1
|
Phen HM, Barth KA, Bilodeau RE, Klinger CE, Brusalis CM, Ricci WM. Dorsal Hook Plating of Patella Fractures With Immediate Range of Motion Results in Reliable Fixation, Low Implant Removal Rates, and Satisfactory Clinical Outcomes. J Orthop Trauma 2024; 38:378-382. [PMID: 38527085 DOI: 10.1097/bot.0000000000002809] [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: 10/09/2023] [Accepted: 03/18/2024] [Indexed: 03/27/2024]
Abstract
OBJECTIVES To evaluate radiographic and clinical patient-reported outcomes following dorsal hook plating of displaced patella fractures with permittance of immediate postoperative active closed chain range of motion. METHODS DESIGN Retrospective review of prospectively collected data. SETTING Urban academic level 1 trauma center. PATIENT SELECTION CRITERIA Adult patients with displaced patella fractures (OTA/AO 34C1-3) who underwent dorsal plating with immediate range of motion between 2018 and 2023. OUTCOME MEASURES AND COMPARISONS Numerical Rating Scale for Pain, Knee Outcome Score (KOS-ADL), Tegner-Lysholm score, radiographic union, and wound complications were collected. RESULTS Sixty-one patients were included (47 female) with an average age of 63 years (SD 14.7, range 22-86 years). The mean BMI was 24.2 (SD 3.6, range 16.6-33.3). There were 13 34-C2 and 48 34-C3 fractures. All but 2 patients (96.7%) achieved bony union after the index procedure. 89% (n = 54) of patients completed outcome surveys with at least 6-month follow-up. Six patients (9.8%) underwent removal of plate implant at a mean of 15.1 months postoperatively. The mean KOS-ADL score was 91.4, the mean Tegner-Lysholm score was 78.1, and the mean NRS was 2.7. CONCLUSIONS Dorsal hook plating offers secure fixation to allow early range of motion, reliable fixation with low nonunion and implant failure rates, low implant removal rates, and satisfactory patient-reported outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
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.
Collapse
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
| | | | | |
Collapse
|
4
|
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.
Collapse
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.)
| | | |
Collapse
|
5
|
Yoo SJ, Ok S, Lee J, Choi S. Can multiple miniplates improve the treatment of comminuted patellar fracture? BMC Musculoskelet Disord 2023; 24:936. [PMID: 38042790 PMCID: PMC10693109 DOI: 10.1186/s12891-023-07045-x] [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: 05/22/2023] [Accepted: 11/16/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND We have applied primarily multiple locking compression miniplates in treating multifragmentary, comminuted patellar fracture in combination with conventional fixation methods. METHODS Medical and radiologic data were retrospectively reviewed for the patients surgically fixated with locking compression miniplates in patellar fracture of AO/OTA 34-C3. The primary outcome was bone union at the final follow-up, and the secondary outcomes were functional outcomes and postoperative complications associated with the procedure. For the functional assessment, the Lysholm score, Tegner scores, and the knee range of motion was compared. RESULTS A total of twenty patients with AO/OTA 34-C3 patellar fracture were included in the study with an average follow-up period of 15 months (range:11 ~ 18 months) between June 2018 and November 2021. Eleven male and nine female patients presented an average age of 57.15 years. The primary fracture union was seen in all twenty patients, and the average time to the union was 15.6 weeks on serial radiograph follow-up. All patients did not show any postoperative complications, such as fixation failure, infection, or revision operations. Postoperatively, all patients achieved an average range of motion of 130 degrees, and the Lysholm and Tegners scores showed an average of 90.4 and 5.0 at the final follow-up, retrospectively. CONCLUSION Fixations with miniplates in comminuted patellar fractures can be a useful option for effective osteosynthesis due to their versatile, efficient, and low-profile nature.
Collapse
Affiliation(s)
- Seung Jin Yoo
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Republic of Korea
| | - Seungwoo Ok
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Republic of Korea
| | - Jaeryun Lee
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Republic of Korea
| | - Sungwook Choi
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju, Republic of Korea.
- Department of Orthopaedic Surgery, School of Medicine, Jeju National University, Jeju, Republic of Korea.
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Stoffel K, Zderic I, Pastor T, Woodburn W, Castle R, Penman J, Saura-Sanchez E, Gueorguiev B, Sommer C. Anterior variable-angle locked plating versus tension band wiring of simple and complex patella fractures - a biomechanical investigation. BMC Musculoskelet Disord 2023; 24:279. [PMID: 37041618 PMCID: PMC10088273 DOI: 10.1186/s12891-023-06394-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/03/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND The aim of this study was to investigate the biomechanical performance of novel anterior variable-angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures. METHODS Sixteen pairs of human cadaveric knees were used to simulate two-part simple transverse AO/OTA 34-C1 and five-part complex AO/OTA 34-C3 patella fractures. The complex fracture pattern was characterized with a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral and an inferior fragment mimicking comminution around the distal patella pole. Eight pairs with simple fractures were split for fixation via either tension band wiring (TBW) through two parallel cannulated screws or anterior variable-angle locked plating, whereas other eight pairs with complex fractures were split for either TBW through two parallel cannulated screws plus circumferential cerclage wiring, or anterior variable-angle locked plating using a cortical caudo-cranial polar screw. Each specimen was tested over 5000 cycles with a range of motion from 90° flexion to full extension by pulling on the quadriceps tendon. Interfragmentary movements were captured by motion tracking. RESULTS For both fracture types, the longitudinal and shear 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 anterior variable-angle locked plating versus TBW, p ≤ 0.01. CONCLUSIONS From a biomechanical perspective, anterior locked plating of both simple and complex patella fractures resulted in less interfragmentary displacement under extended cyclic loading.
Collapse
Affiliation(s)
- Karl Stoffel
- University Hospital Basel, Petersgraben 4, Basel, 4031, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, 7270, Switzerland.
| | - Torsten Pastor
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, 7270, Switzerland
- Cantonal Hospital Lucerne, Spitalstrasse 16, Lucerne, 6000, Switzerland
| | | | - Richard Castle
- DePuy Synthes, Goshen Pkwy, West Chester, PA, 1310, 19380, USA
| | - Jessica Penman
- DePuy Synthes, Goshen Pkwy, West Chester, PA, 1310, 19380, USA
| | - Eladio Saura-Sanchez
- University Hospital of Elche, Carrer Almazara, 11, Elche, Alicante, 03203, Spain
| | - Boyko Gueorguiev
- AO Research Institute Davos, Clavadelerstrasse 8, Davos, 7270, Switzerland
| | - Christoph Sommer
- Cantonal Hospital Graubünden, Loestrasse 170, Chur, 7000, Switzerland
| |
Collapse
|
9
|
D'Ambrosio M, Tang A, Menken L, Thabet AM, Liporace FA, Yoon RS. Adjunct neutralization plating in patella fracture fixation: a technical trick. OTA Int 2022; 5:e217. [PMID: 36569111 PMCID: PMC9782314 DOI: 10.1097/oi9.0000000000000217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 06/30/2022] [Indexed: 11/07/2022]
Abstract
Patella fracture outcomes are positive overall; however, in some cases, traditional fixation methods result in complications, including loss of fixation and irritable hardware requiring removal. We present a technique of plate fixation that we believe has the potential to improve stability and is less offensive in more comminuted fracture patterns. Improved stability should allow unfettered advancement of rehabilitation without concern for loss of fixation. Lower profile fixation offers a potential for diminishing the presence of irritating hardware requiring removal. We present our technique for using plate fixation to augment more complex patella fracture patterns.
Collapse
Affiliation(s)
- Matthew D'Ambrosio
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Alex Tang
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Luke Menken
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Ahmed M. Thabet
- Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Texas Tech University Health Sciences Center—El Paso, El Paso, TX
| | - Frank A. Liporace
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| | - Richard S. Yoon
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Saint Barnabas Medical Center—RWJBarnabas Health, Livingston, NJ
- Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City Medical Center—RWJBarnabas Health, Jersey City, NJ; and
| |
Collapse
|
10
|
Ma X, Cui D, Liu B, Wang Z, Yu H, Yuan H, Xiang L, Zhou D. Treating Inferior Pole Fracture of Patella with Hand Plating System: First Clinical Results. Orthop Surg 2022; 15:266-275. [PMID: 36331126 PMCID: PMC9837230 DOI: 10.1111/os.13539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Inferior pole fractures of patella are notorious fractures where it is difficult to obtain rigid internal fixation by conventional methods. The objective of the study was to introduce the Hand Plating System (HPS), which was a novel surgical technique for inferior pole fractures of patella, and to report the radiological and clinical outcomes following the application of the surgical technique. METHODS The study was designed as a retrospective cohort study. Between July 2017 and December 2018, 30 patients who were diagnosed with inferior pole fracture of the patella without additional orthopaedic injuries were enrolled in this case series. After X-ray and 3D-CT examinations, all patients underwent open reduction and internal fixation by HPS with or without supplementary cannulated screw and lag screw stabilization. The bony union time, final range of motion (ROM), Bostman score, visual analog scale (VAS), and complications were measured as the clinical outcomes under a minimum of 12 months of follow-up. RESULTS All of the operations went well with the mean operative time of 76.2 ± 15.3 min. Bony union achieved in all the cases at an average of 9.5 ± 1.4 weeks after surgery. There was no loss of reduction, fixative failure, or surgical implant removal during follow-up. The average range of motion 1 year postoperatively was 0°-123.3°. The mean Bostman Score at the last follow-up was 26.8 ± 2.1 with the satisfactory rate of 100%. The pain feeling during walking as measured by VAS averaged at 0.9 ± 1.3. No complications developed except for one case of poor incision healing, which healed eventually after surgical debridement. CONCLUSIONS HPS was demonstrated as a secure fixation and as a kind of tension band for inferior pole fractures of the patella. Satisfactory recovery of knee function and low complication rate, including no need for hardware removal, could be expected.
Collapse
Affiliation(s)
- Xiang‐Yu Ma
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Dong Cui
- Department of Cardiology of No.967 Hospital of PLA Joint Logistics Support ForceDalianLiaoning ProvinceChina
| | - Bing Liu
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Zheng Wang
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Hai‐Long Yu
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Hong Yuan
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Liang‐Bi Xiang
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Da‐Peng Zhou
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| |
Collapse
|
11
|
Xie X, Zhu Y, Wang Y, Zhan Y, Eladio SS, Luo C. Multi-planar fixation of displaced, multi-fragmentary patella fractures in elderly patients with anterior locking plates and cerclage wires: preliminary results. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2022:10.1007/s00590-022-03415-8. [PMID: 36273373 DOI: 10.1007/s00590-022-03415-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/01/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the outcomes of displaced, multi-fragmentary patella fractures in elderly patients treated with anterior plating and cerclage wires. PATIENTS AND METHODS Between 2018 and 2020, patients aged at least 60 years old undergoing anterior plating and circumferential wiring for displaced, multi-fragmentary patella fractures with a minimum of 12 months follow-up were included. Fragments were reduced and circumferentially stabilized by loop wires, followed by multi-planar fixation with an anterior locking plate and multi-directional screws. Postoperative outcomes were evaluated with the Böstman scores and range of motion. Patients were also asked about symptomatic hardware as well as satisfaction with postoperative outcomes. RESULTS Sixteen patients with an average age of 71.8 ± 9.3 years old were followed up for an average follow-up was 25.1 ± 8.2 months. At the latest follow-up, the average Böstman scores were 27.2 ± 3.4, and active knee flexion was 123 ± 14°. Two patients complained pinpoint implant irritation and underwent implant removal. Another underwent implant removal due to cultural reasons. Fifteen patients were satisfied with the operative outcomes, and one was unsatisfied due to intermittent patellofemoral pain. Cerclage wire breakage was noted in nine patients on postoperative radiographs, but none elicited pinpoint pain. No wound complications, infections, nonunion or loss of reduction were observed. CONCLUSIONS Anterior locking plates and cerclage wires in tandem provide reliable multi-planar fixation for displaced, multi-fragmentary patellar fractures in elderly patients and resulted in favorable clinical outcomes.
Collapse
Affiliation(s)
- Xuetao Xie
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Yi Zhu
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Yukai Wang
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Yu Zhan
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China
| | - Saura-Sanchez Eladio
- Department of Orthopaedic and Trauma Surgery, University Hospital of Elche, Carrer Almazara 11, 03203, Elche, Spain.
| | - Congfeng Luo
- Department of Orthopaedic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai, 200233, China.
| |
Collapse
|
12
|
Biomechanical comparison of a novel tensioned cable construct versus tension band wiring for transverse patella fracture fixation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022:10.1007/s00590-022-03291-2. [PMID: 35759107 DOI: 10.1007/s00590-022-03291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/05/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Tension band wiring (TBW) is the most widely accepted method for patella fracture fixation. The purpose of our study was to compare the biomechanical efficacy of a novel cable construct to TBW for the fixation of transverse patella fractures. The tensioned cable construct was hypothesized to have less fracture gapping after cyclic flexion-extension loading and greater ultimate load to failure as compared to TBW. METHODS Transverse patellar osteotomies (AO/OTA 34C1.1) were performed on nine pairs of fresh-frozen human cadaveric whole legs (mean age 82.2 years, range 71-101). Treatment with TBW or tensioned cable construct was randomized within each specimen pair. Fracture site displacement was measured after 5000 flexion-extension cycles from 0° to 90° at 0.5 Hz. In load to failure testing, the knee was fixed at 45° of flexion and the quadriceps tendon was pulled proximally at 0.5 mm/sec until patella fixation failure. Comparisons were made using paired t-tests with alpha values of 0.05. RESULTS Eight paired specimens completed the cyclic loading. The tensioned cable construct had significantly less fracture gapping than TBW (2.9 vs 10.9 mm; p = 0.020). Seven paired limbs underwent load to failure testing, which revealed no significant difference between the tensioned cable construct and TBW (1551.6 N vs 1664.0 N; p = 0.26). CONCLUSION In this study of transverse patella fracture fixation, a tensioned cable construct demonstrated significantly less fracture gapping compared to TBW in response to cyclic loading with no significant difference in load at failure.
Collapse
|
13
|
|
14
|
Li M, Qi H, Ma T, Li Z, Ren C, Huang Q, Xue H, Lu Y, Yang Y, Zhang K. Outcomes for a custom-made anchor-like plate combined with cerclage in the treatment of inferior pole patellar fracture. BMC Musculoskelet Disord 2022; 23:452. [PMID: 35568930 PMCID: PMC9107257 DOI: 10.1186/s12891-022-05413-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Objective An inferior pole fracture of the patella requires surgical treatment to restore the knee extension mechanism of the knee joint. Different from other types of patellar fractures, inferior pole fractures are usually comminuted, and other traditional fixation methods, such as tension band wiring, may not meet the fixation needs. We propose fixing inferior pole fractures of the patella with a custom-made anchor-like plate combined with cerclage and report the surgical outcomes. Material and methods This is a retrospective clinical study. From June 2018 to August 2020, 21 patients with inferior patella fracture treated at Hong Hui Hospital Affiliated to Xi’an Jiaotong University received a custom-made anchor-like plate combined with cerclage. Complications of the surgical fixation methods and final knee function were used as the main outcome measures. Results All fractures achieved good union, and the union time ranged from 8 to 12 weeks. No patients had serious complications, such as internal fixation failure or infection. The average duration of surgery of patients was 75.05 7.26 min, and the intraoperative blood loss was 60.099.49 ml. At the last follow-up, the range of motion of the knee was 120°-140°, with an average of 131.436.92°, the Bostman score was 27–30, and the Lysholm score ranged from 82 to 95. All patients showed good knee function one year after the operation. Conclusion We used a modified T-shaped plate combined with cerclage technology to fix inferior fractures pole of the patella, providing reliable fixation, allowing early functional exercise of the knee joint, and providing patients with good knee joint function after surgery.
Collapse
Affiliation(s)
- Ming Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Hongfei Qi
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China.
| | - Teng Ma
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Zhong Li
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Cheng Ren
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Qiang Huang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Hanzhong Xue
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Yao Lu
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| | - Yanling Yang
- Medical College of Yan'an University, No. 30, Guanghua Road, Baota District, Yan'an, 716000, Shaanxi, China
| | - Kun Zhang
- Department of Orthopaedics and Trauma, Hong Hui Hospital, Xi'an Jiaotong, University College of Medicine, No. 555, East Youyi Road, Xi'an, 710000, Shaanxi, China
| |
Collapse
|
15
|
Checketts JX, Scott J, Fishbeck K, Hart T, Pham W, Dadgar A, Calder M, Norris BL. Reoperation and Complication Rates Following Patellar Fracture Repair with Plates: A Retrospective Analysis with Patient-Reported Outcomes at More than 1 Year of Follow-up. JB JS Open Access 2022; 7:JBJSOA-D-22-00012. [PMID: 35620525 PMCID: PMC9116955 DOI: 10.2106/jbjs.oa.22.00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recent work has suggested good clinical and functional results with dorsal surface plating of patellar fractures. The primary outcome measurement of this study was reoperation rates for patellar fractures that had been treated with dorsal plating. Methods This work consists of a retrospective review of clinical and functional outcome data following repair of patellar fractures with dorsal plates. We obtained institutional review board approval for this study and conducted a review of 9 consecutive years of our group's trauma practice. We also contacted patients to assess patient-reported outcomes (PROs) after 12 months. Results Eighty-five patellar fractures were treated with open reduction and internal fixation (ORIF) via plating over 9 years. Eight (9.41%) of the patients required reoperation. Of the 72 patients with complete follow-up of ≥12 weeks, 3 (4.17%) had nonunion of the fracture site and 4 (5.56%) had loss of reduction of the fracture. The average Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score among our sample was 18.84 (slight symptoms); 72.41% of the patients in our sample had slight or no symptoms at ≥12 months postoperatively. Conclusions Our results indicated that plating of comminuted patellar fractures is a safe, viable treatment strategy. The PROs at ≥12 months of follow-up data were promising. Additionally, dorsal plating may allow for early return of function and less postoperative bracing. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,Email for corresponding author:
| | - Jared Scott
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Keith Fishbeck
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Thomas Hart
- University of Oklahoma College of Medicine, Tulsa, Oklahoma
| | - William Pham
- University of Oklahoma College of Medicine, Tulsa, Oklahoma
| | - Azad Dadgar
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
| | - Mark Calder
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
| | - Brent L. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
| |
Collapse
|
16
|
Kumar S, Mittal S, Manhas V, Sharma V. Functional and radiological outcomes following plating for displaced fractures of patella: A pilot study. Injury 2022; 53:691-697. [PMID: 34857370 DOI: 10.1016/j.injury.2021.11.053] [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: 06/27/2021] [Revised: 11/20/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Patellar fractures constitute almost 1% of total skeletal injuries. Existing common operative methods include the use of different types of Tension band wiring techniques like cannulated screws and K-wires. The Patellar plating construct is a relatively newer operative method for patellar fracture fixation with promising outcomes with fewer complications. METHOD We conducted a pilot prospective study at our Apex Trauma center in twenty patients aged 18-65years with displaced patellar fractures, AO type A2, A3, B2, B3, C1, C2, C3. Fractures were fixed with low profile patellar plates (1.8 mm). Radiological and functional follow-up was done using X-rays, CT scans and BKS scoring (Bostman-Knee-Scale), Knee Society Score(KSS), and Tegner Lysholm knee scores respectively for two years. RESULT Mean functional outcome scores at 6 weeks, 3 months, 6 months and 2 years was 25.5, 28.3, 29.05 and 29.9 for BKS; 64.62, 84.12, 90.6, and 97.5 for KSS; 73.75, 89.7,94.8, and 99.3 for Tegner Lysholm knee score respectively. Radiological union, confirmed by CT scan, was observed in all patients at 3 months. Two patients had superficial surgical site infection (SSI) at 2 weeks. Implant impingement was also found in 2 patients at 3 months. None of the patients had a failure of fixation at the end of the study. CONCLUSION Patients with low profile patellar plate constructs have favorable clinical and radiological outcomes with minimal non-specific complications.
Collapse
Affiliation(s)
- Sumit Kumar
- All India Institute of Medical Sciences, New Delhi, India
| | - Samarth Mittal
- All India Institute of Medical Sciences, New Delhi, India
| | - Vikrant Manhas
- All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Sharma
- All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
17
|
Raja BS, Jain A, Paul S, Choudhury AK, Kalia RB. Plate osteosynthesis in patellar fractures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1627-1640. [PMID: 34664117 DOI: 10.1007/s00590-021-03143-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To perform a systematic review and assess the indications, outcomes, complications, and union rates associated with plate osteosynthesis in patellar fractures compared to tension band wiring. METHODS The systematic search was conducted for articles in PubMed, Embase Biomedical, Cochrane central, and LILACS databases (date of inception to July 30, 2020). Articles were included if they were randomized control trials, cohort studies, case-control studies, and case series (with more than five cases), which focused on the clinical outcomes of patients with plate osteosynthesis as a treatment for fracture of the patella and had a minimum follow-up of 3 months. All studies were assessed according to their level of evidence, the number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Meta-analysis could only be done for two parameters (complications and reoperations) due to the paucity of data and heterogeneity of studies' limited statistical analysis. The data are presented as a review table with the key points summarized. RESULTS Twenty studies (seven prospective and 13 retrospective articles) identified 533 patients with 534 fractures who had undergone plate osteosynthesis for fracture of the patella. The most common fracture treated with plate osteosynthesis was 34C. CONCLUSION Basket plate was most commonly used for inferior pole fractures, while mesh plates were for intra-articular patella fractures. Overall plating was associated with better clinical outcomes, fewer complication rates, and high union rates compared to tension band wiring for patella fractures.
Collapse
Affiliation(s)
- Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203
| | - Aakash Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203
| | - Arghya Kundu Choudhury
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203.
| |
Collapse
|
18
|
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.
Collapse
Affiliation(s)
- Jonathan Howatt
- Division of Orthopaedic Surgery, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada
| | | | | |
Collapse
|
19
|
Zhang J, Wan S, Zhong Z, Zeng J, Wu C, Tan L, Lin X. [Comparative study on the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:994-999. [PMID: 34387428 DOI: 10.7507/1002-1892.202102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures. Methods Between January 2017 and January 2019, 26 patients with type C patellar fractures were treated with improved Kirschner wire tension band fixation (group A), and 24 patients were treated with traditional Kirschner wire tension band fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, and side and type of fracture between 2 groups ( P>0.05). The operation time, intraoperative blood loss, the visual analogue scale (VAS) scores at 1 and 3 days after operation, the fracture healing time, and the occurrence of complications (skin irritation of Kirschner wires, failure of internal fixation, fracture reduction loss) were recorded, and the knee function was evaluated by Lysholm scoring standard in 2 groups. Results The operation time in group A was significantly less than that in group B ( t=-4.742, P=0.000). There was no significant difference in the intraoperative blood loss and VAS scores at 1 and 3 days after operation between 2 groups ( P>0.05). All incisions healed by first intention. All patients were followed up 8-15 months, with an average of 11 months. The fracture healing time was (3.3±0.6) months in group A and (3.2±0.6) months in group B, showing no significant difference ( t=0.589, P=0.559). At last follow-up, the knee joint function was evaluated according to Lysholm scoring standard. And there were 15 cases of excellent, 8 cases of good, and 3 cases of fair, with an excellent and good rate of 88.5% in group A; there were 8 cases of excellent, 7 cases of good, 7 cases of fair, and 2 cases of poor, with an excellent and good rate was 62.5%. The difference between 2 groups was significant ( Z=2.828, P=0.005). The internal fixators were removed after the fracture healed in 2 groups. At last follow-up, no skin irritation of Kirschner wires occurred in group A, but 3 cases in group B. X-ray films reexamination showed that 5 cases of internal fixation failure and no fracture reduction loss were found in group A, while 9 cases of internal fixation failure and 1 case of fracture reduction loss in group B. The incidence of complications in group A was 19.2% (5/26), which was significantly lower than that in group B (54.2%, 13/24) ( χ 2=6.611, P=0.010). Conclusion Compared with the traditional Kirschner wire tension band fixation, the improved Kirschner wire tension band fixation in treatment of type C patellar fracture can shorten the operation time, reduce the incidence of complications, and benefit the functional recovery of knee joint.
Collapse
Affiliation(s)
- Jian Zhang
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Shengyu Wan
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Zeli Zhong
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Jun Zeng
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Chao Wu
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Lun Tan
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Xu Lin
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| |
Collapse
|
20
|
Open Reduction and Internal Fixation of Patella Fracture With Contoured Dorsal Plating. J Orthop Trauma 2021; 35:S34-S35. [PMID: 34227603 DOI: 10.1097/bot.0000000000002171] [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] [Accepted: 05/05/2021] [Indexed: 02/02/2023]
Abstract
In this article, we present a novel patella fixation technique using a low-profile highly contoured dorsal mini-fragment locking plate. This procedure is ideally indicated in patients with fracture patterns that are transverse without significant comminution. Long-term clinical studies are being performed to evaluate the effectiveness of this surgical technique.
Collapse
|
21
|
Abstract
Patellar fracture morphology varies based on the mechanism of injury. Most fractures are either a result of direct impact or through an indirect eccentric extensor contraction injury. Each fracture pattern requires appropriate preoperative planning and individualization of the fixation method. Displaced fractures affect the extension apparatus, and often require surgical fixation. Surgical treatment is recommended in fractures with any of the following features: articular step-off > 2 mm, > 3 mm of fracture displacement, open fractures, and displaced fractures affecting the extensor mechanism. Meticulous handling of the soft-tissue envelope is of the utmost importance, given the patella's tenuous blood supply and limited soft-tissue envelope. Incongruent articular surface can result in detrimental long-term effects; therefore, surgical treatment is directed toward anatomic reduction and fixation. The evolution of patellar fracture fixation continues to maximize options to balance rigid fixation with low-profile fixation constructs. Improving functional outcomes, minimizing soft-tissue irritation, and limiting postoperative complications are possible by using the therapeutic principles of rigid anatomical fixation and meticulous soft-tissue handling.
Collapse
|
22
|
Functional Outcomes of Patella Fractures Treated With Anterior Plate Osteosynthesis at One Year. J Orthop Trauma 2021; 35:e1-e6. [PMID: 33079836 DOI: 10.1097/bot.0000000000001868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the functional outcomes of patients with displaced patellar fractures treated with anterior plate constructs. DESIGN Prospective cohort and retrospective clinical and radiographic assessment. SETTING Level I Trauma Center. PATIENTS/PARTICIPANTS Between 2014 and 2018, 18 patients who underwent operative intervention for an isolated, displaced patella fracture (OTA/AO 34C1-3) with a minimum of 1-year follow-up agreed to participate in the study. The mean follow-up was 19.5 ± 6.0 months. INTERVENTION Patients were treated with 2.4 or 2.7-mm plates and supplemental screws or cerclage wires. MAIN OUTCOME MEASUREMENTS Patients were evaluated with the Short Form-36 Survey and the Knee Injury and Osteoarthritis Outcome Scores and asked about symptomatic implants. The range of motion was assessed by goniometer. RESULTS The cohort had no wound complications, infections, nonunion, loss of reduction, or implant failure. Active knee flexion was 131 ± 7 degrees. Five patients (28%) endorsed implant irritation. Only one patient (5.5%) underwent implant removal, which consisted of transverse screw removal alone. Twelve of the 14 patients (86%), who were previously employed, returned to work at 10 ± 7 weeks. All Knee Injury and Osteoarthritis Outcome Scores subscale scores and the Short Form-36 Survey scores for physical functioning, limitations due to physical health, limitations due to mental health, and social functioning were significantly lower than reference population norms (P < 0.05). CONCLUSIONS Anterior plating provides reliable fixation for displaced patellar fractures and results in a low incidence of implant irritation. However, patients who had anterior fixation for displaced patella fractures continue to exhibit functional deficits at 1-year postoperatively. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Collapse
|
23
|
Pires RE, Giordano V, Boni G, Campos TVO, Lopes MTC, de Andrade MAP. Expanding the indications for calcaneal plates beyond foot fractures: a technical trick and case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:275-282. [PMID: 32809148 DOI: 10.1007/s00590-020-02757-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022]
Abstract
Although non-locking calcaneal plates are designed to treat calcaneal fractures, they present some interesting characteristics that justify using them beyond their current application in fractures of the foot. Calcaneal plates are malleable, have an increased footprint area for fracture containment or buttressing, and present several hole options for screw placement in different trajectories, thereby providing proper fixation even in comminuted fracture patterns. The aim of this study is to describe the unconventional use of calcaneal plates in the orthopaedic trauma scenario.
Collapse
Affiliation(s)
- Robinson E Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil.
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro - Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - Guilherme Boni
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tulio Vinicius Oliveira Campos
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil.,Serviço de Ortopedia e Traumatologia. Hospital Metropolitano Célio de Castro, Belo Horizonte, MG, Brazil
| | - Marcos Tadeu Caires Lopes
- Serviço de Ortopedia e Traumatologia. Hospital Metropolitano Célio de Castro, Belo Horizonte, MG, Brazil
| | - Marco Antônio Percope de Andrade
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil
| |
Collapse
|
24
|
Abstract
Effective fracture surgery requires contouring orthopaedic implants in multiple planes. The amount of force required for contouring is dependent on the amount and type of material contained within the plane to be altered. The type of contouring used depends on the desired plate function; for example, buttress mode often requires some degree of undercontouring, whereas compression plating may require prebending. Other reasons to contour a plate include matching patient anatomy either to maximize fixation options or to reduce implant prominence. Precontoured plates can be convenient and help to facilitate soft-tissue friendly techniques but have the potential to introduce malreduction if the plate position and fit are not carefully monitored.
Collapse
|
25
|
Yoon YC, Oh CW, Lee DW, Sim JA, Oh JK. Miniplate osteosynthesis in fracture surgeries: Case series with review of concepts. Injury 2020; 51:878-886. [PMID: 32111462 DOI: 10.1016/j.injury.2020.02.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/09/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Miniplates were initially developed as targets for foot and hand fractures, but they have been used in the treatment of fixation of small bone fragments, reduction of long bone fractures and non-union treatment, which have been difficult to treat. In this study, the authors used miniplates to treat fractures of the upper extremities, lower extremities, and pelvis obtained good outcomes. Herein, the authors report these good outcomes and review the current concept of miniplates. PATIENTS AND METHODS Forty-two patients treated with miniplates between March 2012 and March 2017 who attended follow-up for > 1 year were included in this retrospective study. Miniplates were selected according to purpose, which was classified into three categories: fixation, reduction, and stability enhancement. For fixation, miniplates were used to fix distal fibular fractures occurring distal to the syndesmosis and treat patellar and olecranon fractures with severe comminution. For reduction, miniplates were used to reduce the tibia during intramedullary nailing in tibiofibular shaft fractures, while reduction was performed in advance of definitive plating fixation in patients with humeral and pelvic fractures. To enhance stability, the miniplate was inserted after autobone graft for atrophic nonunion at the humeral shaft following nail insertion. The validity of a miniplate was analyzed by reviewing the published literature on the use of miniplates in orthopedic fracture surgeries. RESULTS Bony union was achieved in all cases. No specific postoperative complications were observed; however, mild pain and limited range of motion observed in two patients were resolved after implant removal. Sixteen studies on fracture treatment using miniplates reported clinically fair outcomes. CONCLUSION Miniplates are not just small metal plates. Depending on the location and treatment of the fracture, the miniplate can effectively fix small bone fragments, help the main plate to maintain the reduction of large bone fragments, and increase the fixation force for nonunion treatment.
Collapse
Affiliation(s)
- Yong-Cheol Yoon
- Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Namdong-gu, Incheon, Republic of Korea
| | - Chang-Wug Oh
- Department of Orthopaedic Surgery, Kyungpook National University Hospital, Chung-gu, Daegu, Republic of Korea
| | - Dong-Whan Lee
- Department of Orthopaedic Surgery, Gachon University College of Medicine, Namdong-gu, Incheon, Republic of Korea
| | - Jae-Ang Sim
- Department of Orthopaedic Surgery, Gachon University College of Medicine, Namdong-gu, Incheon, Republic of Korea
| | - Jong-Keon Oh
- Department of Orthopaedic Surgery, Korea University College of Medicine, Guro Hospital, Guro-gu, Seoul, Republic of Korea.
| |
Collapse
|
26
|
Busel G, Barrick B, Auston D, Achor K, Watson D, Maxson B, Infante A, Sanders R, Mir HR. Patella fractures treated with cannulated lag screws and fiberwire® have a high union rate and low rate of implant removal. Injury 2020; 51:473-477. [PMID: 31679830 DOI: 10.1016/j.injury.2019.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 09/20/2019] [Accepted: 10/01/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study is to report the results of open reduction internal fixation of patella fractures (OTA 34 A-C) using cannulated lag screws and FiberWire® (Arthrex, Naples, FL, USA) with regard to union and symptomatic implant removal. DESIGN Retrospective review of prospectively collected database. SETTING Urban Level 1 trauma center and Level 2 trauma center METHODS: All displaced intra-articular patella fractures (OTA 34 A-C) treated with ORIF by cannulated lag screws and FiberWire® tension band/cerclage between January 1, 2009 and August 1, 2018. Three hundred and eighty seven consecutive patients were identified. Fifty fractures were included in the final analysis. MAIN OUTCOME MEASUREMENT All patients were followed to clinical and radiographic union. Nonunion was defined as lack of clinical and radiographic union, fracture displacement, and/or return to OR for revision surgery. Rate of symptomatic implant removal was recorded. RESULTS Average age was 57.7 years (range 21-86). Average follow up was 20.6 months (range 6-98 months). Average time to clinical and radiographic union was 3.1 months (range 3-7 months). Four fractures were open. There was a 96% (48/50) rate of primary union, with one patients requiring revision surgery to achieve union, and one developing an asymptomatic radiographic nonunion. The rate of symptomatic implant removal was 8% (4/50). Only 1 of the 4 was operated for a prominent suture knot, and the remaining 3 were for prominent screw removal. Knee range of motion averaged 0.37° extension to 119° flexion (range, 0-150°). CONCLUSION Patella fractures can be treated with cannulated lag screws and FiberWire® with a high rate of primary union (96%) and a low rate of symptomatic implant removal (8%). The implant removal rate compares favorably with alternative constructs, with an equivalent rate of fracture union.
Collapse
Affiliation(s)
- Gennadiy Busel
- Health Partners, Minneapolis, MN, United States of America.
| | - Brett Barrick
- Saint Francis Health System, Tulsa, OK, United States of America
| | - Darryl Auston
- OrthoONE North Suburban Medical Center, Thornton, CO, United States of America
| | - Kyle Achor
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - David Watson
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - Ben Maxson
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - Anthony Infante
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - Roy Sanders
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| | - Hassan R Mir
- Florida Orthopaedic Institute, Tampa, FL, United States of America
| |
Collapse
|
27
|
Kloen P, Hamdy RC, Bech NH. Plethora of Traumatic Lesions of Bilateral Knee Extensor Mechanism in Osteogenesis Imperfecta. Front Endocrinol (Lausanne) 2020; 11:603638. [PMID: 33551996 PMCID: PMC7859265 DOI: 10.3389/fendo.2020.603638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 11/23/2020] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Injuries to the quadriceps extensor mechanism are rare in patients with Osteogenesis Imperfecta (OI). To the best of our knowledge, non-union of the patella in OI, either as an isolated problem or in combination with an acute fracture, has not been previously reported. CASE REPORT We describe how we surgically approached both the fracture and the non-union simultaneously. The surgical technique and steps are described in detail. Post-operative course was uneventful and the outcome was favorable, with full return of function for the patient. CONCLUSION A review of various knee extensor mechanism injuries in OI is described as illustrated in a single patient. The unusual simultaneous surgical treatment of a non-union and an acute fracture in the same patella shows that despite the severely compromised bone in this rare bone disease the bone still has a capacity to heal with a functional outcome.
Collapse
Affiliation(s)
- Peter Kloen
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
- *Correspondence: Peter Kloen,
| | - Reggie Charles Hamdy
- Division of Orthopaedic Surgery, McGill University Health Centre, Shriners Hospital for Children, Montreal, QC, Canada
| | - Niels Hendrik Bech
- Department of Orthopedic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| |
Collapse
|
28
|
Bui CN, Learned JR, Scolaro JA. Treatment of Patellar Fractures and Injuries to the Extensor Mechanism of the Knee: A Critical Analysis Review. JBJS Rev 2019; 6:e1. [PMID: 30277900 DOI: 10.2106/jbjs.rvw.17.00172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Christopher N Bui
- Department of Orthopaedic Surgery, University of California, Irvine, Orange, California
| | | | | |
Collapse
|
29
|
Abstract
PURPOSE Tension band wiring is considered the standard treatment for patella fractures. However, it is limited for fractures with marginal involvement, comminution, and osteoporotic bone. Our experience indicates that these limitations can be overcome with the hook plate. We evaluated the radiographic and clinical outcomes in patients with patella fracture treated with hook plating. METHODS We enrolled 30 patients who underwent hook plating for patella fracture at two institutions between 2013 and 2017. Fracture classification and surgical options were reviewed. Postoperative fracture gap and time to union as radiographic measurements, and complications, range of motion, and functional outcome with the Lysholm score as clinical outcomes, were evaluated retrospectively. RESULTS Nine fractures were AO/OTA 34A1, three B1, one B2, two C1, nine C2, and six C3. All were closed fractures. There were 3 cases of revision, 4 with lateral or medial marginal fracture, 9 with isolated inferior pole fracture, and 14 with comminuted fracture. The average postoperative fracture gap was 0.4 (range, 0-2.0) mm, and bone union was achieved without additional intervention. The average time to union was 11.6 (range, 7-24) weeks. There were no complications, and no extension lag except in one case (10°). The average flexion was 138.5° (range, 110-145°). For functional outcomes, the average Lysholm score was 89.5 (range, 74-95), with 13 excellent, 14 good, 3 fair, and no poor cases. CONCLUSION This study suggests that hook plating can result in good bone union and restored knee function in marginal or comminuted fractures of the patella.
Collapse
Affiliation(s)
- Jae Hoon Jang
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Seung Joon Rhee
- Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Ji Wan Kim
- Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| |
Collapse
|
30
|
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.
Collapse
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.
| |
Collapse
|
31
|
Abstract
The aim of this study was to introduce various applications of miniplate augmented tension-band wiring (TBW) for comminuted patella fractures and to evaluate the clinical outcomes. Comminuted articular patella fractures were managed with anterior cortical miniplate fixation with a TBW technique from January 2014 to January 2016. The primary end point was radiographic union. Secondary end points were complications related to the procedure. Functional outcomes including range of motion were also evaluated. Thirty patients were followed up for a mean of 20 months (range, 12-28) postoperatively. The primary union rate was 96% (29 of 30 patients). Mean time to union was 3.2 months. One patient required additional surgery because of acute postoperative infection. Twenty-five patients recovered a full range of motion relative to the contralateral limb. The mean Bostman score at the last follow-up was 28.6 points (range, 26-30). In conclusion, miniplate augmented TBW is a versatile and useful technique for comminuted patella fracture fixation.
Collapse
|
32
|
Henrichsen JL, Wilhem SK, Siljander MP, Kalma JJ, Karadsheh MS. Treatment of Patella Fractures. Orthopedics 2018; 41:e747-e755. [PMID: 30321439 DOI: 10.3928/01477447-20181010-08] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 03/07/2018] [Indexed: 02/03/2023]
Abstract
Patella fractures comprise 1% of all fractures. Treatment options vary based on fracture displacement, classification, and patient factors. Traditionally, nonoperative treatment has been reserved for nondisplaced fractures. Many operative treatments are available with differing indications and levels of success. Tension band constructs have been the most commonly employed approach to fixation, with cerclage wiring for comminuted fractures. Recently, plate fixation of patella fractures has become more popular. Plating constructs offer a low-profile design with stable fixation, allowing for earlier mobilization and potentially improved functional outcomes. Data regarding the long-term outcomes of plating techniques are limited, and further studies are needed. [Orthopedics. 2018; 41(6):e747-e755.].
Collapse
|
33
|
Xie L, Guo X, Zhang SJ, Fang ZH. Locking compression plate distal ulna hook plate fixation versus intramedullary screw fixation for displaced avulsion fifth Metatarsal Base fractures: a comparative retrospective cohort study. BMC Musculoskelet Disord 2017; 18:405. [PMID: 28950848 PMCID: PMC5615762 DOI: 10.1186/s12891-017-1766-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/21/2017] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Intramedullary screw (IMS) fixation was wildly used in fifth metatarsal base fractures (FMBFs) and the results were satisfactory. However, in the comminuted osteoporosis or small displaced avulsion FMBFs, anatomical reduction and stable fixation could not be achieved with IMS. The Locking Compression Plate (LCP) distal ulna hook plate fixation was a novel alternative fixation method. The aim of this retrospective cohort study was to determine if LCP distal ulna hook plate fixation resulted in improved outcomes compared to the traditional IMS fixation in displaced avulsion FMBFs. METHODS Of 43 patients with displaced avulsion FMBFs, 18 patients were treated with LCP distal ulna hook plate fixation and 25 were treated with IMS fixation. The patients were evaluated clinically and radiographically and followed up to 12 months. The surgery time, time for hospital stay, time for weight-bearing, time for bony union, time for return to daily life, pain relief, functional outcome and complications after treatment with LCP distal ulna hook plate fixation or IMS fixation were compared. The functional outcome was assessed by the AOFAS (American Orthopedic Foot and Ankle Society) mid-foot score at 3, 6, 9, and 12 months after surgery. Meanwhile, pain scores were obtained at 3, 6, 9, and 12 months after surgery. RESULTS The two cohorts had similar baseline characteristics. Surgery time was less in LCP distal ulna hook plate fixation cohort compare to IMS fixation cohort (p < 0.0001). Time for partial weight-bearing (p < 0.0001) and full weight-bearing (p < 0.0001) also demonstrated significant improvements in patients with LCP distal ulna hook plate fixation compared to IMS fixation. Patients in the LCP distal ulna hook plate fixation cohort had significantly increased AOFAS at 9 months (p < 0.0001) and 12 months (p < 0.0001) after surgery compared to the IMS fixation cohort. CONCLUSION In this retrospective cohort study, LCP distal ulna hook plate fixation as an alternative fixation method was better therapy for the displaced avulsion FMBFs compared to IMS fixation. LCP distal ulna hook plate fixation had a short surgery time and improved functional performance.
Collapse
Affiliation(s)
- Lin Xie
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan City, Hubei Province, 430033, China
| | - Xin Guo
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan City, Hubei Province, 430033, China
| | - Shu-Jun Zhang
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan City, Hubei Province, 430033, China
| | - Zhen-Hua Fang
- Department of Orthopedic Surgery, Wuhan Orthopedic Hospital, Wuhan Puai Hospital, Huazhong University of Science and Technology, Hanzheng Street 473#, Wuhan City, Hubei Province, 430033, China.
| |
Collapse
|