Showing papers on "Patella fracture published in 2017"

Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation.

Abstract: Purpose The aim of this study was to investigate the validity of the dynamic compression principle of tension band wiring in two techniques for patella fracture treatment Methods Twelve human cadaveric knees with simulated transverse patella fractures were assigned to two groups for treatment with tension band wiring using either Kirschner (K-) wires or cannulated screws Biomechanical testing was performed over three knee movement cycles between 90° flexion and 0° full extension Pressure distribution in the fracture gap and fracture site displacement were evaluated at the 3 rd cycle in 15° steps, namely 90°–75°–60°–45°–30°–15°–0° extension phase and 0°–15°–30°–45°–60°–75°–90° flexion phase Results Mean anterior / posterior interfragmentary pressure in the groups with K-wires and cannulated screws ranged within 016–040 MPa / 012–035 MPa and 037–059 MPa / 010–030 MPa, respectively These changes remained non-significant for both groups and loading phases (P ≥ 0171) Mean anterior / posterior fracture site displacement for K-wires and cannulated screws ranged within −001–053 mm / 011–074 mm and 011–055 mm / –010–050 mm, respectively Anterior displacement remained without significant changes for both groups and loading phases (P ≥ 0112) However, posterior displacement underwent a significant increase in the course of knee extension for K-wires (P ≤ 0047), but not for cannulated screws (P ≥ 0202) Significantly smaller displacement at the posterior fracture site was detected in the group with cannulated screws compared to K-wires at 60° and 75° extension phase (P ≤ 0017), as well as at 45°, 60° and 75° flexion phase (P ≤ 0018) The critical value of 2 mm displacement at the posterior fracture site was not reached for any specimen and fixation technique Knee extension was accompanied by synchronous increase in quadriceps pulling force Conclusions Tension band wiring fulfills from a biomechanical perspective the requirements for sufficient stability of transverse patella fracture fixation It should, however, rather be considered as a static fixation principle than a dynamic one Tension band wiring with cannulated screws was found advantageous over Kirschner wires in terms of interfragmentary movements at the posterior fracture site

Superior Outcomes after Operative Fixation of Patella Fractures Using a Novel Plating Technique: A Prospective Cohort Study

Abstract: OBJECTIVE The purpose of this prospective cohort study was to determine if a new patella fracture fixation construct resulted in improved outcomes compared with traditional tension band techniques. DESIGN Comparative cohort study. SETTING Academic level I trauma center. PATIENTS/PARTICIPANTS Patients with isolated, unilateral patellar fractures were enrolled prospectively. From 2012 to 2014, 33 patients underwent fixation with a novel plate construct that spans half of the patella circumference laterally and provides multiplanar fixation through a low-profile plate. A comparison cohort was drawn from 25 patients treated from 2008 to 2012, where treatment consisted of traditional tension band fixation techniques. INTERVENTION Surgical fixation of patella fractures was performed with either a tension band or novel plate construct. MAIN OUTCOME MEASUREMENTS Subjective postoperative clinical outcomes and objective functional and strength measurements were subsequently collected. RESULTS The 2 cohorts had similar baseline characteristics. Patients with the plate construct had clinically and statistically significantly superior Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS) scores throughout the study period (P < 0.001). Functional testing also demonstrated significant improvements in patients with plate constructs compared with tension band constructs at 12 months. Patients in the plate cohort had significantly increased thigh circumferences (P = 0.003) and decreased anterior knee pain (P < 0.0001) compared with the tension band cohort. CONCLUSIONS In this prospective cohort study, the use of a novel fixation construct with multiplanar and interfragmentary fixation and minimal disruption of patellar vascularity enables improved clinical outcomes and functional performance. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

The Use of Mesh Plates for Difficult Fractures of the Patella.

Abstract: Patella fractures present some of the more complicated fracture patterns in orthopaedic trauma care. This is partially due to the small size of the fragments but also the articular nature of each fragment. Fixation methods such as cerclage wiring, excision of smaller fragments, and screw fixation of larger fragments all have their own challenges. Our study examined our Level I trauma center's experience with variable angle locked 2.7 mm titanium plates for treatment of comminuted patella fractures or treatment of patellar nonunion. After Institutional Review Board approval, we used billing records to identify 105 patients who had undergone operative management of a displaced patella fracture between January 2011 and December 2015. We reviewed the radiographs of these patients to identify which patients underwent treatment with a mesh plate. We found 16 patients (6 males and 10 females) who had undergone fixation with a mesh plate; mean age was 47 years. Nine patients underwent primary open reduction internal fixation (ORIF) and seven underwent mesh plate fixation for failed ORIF of a patella fracture. The mean visual analog pain score was 2.75 (range, 0–9). The mean range of motion was 1 degree of extension (range, 0–10 degrees) to 110 degrees of flexion (range, 45–135 degrees). All fractures healed. Five patients required hardware removal for pain. This review illustrates the effectiveness of the locking mesh plate in two challenging clinical scenarios: that of patellar nonunion and comminuted fractures that preclude standard fixation methods. Although multiple options exist for patellar fracture fixation, the titanium mesh locking plate can be an effective option for retaining the patella in the setting of comminution. Further comparative studies should be undertaken to determine which method of treatment may be superior in the treatment of these fractures.

Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report.

Abstract: Objectives:To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional outcome. To provide an ...

Effect of Transosseous Tunnels on Patella Fracture Risk After Medial Patellofemoral Ligament Reconstruction: A Cadaveric Study

Abstract: Purpose To determine whether (1) tunnels that breach the anterior cortex of the patella result in increased fracture risk and (2) transosseous tunnels drilled across the patella significantly reduce the tensile force needed to fracture the patella. Methods Twenty-six fresh-frozen cadaveric human patellas were randomized to 1 of 3 groups: a control group with unmodified patellas, a group with 2 transverse tunnels (TT) that did not breach the anterior cortex, and a group with 2 TT that breached the anterior cortex of the patella (PA). Patellas were connected in series to a load cell via freeze clamp attachments to the quadriceps and patellar tendons. Pull was fixed at 45° with the patella set in the trochlear groove of a synthetic femur. Patellas were loaded cyclically, then to failure. Results Twenty-six patellas were tested (mean age = 71.4 years; range = 37-95, standard deviation [STD] = 11.5 years). PA patellas were more likely to fracture through the tunnel than TT patellas (100% vs 25%, P = .033). Control, TT, and PA groups failed at 1,915 N (STD = 508 N), 1,901 N (STD = 884 N), and 1,640 N (STD = 625 N), respectively. There was no statistically significant difference in overall load to failure between control and TT ( P = .969), control and PA ( P = .321), and TT and PA ( P = .488) groups. Conclusions Transosseous patellar tunnels for medial patellofemoral ligament reconstruction that breached the anterior cortex were more likely to fracture during longitudinal load than those that did not breach the anterior cortex. However, we found no statistically significant difference in the tensile load to failure between native patellas and patellas with either type of transosseous tunnel. Clinical Relevance The results of this study show that breaching the anterior cortex during transosseous drilling increases the risk of a patellar fracture occurring through the transosseous tunnel.

Factors affecting the outcomes of modified tension band wiring techniques in transverse patellar fractures.

Abstract: Introduction Modified tension band wiring has been widely used to treat transverse patellar fractures. However, few studies have evaluated the clinical outcomes using different methods of Kirschner wire bending, location of the tension band, and depths of Kirschner wires. Thus, we tried to clarify these factors according to our clinical outcomes. Patients and methods This retrospective cohort study recruited consecutive patients underwent surgical fixation for patellar fractures using modified tension band technique between January 2010 and December 2015. Different factors in this procedure, including the bending manner of the Kirschner wires, their depth, and location of the tension band with respect to the superior and inferior border of the patella were recorded and analysed. The primary outcome was early loss of fixation. The secondary outcomes were minor loss of reduction, implant breakage, deep infection, and the need for implant removal. Results This study included 170 patients with patellar fractures. Regarding the bending method, similar results were obtained with bilaterally or proximally bent Kirschner wires. Regarding length, the tension band was placed closely (within 25% of the patella length) in 124 patients and distantly in 46 patients. The rates of loss of reduction and implant breakage were significantly higher in the distantly placed tension bands. Regarding depth, 37 patellar fractures were fixed with the Kirschner wires at the superficial one third of the patellae while the K- wires at the middle layer of patella were used in the remaining 133 patellar fractures. A significantly higher rate of minor loss of reduction was obtained using the superficial Kirschner wires. Conclusion The modified tension band technique for transverse patella fractures provides favourable clinical outcomes, with low failure (5%) and infection (2%) rates. Implant irritation is the major complication, and almost half of cases require implant removal. The location of the tension band with respect to the superior and inferior border of the patella plays an important role in clinical outcomes. Placing the wire close to the patella may prevent major loss of reduction and implant breakage. Superficially placed Kirschner wires also affect clinical outcomes by increasing the rate of minor loss of reduction.

Medial Patellofemoral Ligament Reconstruction with Semi-Patellar Tunnel Fixation: Surgical Technique and Mid-Term Follow-Up.

Abstract: BACKGROUND The present study aimed to describe a new safe and economical technique for medial patellofemoral ligament (MPFL) reconstruction with satisfactory clinical outcomes, and present the results of a four-year follow-up. MATERIAL AND METHODS Thirty-two patients with recurrent patella dislocation, who underwent MPFL reconstruction with two semi-patellar tunnels and hardware-free patellar fixation between 2011 and 2013, were included in the study. Patella stability was tested by an apprehension test preoperatively and at follow-up. Knee function was evaluated using the Kujala score, Lysholm score, and Crosby-Insall grading system. Patellar congruence angle and patellar tilt angle were measured using an axial computed tomography scan. Furthermore, objective feelings of patients and complications were recorded. RESULTS Thirty knees (30 patients) were followed for a minimum of 48 months. The apprehension test was positive in all patients preoperatively, but negative at follow-up. Kujala and Lysholm scores increased from 58.9±9.6 to 92.0±4.8 (p<0.001) and 53.3±5.6 to 91.6±3.5 (p<0.001), respectively, at the last follow-up. Seventeen patients were graded as excellent and 13 were graded as good by the Crosby-Insall grading system. The patellar congruence angle and patellar tilt angle also improved significantly. No patient experienced patellar re-dislocation, subluxation, or patella fracture. Most patients (93%) were satisfied with the surgery. CONCLUSIONS MPFL reconstruction with two semi-patellar tunnels and hardware-free patellar fixation was described and the study observations indicated it was a safe and economical surgical procedure for recurrent patella dislocation with satisfactory results. It could be an alternative surgery method for patients with patella recurrent dislocation.

Is There Any Role for Direct Repair of Extensor Mechanism Disruption Following Total Knee Arthroplasty

Abstract: Background Extensor mechanism disruption remains a challenging problem in total knee arthroplasty (TKA) with historically poor outcomes. The purpose of our study is to determine if patients undergoing acute extensor mechanism repair had different outcomes than patients undergoing allograft reconstruction. Methods We reviewed a series of 126 total knee arthroplasty patients requiring surgical repair or reconstruction of an extensor mechanism injury from 2005 to 2014 with a minimum of 24 months of follow-up. Demographics, comorbidities, Knee Society Scores, time from injury, and reoperations were all recorded from the medical record. A poor outcome was defined as an extensor lag >30°, postoperative Knee Society Scores Results Of the 126 patients, there were 58 patients who underwent direct extensor repair (46%) and 68 patients who underwent allograft reconstruction (54%) at a mean postsurgical follow-up of 81.2 months. Rates of poor outcomes were comparably high in both groups (33% vs 44%, P = .192). Patella tendon repair had the highest rate of poor outcomes compared to quadriceps repair and patella fixation (63% vs 22% vs 8%, P = .002). Independent risk factors for poor outcomes included patients with a history of infection (odds ratio 4.559, P = .002) and injury greater than 2 weeks duration (odds ratio 4.237, P = .031). Conclusion Outcomes following direct extensor mechanism are comparable to extensor mechanism allograft reconstruction; however, patients should be counseled regarding poor outcomes. Direct repair of patellar tendon injuries should likely be avoided due to prohibitively high complication rate.

Augmentation of Patellar Tendon Repair With Autologous Semitendinosus Graft—Porto Technique

Abstract: Patellar tendon ruptures can lead to significant functional deficiency of the extensor mechanism of the knee. These injuries, because of their inherent nature and associated complications, may require a complex treatment and remains a challenge for orthopaedic surgeons. Current surgical techniques present significant complications, including patellar fracture, damage to patellar articular cartilage, and abnormal patella height. This note describes a surgical technique to provide an additional reinforcement to the patellar tendon repair with a semitendinous autograft, without the necessity to perform any transosseous tunnels at the patella bone. First, the patellar tendon is repaired with an end-to-end technique and the semitendinous tendon is harvested. A transosseous tunnel at the tibial tubercle is drilled and 2 rents are made, both medial and lateral to the retinaculum at the level of the intermedial segment of the patella close to the patellar margin. The graft is passed through the tunnel and rents in a U-shaped form. The graft is sutured along the length of the patellar tendon on both margins in tension at 30° of knee flexion. Fluoroscopy imaging is performed to assess the patella height. This technique provides a significant augmentation of patellar tendon, avoiding the potential patella bone tunnel complications.

Novel Anterior Plating Technique for Patella Fracture Fixation.

Abstract: Patella fracture fixation remains a significant challenge for orthopedic surgeons. Although tension band fixation allows for reliable osseous union, especially in simple fracture patterns, it still presents several problems. Plate fixation of patella fractures is a method that allows for more rigid stabilization and earlier mobilization. At the authors' level 1 trauma center, one fellowship-trained trauma surgeon has transitioned to using a novel anterior, low-profile mesh plate construct for all types of patella fractures. This construct allows for stable fixation, osseous union, and neutralization of the inferior pole for even the most comminuted of patella fractures. [Orthopedics. 2017; 40(4):e739-e743.].

A double button adjustable loop device is biomechanically equivalent to tension band wire in the fixation of transverse patellar fractures-A cadaveric study.

Abstract: Introduction Tension-band wire fixation of patellar fractures is associated with significant hardware-related complications and infection. Braided polyester suture fixation is an alternative option. However, these suture fixations have higher failure rates due to the difficulty in achieving rigid suture knot fixation. The Arthrex syndesmotic TightRope, which is a double-button adjustable loop fixation device utilizing a 4-point locking system using FibreWire, may not only offer stiff rigid fixation using a knotless system, but may also obviate the need for implant removal due to hardware related problems. The aim of our study is to compare the fixation rigidity of patella fractures using Tightrope versus conventional tension-band wiring (TBW) in a cadaveric model. Materials and methods TBW fixation was compared to TightRope fixation of transverse patella fractures in 5 matched pairs of cadaveric knees. The knees were cyclically brought through 0–90° of motion for a total of 500 cycles. Fracture gapping was measured before the start of the cycling, and at 50, 100, 200 and 500 cycles using an extensometer. The mean maximum fracture gapping was derived. Failure of the construct was defined as a displacement of more than 3 mm, patella fracture or implant breakage. Results All but one knee from each group survived 500 cycles. The two failures were due to a fracture gap of more than 3 mm during cycling. There was no significant difference in the mean number of cycles tolerated. There was no implant breakage. There was no statistical significant difference in mean maximum fracture gap between the TBW and TightRope group at all cyclical milestones after 500 cycles (0.3026 ± 0.4091 mm vs 0.3558 ± 0.7173 mm, p = 0.388). Conclusions We found no difference between the TBW and Tightrope fixation in terms of fracture gapping and failure. With possible lower risk of complications such as implant migration and soft tissue irritation, we believe tightrope fixation is a feasible alternative in fracture management of transverse patella fractures.

Complications Related to Implant Fixation of Patellar Fractures: Comparison of Ring Pins versus Bent K-Wires.

Abstract: Patellar fractures are characterized by injuries to the extensor and typically require surgical fixation. Among the methods used for fixation, the most common is the modified AO tension-band wiring technique. However, using this technique, implant migration occurs due to the lack of connections between the K-wires and the tension-band wire, which causes irritation and reduces fracture stability. Recently, new methods for tension-band wiring have been developed in which tension bands lock the K-wires through an attached "ring" to prevent migration. The purpose of this study was to compare the clinical outcomes when either the conventional or novel technique was used for tension-band wiring. This was a retrospective study involving 48 patients who underwent tension-band wiring to correct a patellar fracture. Patients in group 1 (n = 23) were treated between December 2010 and February 2012 using conventional tension-band wiring, while patients in group 2 (n = 25) were treated between March 2012 and May 2014 using the novel ring pin method. Different surgeons performed the operations in the two groups, while all other conditions were consistent. The surgical outcomes were assessed according to the level of implant migration, irritation, and implant removal procedures. All patients in group 2 achieved a union of the patella, while two patients in group 1 did not. These two patients underwent partial patellectomy within 1 year of the initial surgery. Implant migration and removal were significantly more common among patients in group 1 (p = 0.0038 and 0.011, respectively), with the implant removal period being significantly shorter as well (p = 0.005). The novel ring pin method was superior to the conventional method in terms of preventing implant migration, removal, or other secondary operations for the correction of complications.

A classification-based approach to the patella in revision total knee arthroplasty

Abstract: Background There is a paucity of data to guide management of the patella in revision total knee arthroplasty (RTKA). The purpose of this study was to review our experience with patellar management in RTKA. Methods We retrospectively reviewed 422 consecutive RTKAs at a minimum of 2 years (mean, 42 months). Patellar management was guided by a classification that considered stability, size, and position of the implanted patellar component, thickness/quality of remaining bone stock, and extensor mechanism competence. Results Management in 304 aseptic revisions included retention of a well-fixed component in 212 (69.7%) and revision using an all-polyethylene component in 46 (15.1%). Patella-related complications included 5 extensor mechanism ruptures (1.6%), 3 cases of patellar maltracking (1.0%), and 2 periprosthetic patellar fractures (0.7%). Of 118 2-stage revisions for infection, an all-polyethylene component was used in 88 (74.6%), patelloplasty in 20 (16.9%), and patellectomy in 7 (5.9%). Patella-related complications included 4 cases of patellar maltracking (3.4%), 3 extensor mechanism ruptures (2.5%), and 1 periprosthetic patellar fracture (0.8%). Conclusions Septic revisions required concomitant lateral releases more frequently (38.1% vs 10.9%; P P = .40). No cases required rerevision specifically for failure of the patellar component. Patients who had a patelloplasty had worse postoperative Knee Society functional scores than those with a retained or revised patellar component. In most aseptic RTKAs, a well-fixed patellar component can be retained. If revision is required, a standard polyethylene component is sufficient in most septic and aseptic revisions. Rerevisions related to the patellar component are infrequent.

Comparison of titanium cable tension band and nickel-titanium patella concentrator for patella fractures

Abstract: Background Patellar fractures account for approximately 1% of all fractures. Due to the patella's importance as regards the extensor mechanism, effort should be made to preserve the patella. Several operative treatment methods have been introduced for patella fractures. Objectives This study aims to compare the clinical effect of a titanium cable tension band and nickeltitanium (NiTi) patella concentrator (NT-PC) in treating patella fractures. Material and methods Thirty-nine patients with patella fractures were enrolled in this retrospective study. All the patients were treated via the open reduction internal fixation procedure using a titanium cable tension band or NT-PC. All the patients were followed up over an average period of 13 months. The main outcome measures were operation time, time of fracture union, postoperative complications, and Bostman knee scores. Statistical analyses were conducted between the 2 groups. Results All the patients were operated on successfully. The operation time of the NT-PC treatment group was less than that of the titanium cable tension band treatment group (p 0.05). Conclusions Both titanium cable tension band and NT-PC showed good efficacy for the treatment of patellar fractures. NT-PC fixation, a new option for the treatment of patella fractures, is a simple and effective fixation method.

Suture Repair of a Pole Patella Fracture.

Abstract: Purpose Operative fixation of displaced patella fractures is considered to be standard of care. However, patients with inferior pole patella fractures have limited options in terms of fixation. This video demonstrates the repair of an inferior pole patella fracture using nonabsorbable suture fixation. Methods Suture repair of patella fractures is a clinically acceptable technique, yielding similar functional results to patella fractures treated with K-wires or cannulated screws while reducing the rates of removal of hardware after fixation. Results This video features the repair of a displaced, comminuted inferior pole patella fracture using 5 Ethibond and Fiberwire. Postoperative radiographs confirm bony union. Conclusions Suture fixation for pole patella fractures provides reliable fixation and reduces the risk of postoperative complications secondary to hardware irritation. This case highlights the success of this technique.

ORIF Patella Fracture With a Tension Band Construct.

Abstract: Patellar fractures can occur as a result of direct or indirect injuries. Indirect injury is more common and occurs when the patella fails in tension when the force exerted by the extensor mechanism exceeds that of the bone. Common mechanism of indirect injury is rapid knee flexion with fully contracted quadriceps muscle. Treatment with a tension band construct is indicated for transverse patella fractures without significant comminution. This can be performed with 18-gauge wire and either 2 parallel, longitudinally oriented cannulated screws or 2 Kirschner wires. Biomechanical studies have shown higher load to failure when performed with cannulated screws. We presented our technique for management of a transverse patella fracture with disrupted extensor mechanism using tension banding technique with cannulated screws.

Biomechanical evaluation of simulated feline patellar fracture repairs

Abstract: Objective: To investigate four techniques for stabilization of feline patellar fracture. Methods: Feline cadaveric stifles with simulated patellar fracture were stabilized with one of four techniques: Group A - circumferential wire, group B - figure-of-eight wire, group C - combined figure-of-eight and circumferential wire, group D - pin and tension band wire. All repairs were subjected to a period of cyclic loading prior to load to failure testing. Experiments were recorded by video capture to determine load at failure and failure mode. Failure was defined as an opening of the fracture gap of 3 mm. Results: Mean fracture gap opening (±SD) during peak loading after 1000 cycles was: group A with 1.66 mm (± 0.69), group B with 1.01 mm (± 0.45), group C with 0.81 mm (± 0.58), and group D with 0.65 mm (± 0.54). Groups C and D had significantly lower mean fracture gap opening after 1000 cycles when compared to group A (p

Extensor Mechanism Reconstruction for Chronic Patellar Fracture.

Abstract: Patients with displaced patellar fractures typically present with disruption to the extensor mechanism requiring acute surgical intervention. Chronic patellar fractures with disruption of the extensor mechanism are uncommon, and few surgical options are available. The authors present a patient who sustained a fracture to the inferior pole of the patella in Africa 5 years prior that was managed conservatively with bands and a brace. He decided to pursue surgical intervention because of difficulties with leg extension, weakness, and ambulation. The patient underwent a novel reconstruction of his chronic extensor mechanism loss with a combination of inferior pole patellar fracture excision, z-plasty and lengthening of the quadriceps tendon, and Achilles tendon reconstruction of the patellar tendon with both hamstring autograft and acellular human dermal matrix allograft augmentation of the entire reconstruction construct. At the final 2-year follow-up, the patient had restored active extension with no extensor lag and had returned to his preinjury activities, including running and playing soccer. [Orthopedics. 2018; 41(1):e145-e150.].

Biomechanical Evaluation of a Novel Suture Augment in Patella Fixation.

Abstract: Patella fractures, although uncommon in the context of corresponding long bone fractures, carry a disproportionately high degree of morbidity, and are often challenging to treat. As such, this study sought to evaluate the efficacy of a Krackow suture augment when compared to standard tension band fixation and cerclage suture augment in patella fracture repair. Cadaveric patella extensor mechanisms were used for biomechanical testing. Specimens were divided among 3 groups, each with a different repair technique: modified anterior tension band (MATB), MATB plus cerclage suture, and MATB plus Krackow suture. Specimens were biomechanically tested in both cyclic and maximum load settings. Mean displacement and load-to-failure forces were measured for cyclic and maximum load testing, respectively. Data was then analyzed with both one-way analysis of variance and independent t-testing. Both augmentation techniques showed improved strength in both cyclic and maximum load testing, with the Krackow suture augment showing the greatest strength. In cyclic testing, cerclage augment showed a 30% decrease in mean displacement while Krackow suture augment showed a 40% decrease when compared to the MATB repair group. Likewise, in maximum load testing, cerclage repair showed a 5% increase and Krackow a 14% increase in load-to-failure force when compared to MATB. Likely due to small sample size, the increases in repair strength did not reach statistical significance. This study provides support for the use of a Krackow suture augment in patella fracture repair, and we suggest this technique may be most useful in the setting of poor bone quality where conventional repair techniques are limited. Although failing to reach statistical significance, these results are encouraging and warrant further investigation in both biomechanical and clinical settings.

Percutaneous Tension-Band Suture Technique for Distal Patella Fracture Fixation

Abstract: MOJ Orthop Rheumatol 2017, 8(3): 00315 reported rates up to 60 % [3,8,9]. For this reason, some have advocated the use of nonabsorbable sutures such as braided polyester, lowering the rate of revision surgery secondary to symptomatic hardware [3,10-14]. Studied suture material has included number 5 Ethibond (Ethicon, Somerville, NJ, USA), number 5 Ti-Cron (Davis and Geck, Gosport, Hampshire, UK) and number 5 FiberWire sutures (Arthrex, Naples, FL, USA).

Femoral Head Fracture

Abstract: Various common injuries in the pelvis and lower extremity are investigated in this chapter. Significant attention is paid not only to proper diagnostic examination and imaging, but also to optimal nonoperative and operative treatment options to manage these conditions.

Medial Patellofemoral Ligament Reconstruction in a Revision Setting: Anchor and Interference Screw Fixation.

Abstract: Recurrent patellar instability is a common pathology and typically affects younger and more active patients. To prevent complete lateral dislocation of the patella, several osseous and soft-tissue procedures have been previously described, including reconstruction of the medial patellofemoral ligament (MPFL), which has been identified as the primary medial stabilizer of the patella. Several techniques have been reported for reconstruction of the MPFL, sometimes in conjunction with other procedures, with the majority showing success in the treatment and resolution of patellar instability. However, MPFL reconstruction is not free of complications, with previous reports of recurrence of medial patellar instability and patellar fracture after surgery. The objective of this Technical Note is to describe our preferred technique, comprising anchor as well as interference screw fixation, for reconstruction of the MPFL in a primary or revision setting.

Forensic Identification of Bipartite Patella Misdiagnosed as Patella Fracture

Abstract: Bipartite patella is recognized as a developmental anomaly of ossification. Most of them are asymptomatic and are discovered incidentally. Bipartite patella is sometimes misdiagnosed as a patella fracture, because the x-ray images of both these conditions may appear very similar. In this case, the patient complained of left knee pain after x-ray films revealed a fracture-like line in the left patella. The patient was then diagnosed as having a patella fracture. In China, the injury degree is categorized as serious injury, minor injury, and trivial injury. As the injury degree of patellar fracture is identified as minor injury, the defendant who injured the patient will be sentenced to prison for ≤3 years. However, the defendant objected to this judgment and applied for the second evaluation of injury degree. On the basis of the site of injury, clinical manifestations, and imaging findings, we diagnosed the patient with bipartite patella which belongs to normal anatomic variant. Therefore, the injury degree of the patient was not minor injury.

Osteosynthesis of a periprosthetic patella fracture with a locked mesh plate

Abstract: Periprosthetic patellar fractures continue to be associated with poor functional outcomes and low rates of bony union. We present a patient with a periprosthetic patellar fracture treated with a novel mesh locking plate technique. In this technique, Kirshner wires were used to help reduce the patellar fracture and an interfragmentary compression screw was placed. The fracture was then neutralized with a locked mesh plate compressed anteriorly onto the patella with cortical screws. By two months follow-up, the patient had return to preoperative knee range of motion, mild knee pain, and a Knee Outcome Score – Activities of Daily Living Scale of 88.6.

Complete longitudinal patellar fracture in a cat: A rare case.

Abstract: Longitudinal patellar fractures in cats are extremely rare with only 1 other report of a comminuted longitudinal fracture for which pins and wires were placed in the patella for stabilization. This report describes the surgery and outcome of a strictly longitudinal patellar fracture in a cat.

Rare case of the hip injury-posterior dislocation and femoral head fracture associated with patella fracture, case report and literature review

Abstract: Now-a-days traffic accidents and high–energy injuries are increasingly common. Hip dislocations are classified as high–energy traumas. Femoral head fractures, although not common in orthopedic surgery, are often associated with posterior hip dislocations. Issue of the femoral head fractures was compiled by Pipkin and assigned to I-IV types. Methods of treatment and surgical approaches depend on pattern and type of the fracture. In this paper, we present clinical case of the Pipkin II type femoral head fracture with hip dislocation and ipsilateral transverse patella fracture. We performed an open reduction and internal fixation with four cortical screws via Kocher–Langenbeck approach and tension band wiring.

Late MRI-detected patellar sleeve fracture: A case report and review of the literature

Abstract: This is a detailed report of a case and a review of literature concerning the patellar sleeve fracture. The diagnosis of this type of fracture is often missed in the emergency room, which the mentioned case also stresses. The fracture is a subtype of patellar fractures, and is mostly seen among children between eight between sixteen years of age. The trauma mechanism is an indirect powerful extension of the knee with a simultaneous contraction against a resistance of the quadriceps muscle group. Inflicted patients have often been trampolining, skateboarding or playing soccer. A bruised, painful and immobile knee is the typical clinical presentation. Ultrasound or/and magnetic resonance imaging are alternatives when plain radiographs are inconclusive. The treatment is often an open surgical fixation of the bone fragment. Early treatment is essential for a good prognosis.