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Giuseppe R, Michele R, Luca F, Michele G, Giuseppe G, Valentina M, Giustra F, Bosco F, Camarda L. Nonmetallic tension band fixation is a viable and low-complication surgical technique in patellar fractures: a five-year retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2065-2071. [PMID: 38530504 PMCID: PMC11101544 DOI: 10.1007/s00590-024-03887-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/28/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Traditionally, patellar fractures (PFs) have been managed using metallic tension band fixation, a method often associated with a notable rate of complications. Considering these challenges, this study explores the potential of nonmetallic fixation as a treatment option for PFs. This research aims to provide robust evidence supporting the use of the nonmetallic tension band fixation technique as an effective alternative to conventional metallic tension band fixation, thereby advancing the standard of care in treating these fractures. METHODS This retrospective study analyzed a consecutive patient series presenting with PFs from 2008 to 2021, treated with a nonmetallic tension band fixation technique. Inclusion criteria were strictly defined to include individuals over 18 years of age with isolated PFs requiring surgical intervention. The study focused on evaluating postoperative complications and clinical outcomes, as measured by standardized scoring systems, at the final follow-up point to assess the efficacy and safety of the employed surgical technique. RESULTS In this study, with a mean follow-up of 64 ± 7 months, a total of 64 patients who received open reduction and internal fixation (ORIF) for PFs were enrolled. Among these, five cases required additional surgical interventions. Specifically, two cases were due to knee stiffness, while the remaining three involved complications such as superficial infection, skin irritation, or delayed wound healing. The mean postoperative values recorded for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, Oxford knee score (OKS), and visual analog scale (VAS) were 20.4 ± 2.3, 35.5 ± 5.3, and 1.6 ± 0.4, respectively. There were no complications related to the nonmetallic fixation technique or instances of loss of reduction. CONCLUSION This study substantiates that nonmetallic tension band fixation is a safe and effective alternative to traditional metallic tension band fixation for patellar fractures. The study's low-complication rate and reoperation frequency underscore the value of nonmetallic implants in mitigating adverse effects and enhancing clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Rovere Giuseppe
- Department of Clinical Science and Translational Medicine, Section of Orthopaedics and Traumatology, University of Rome "Tor Vergata", Rome, Italy
| | - Romeo Michele
- Department of Orthopedic and Traumatology (DICHIRONS), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy
| | - Farinelli Luca
- Clinica Ortopedica Dell'Adulto E Pediatrica Dipartimento Di Scienze Cliniche E Molecolari, Università Politecnica Delle Marche, Ancona, Italy
| | - Giancani Michele
- Department of Orthopedic and Traumatology (DICHIRONS), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy
| | - Gangi Giuseppe
- Department of Orthopedic and Traumatology (DICHIRONS), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy
| | - Manuri Valentina
- Department of Orthopedic and Traumatology (DICHIRONS), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy
| | - Fortunato Giustra
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco-ASL Città di Torino, Turin, Italy
| | - Francesco Bosco
- Department of Orthopedic and Traumatology (DICHIRONS), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy.
- Department of Orthopaedics and Traumatology, G.F. Ingrassia Hospital Unit, ASP 6, Palermo, Italy.
- Department of Precision Medicine in Medical, Surgical and Critical Care (Me.Pre.C.C.), University of Palermo, Palermo, Italy.
| | - Lawrence Camarda
- Department of Orthopedic and Traumatology (DICHIRONS), University of Palermo, Via del Vespro, 129, 90127, Palermo, Italy
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Rivenburg RE, Maxwell EA, Bertran J, Souza CHDM, Smith BL. Biomechanical comparison of canine median sternotomy closure using suture tape and orthopedic wire cerclage. Vet Surg 2023; 52:1057-1063. [PMID: 37603027 DOI: 10.1111/vsu.14015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/07/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To compare the mechanical properties of suture tape and orthopedic wire cerclage in an ex vivo canine median sternotomy model. STUDY DESIGN Ex vivo. ANIMALS Twelve large-breed canine cadaveric sternums. METHODS Median sternotomies were performed, leaving the manubrium intact. The specimens were randomly assigned to group W (20-gauge stainless steel orthopedic wire cerclage in a figure-of-eight pattern) or group ST (suture tape in a figure-of-eight pattern). Each specimen was laterally distracted until failure using an electrodynamic materials-testing system. RESULTS No differences were observed for displacement, yield load, maximum load, implant failure between the groups. The orthopedic wire construct was stiffer than the suture tape construct. CONCLUSION Suture tape was biomechanically similar to orthopedic wire cerclage for sternotomy closure in dogs, although wire constructs were stiffer. CLINICAL SIGNIFICANCE Suture tape may represent an alternative to cerclage wire for sternotomy closure in dogs. Additional studies evaluating its clinical use are needed.
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Affiliation(s)
- Rachel E Rivenburg
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Elizabeth A Maxwell
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Judith Bertran
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Carlos H De Mello Souza
- Department of Small Animal Clinical Sciences, University of Florida College of Veterinary Medicine, Gainesville, Florida, USA
| | - Benjamin L Smith
- Arthrex Inc., Department of Orthopedic Research, Naples, Florida, USA
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Fixation of patella fractures with metallic implants is associated with a significantly higher risk of complications and re-operations than non-metallic implants: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2022; 46:2927-2937. [PMID: 36208340 DOI: 10.1007/s00264-022-05565-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/12/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE The use of metallic implants for the treatment of patella fractures often involves complications related to the hardware. As a result, there has been a considerable focus on the use of non-metallic implants. The aim of this study was to determine the differences in clinical outcomes, including the rates of complications and re-operations following the surgical management of patellar fractures with metallic versus non-metallic implants. METHODS The systematic review was conducted in accordance with PRISMA guidelines. Two investigators independently applied the search strategy to PubMed, SCOPUS, Google Scholar, and Cochrane databases, limited to publications between 1st January 2000 to 30st September 2021. The search strategy identified studies in which there was a comparison between the clinical outcome of the metallic and non-metallic fixation. Meta-analysis was conducted according to the Cochrane Collaboration and Quality of Reporting of Meta-Analysis (QUORUM) guidelines. RESULTS A total of 19 studies were selected for the systematic review and seven studies for the meta-analysis. Two hundred ninety-sixt patients formed the pooled study population for the meta-analysis. The outcomes evaluated in the meta-analysis were range of motion (ROM), complications, and re-operation rates. There was no significant difference between groups regarding ROM, but the risk ratio (RR) of re-operation (RR 0.19, 95% CI [0.09-0.41]) and complications (RR 0.30, 95% CI [0.17-0.55]) was significantly in favor of fixation with non-metallic implants. CONCLUSION The use of non-metallic implants for fixation of patella fractures was associated with significantly lower risk of complications and re-operations than fixation with metallic implants, without any difference between groups with respect to the final range of motion or functional outcome measures.
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