowen Lin
- Department of Bone and Joint, Shenzhen People's Hospital, The First Affiliated Hospital of Nanfan University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, People's Republic of China
| | - Xiaoming Zhang
- Department of Bone and Joint, Shenzhen People's Hospital, The First Affiliated Hospital of Nanfan University of Science and Technology, The Second Clinical Medical College of Jinan University, Shenzhen, 518020, People's Republic of China.
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Cannulated Screw Prominence in Tension Band Wiring of Patella Fractures Increases Fracture Gapping: A Cadaver Study. Clin Orthop Relat Res 2019; 477:1249-1255. [PMID: 30998643 PMCID: PMC6494319 DOI: 10.1097/corr.0000000000000683] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Transverse patella fractures are often treated with cannulated screws and a figure-of-eight anterior tension band. A common teaching regarding this construct is to recess the screws so that their distal ends do not protrude beyond the patella because doing so may improve biomechanical performance. However, there is a lack of biomechanical or clinical data to support this recommendation. QUESTION In the treatment of transverse patella fractures, is there a difference between prominent and recessed cannulated screw constructs, supplemented by tension banding, in terms of gap formation from cyclic loading and ultimate load to failure? METHODS Ten pairs of fresh-frozen cadaver legs (mean donor age, 72 years; range, 64-89 years) were randomized in a pairwise fashion to prominent or standard-length screws. In the prominent screw group, screw length was 15% longer than the measured trajectory, resulting in 4 to 6 mm of additional length. Each patella was transversely osteotomized at its midportion and fixed with screws and an anterior tension band. Gap formation was measured over 40 loaded flexion-extension cycles (90° to 5°). Ultimate load to failure was assessed with a final monotonic test after cyclic loading. Areal bone mineral density (BMD) of each patella was measured with dual energy x-ray absorptiometry (DEXA). There was no difference in BMD between the recessed (1.06 ± 0.262 g/cm) and prominent (1.03 ± 0.197 g/cm) screw groups (p = 0.846). Difference in gap formation was assessed with a Wilcoxon Rank Sum Test. Ultimate load to failure and BMD were assessed with a paired t-test. RESULTS Patella fractures fixed with prominent cannulated screws demonstrated larger gap formation during cyclic loading. Median gap size at the end of cyclic loading was 0.13 mm (range, 0.00-2.92 mm) for the recessed screw group and 0.77 mm (range, 0.00-7.50 mm) for the prominent screw group (p = 0.039; 95% confidence interval [CI] difference of geometric means, 0.05-2.12 mm). There was no difference in ultimate failure load between the recessed screw (891 ± 258 N) and prominent screw (928 ± 268 N) groups (p = 0.751; 95% CI difference of means, -226 to 301 N). Ultimate failure load was correlated with areal BMD (r = 0.468; p = 0.046). CONCLUSIONS In this cadaver study, when using cannulated screws and a figure-of-eight tension band to fix transverse patella fractures, prominent screws reduced the construct's ability to resist gap formation during cyclic loading testing. CLINICAL RELEVANCE This biomechanical cadaver study found that the use of prominent cannulated screws for the fixation of transverse patella fractures increases the likelihood of interfragmentary gap formation, which may potentially increase the risk of fracture nonunion and implant failure. These findings suggest that proximally and distally recessed screws may increase construct stability, which may increase the potential for bony healing. The findings support further laboratory and clinical investigations comparing recessed screws supplemented by anterior tension banding with other repair methods that are in common use, such as transosseous suture repair.
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Outcomes after locked plating of displaced patella fractures: a prospective case series. INTERNATIONAL ORTHOPAEDICS 2019; 43:2807-2815. [PMID: 31041522 DOI: 10.1007/s00264-019-04337-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Tension band wiring remains a common treatment for patella fractures, but complication rates are high, with unsatisfactory results. The purpose of this observation study was to evaluate clinical results and complication rates of a novel patella locking plate fixation. METHODS Twenty patients (mean age, 59.2 ± 18 years) with displaced patella fractures were prospectively enrolled. Range of motion, knee scores (Tegner, Lysholm, Kujala), complications, and revision surgeries were assessed six weeks, six months, 12 months, and 24 months after surgery. Results were compared to the situation before trauma in regards to the time of follow-up using a paired sample t test. RESULTS According to the OTA classification, the fractures were classified as follows: one A1, four C1, six C2, and nine C3. Range of motion improved from 121° after six weeks to 140°, 141°, and 143° within the follow-up period. While the Tegner, Lysholm, and Kujala scores were 4.1/97/97, respectively, before trauma, they improved from 2.6/80/89 to 3.6/94/89, 3.7/95/94, and 4.1/97/97 within the follow-up period. Three patients had a complication (15%): one fracture dislocation, one reactive bursitis, and one renewed fracture. Four patients reported discomfort or anterior knee pain especially when kneeling on the implant. CONCLUSIONS The patella locking plate is a safe and effective treatment for patella fractures, including comminuted fractures. Function can be restored within six months after surgery, and the complication rate is low. Nonetheless, the implant can cause discomfort or anterior knee pain especially when kneeling, which can necessitate an implant removal.
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