Showing papers on "Patella fracture published in 2023"

[Double-pulley combined with suture bridge technique for fixation of comminuted fractures of distal patella pole].

Abstract: OBJECTIVE To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella. METHODS From January 2018 to June 2020, 15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology, including 9 males and 6 females, aged 28 to 68 years old with an average of (42.4±9.6) years old. All patients had obvious knee joint pain and limited movement after injury. All knee joints were examined by X-ray and CT, which confirmed that they were all comminuted fractures at the lower level of the patella. After operation, X-ray films of the knee joint were taken regularly to understand the fracture healing, the Insall Salvati index was measure, the range of motion of the joint was recorded, and the function of the knee joint was evaluateed by the Bostman scoring system. RESULTS All the 15 patients were followed up for 7 to 24 months with an average of (11.4±4.2) months, and there was no obvious anterior knee pain. At the last follow-up, the knee joint range of motion of the affected limb was 105° to 140° with an average of (128.5±12.8) °, and the Insall Salvati index was 0.79 to 1.12 with an average of (0.92±0.18). The X-ray film showed that the patella was bone healing, and no anchor fell off, broken, or displaced fracture block was found. Bostman patellar fracture function score was 27.85±2.06, 13 cases were excellent, 2 cases were good. CONCLUSION Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella, and patients can start functional exercise early after operation.

Biomechanical comparison of different screw-included angles in crossing screw fixation for transverse patellar fracture in level walking: a quasi-dynamic finite element study

Abstract: Abstract Background A minimally invasive technique with various screw configurations without open surgery is currently used for the fixation of transverse patellar fractures. Percutaneous crossing screw configuration has been reported to have a good bone union rate in patellar fractures. However, the difference in mechanical stability of the fractured patella between different screw-included angles has not been fully investigated. Hence, this study aims to compare the mechanical stability of parallel and crossing screw fixations with different screw-included angles for the fixation of transverse patellar fractures during level walking. Methods A finite element knee model containing a patella with a transverse fracture is created. Two headless compression screws with different angles (0°, 30°, 60°, and 90°) are used to fix the fracture. The loading conditions of the knee joint during level walking are used to compare the stability of the fractured patella with different fixation screw configurations. Results The results indicate that the maximum fracture gap opening distance increased with an increase in the included angle. Two parallel screws yield the smallest gap distance among all screw configurations. The maximum gap opening distances at the anterior leading edge of the fractured patella with two parallel screws and two screws having an included angle of 90° are 0.73 mm and 1.31 mm, respectively, at 15% walking cycle. Conclusions Based on these results, the superior performance of two parallel screws over crossing screw fixations in the fixation of transverse patellar fractures is established. Furthermore, the smaller the angle between the crossing screws, the better is the stability of the fractured patella.

The use of a 30-degree radiolucent triangle during surgery in distal avulsion fractures of the patella

Abstract: Avoiding patella baja or alta after the Krackow suture technique for distal avulsion fractures of the patella can be challenging. We aim to introduce a simple and reproducible technique using a 30-degree radiolucent triangle involving the contralateral knee to ensure the correct positioning of the patella intraoperatively.The radiolucent triangle is positioned under the contralateral knee before operating the injured knee. A strict lateral view is obtained using fluoroscopy as a reference before a Krackow technique is performed on the avulsion fracture of the patella.The triangle technique is straightforward and easily reproducible by surgeons of all levels. It allows the surgeon to correctly position the patella intraoperatively in avulsion fracture repair and modify tension on the patellar tendon.This method avoids millimetric mispositioning of the operated patella, thus improving the management intraoperatively and could decrease postoperative complications.

Anterior Hook Plating of Patella Fractures: A Biomechanical Analysis and Clinical Series

Abstract: Objectives: Compare anterior hook plating to established fixation constructs biomechanically and report outcomes and complications in a cohort of patella fractures treated with the technique. Design: Lab based biomechanical study and clinical multicenter retrospective cohort study. Setting: Two US level one trauma centers. Patients/Participants: 51 patients (28M, 23F) with 30 simple transverse and 21 comminuted patella fractures. 36 cadaveric patellae for the biomechanical study. Intervention: Biomechanical- Compared dorsal plating with cerclage wiring and modified tension band cable fixation in a comminuted patella fracture model in 36 cadaveric patellae. Constructs were tested in 0° and 45° of flexion. Clinical - We reviewed a consecutive series of patella fractures in two centers for outcome and complications. Main Outcome Measurements: Biomechanical – construct stiffness. Clinical – reduction, union, complications, range of motion. Results: Stiffness greatest in dorsal plating in both 0° and 45°. Dorsal plating (976 N, 1643 N) > modified tension band (317, 297) > cerclage (89.8, 150.3). 51 patients with patella fractures fixed with dorsal 2.7 mm mini-fragment plates including a distal to proximal lag screw through the plate from the nose of the patella. 9 Cases were small distal fragments not easily managed with screws and cables. All patients were followed to union. There were 2 infections (1 superficial, 1 deep with nonunion) and 5 had hardware removal (9.8%). Conclusions: Dorsal plating is biomechanically and clinically superior to modified tension band and cerclage techniques in comminuted patella fractures. This method allows for fixation of small distal pole fractures.

Tension-band wiring through a single cannulated screw combined with suture anchors to treat inferior pole fracture of the patella.

Abstract: To evaluate the feasibility and clinical outcomes of tension-band wiring through a single cannulated screw combined with two suture anchors in treating inferior pole fracture of the patella.Between September 2018 and September 2021, a total of 22 patients with a mean age of 55 years who sustained inferior pole fracture of the patella and were treated by tension-band wiring through a single cannulated screw combined with two suture anchors were enrolled. X-ray radiographs were performed to observe the bone union time. The duration of each operation was recorded to reflect the complexity of surgical treatment. Functional measurements, comprising range of motion (ROM), the Böstman scale, and the Knee Injury and Osteoarthritis Outcome Score (KOOS), were taken. Postoperative complications including fixation failure, incision infection, loss of reduction, and malunion were evaluated.All patients were followed up for an average of 17 months (range: 12-25 months). The average clinical bone union time was 8 weeks (range: 6-12 weeks), and the radiographic bone union time was 11 weeks (range: 8-12 weeks). At the final follow-up, the mean ROM was 136° (range: 115°-140°), the KOOS was 85 (range: 68-100) and the Böstman score was 28 (range: 20-30); these outcomes were classified as excellent in 17 cases and good in 5 cases, with no instances of poor results. Loss of reduction occurred in one case, while no cases of incision infection, fixation failure or malunion were observed.For inferior pole fracture of the patella, tension-band wiring through a single cannulated screw combined with suture anchors can offer sufficient fixation stability to achieve a satisfactory clinical outcome with reduced operational complexity; this procedure should be recommended in clinical practice.

Ring-Pins combined with cable cerclage for the fixation of displaced inferior patellar pole fractures

Abstract: Objective The study aimed to present the clinical results and complication rates of ring-pins with cable cerclage for treating the inferior pole of patella fracture. Method A study that retrospectively reviewed consecutive patients of the displaced inferior pole of patella fracture (AO/OTA 34-A1) operated with a ring-pin tension band using cable cerclage between October 2015 and October 2017 was performed. The duration of surgery, motion range of the knee, function outcomes, and complications were recorded. Results The average follow-up of 31 patients was 21 months. The mean operation time was 50 min. Fractures in all 31 patients healed at a mean duration of 8 weeks. There was no infection, no withdrawing of ring-pins, no implant breakage, and no loss of fracture reduction. The mean range of motion was 120°, and no patient complained of implant irritation at the final follow-up. The average Bostman score was 29.0 points, and 28 patients graded clinical outcomes excellent and 3 patients graded clinical outcomes good at the last follow-up. Conclusions Ring-pin combined with cable cerclage for treating the displaced inferior pole of patellar fracture is simple, and the postoperative internal fixation-related complication rate is low. It is a good choice for treating the displaced inferior pole of the patellar fracture.

A modified wire tension band technique for treatment of comminuted displaced patellar fractures

Abstract: Abstract Purpose: Wire tension band technique, as a widely accepted strategy for the treatment of patellar fractures, is undergoing constant improvement. This study aims to assess the clinical effect of a modified wire tension band technique for treatment of comminuted displaced patellar fractures. Methods: From January 2015 to December 2021, 97 adult patients (52 males and 45 females) with comminuted displaced patellar fractures were treated with wire tension band technique in our department. The age ranged from 18 to 68 years old with an average of 39 years old. All patients had single closed comminuted displaced patellar fractures and all were treated with open reduction internal fixation. There were 58 patients in the modified wire tension band group (The MW group) and 39 patients included in the Kirschner wire tension band group (The KW group). Operating time, intraoperative bleeding, length of hospital stay, postoperative follow-up, fracture healing time, and knee motion and function scores were recorded and compared between the two groups. The incidence of postoperative complications such as non-union of the fracture, infection, failure of the internal fixation, re-fracture, and broken of the internal fixation were recorded and evaluated. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. VAS (Preoperative and last follow-up scores in the Visual Analogue Scale) and Böstman scale were recorded and evaluated. Results: There were no significant differences in basic information such as age, gender, BMI, mechanism of injury, history of smoking and alcohol, injured limb and follow-up time in the MW group compared to the KW group. Intraoperative time (49.91±3.88, min ) in the MW group was significantly lower than intraoperative time (67.64±4.27, min) in the KW group and the difference was statistically significant (P＜0.05). In the MW group (102.59±10.01, ml), intraoperative blood loss was significantly lower than in the KW group (126.41±13.86, ml), and the difference between the two groups was statistically significant(P＜0.05). The intraoperative time of fluoroscopy in the MW group was (8.14±1.82, s), which was lower than the intraoperative time of fluoroscopy in the KW group (10.41±1.67, s), and the difference between the two groups was statistically significant(P＜0.05). The hospital days were also significantly shorter in the MW group (6.07±1.23, d) than in the KW group (6.79±1.42, d). The difference was statistically significant(P＜0.05). There was no significant difference between the two groups in terms of fracture healing time, mobility, VAS score and Böstman score after surgery. There were no complications such as infection or non-healing fractures. However, there were 2 cases of wire fracture complications in both the MW and KW groups when the internal fixation was removed. Conclusion: The modified wire tension band technique for fixation of patellar fractures is an effective new technique for the safe and reliable management of patellar fractures and offers an alternative strategy for the treatment of patellar fractures.

Osteochondral impression fracture of the patella after sports collision injury

Abstract: This article reports a case of a teenager who suffered a frontal collision sports injury. Computed Tomography (CT) revealed a fracture of the inferior pole of the patella without obvious displacement and retro patellar cortical impression with 5 mm step off. Surgical intervention was performed using β-tricalcium phosphate (β-TCP) and 3.0 cannulated screw fixation. At 3-month follow-up, the wound showed good healing. No pain was observed. The patient was able to flex up to 100° with full extension. There were no signs of hydrops with full stability of the knee. Good postoperative results can be obtained in osteochondral impression fractures of the patella using surgical intervention to elevate the osteochondral fragment, graft it with β-TCP and raft it with 3.0 cannulated screws.

Biomechanical evaluation of three fixation methods in a feline transverse patella fracture model

Abstract: This study aimed to compare the biomechanical properties of three stabilisation techniques in feline patella transverse fractures and select the strongest method with potentially minimal complications.Patella fracture was simulated in 27 feline cadaveric pelvic limbs (mean weight of the cadavers 3.78 kg), and the limbs were randomly grouped to be stabilised with one of the three stabilisation methods. The modified tension band wiring technique with a single Kirschner wire (0.9 mm) and figure-of-eight wiring (20 G) was applied to group 1 (n = 9). Group 2 (n = 9) was stabilised with a combination of circumferential and figure-of-eight wiring techniques with orthopaedic wire (20 G). Group 3 (n = 9) was stabilised with the same technique as group 2, but with #2 FiberWire. The knee joints were positioned and fixed in the neutral standing angle (135°) and tested by applying tensile force. The loads at gap formations of 1, 2 and 3 mm were recorded, and the maximum failure load was measured in each group.In all the loads at displacement (1, 2 and 3 mm), group 3 was significantly stronger than groups 1 and 2, respectively (P <0.017). Group 3 (261.0 ± 52.8 N) showed significantly stronger fixation in the maximum load compared with group 1 (172.9 ± 45.6 N) (P <0.017). No significant difference was observed between groups 1 and 2 (204.9 ± 68.4 N) or between groups 2 and 3.This study shows that the combination of circumferential and figure-of-eight techniques with FiberWire is more resistant to displacement than metal wire in this ex vivo feline patella fracture model.

Double-Bundle Quadriceps Tendon Autograft for Reconstruction of the Medial Patellofemoral Complex to Manage Recurrent Patellar Dislocation in Patients With Open Physes

Abstract: Management of chronic patellar instability in patients with open physis requires special reconstruction techniques to minimize the risks of femoral growth plate injury due to the close proximity of the open physis to the native femoral origin of the medial patellofemoral ligament (MPFL). Children and adolescents have a relatively smaller patella than the adult group, so, there is a higher risk of patellar fracture when tunnels are performed in the patella. It is wise to mimic the normal anatomy of the medial patellofemoral complex (MPFC) by reconstruction of both of the medial quadriceps tendon femoral ligament (MQTFL) and MPFL, so as to restore the normal fan-shaped MPFC, with its wide anterior attachment to both of the patella and quadriceps tendon (QT). This article describes a simple, safe, reproducible, and cost effective technique for surgical management of chronic patellar instability in patients with open physis by reconstruction of the MPFC using a double-bundle QT autograft.

Is tension band wiring (osteosynthesis) with three Kirschner wires provide better outcome as compared with two Kirschner wires in patella fracture: A prospective randomized study

Abstract: Background: Fractures of the patella constitute approximately 1% of all skeletal injuries, resulting from either direct or indirect trauma. Many forms of internal fixation for patellar fractures have been described in the literature but perfect anatomical reduction during surgery has an excellent outcome irrespective of the method of fixation used. The conventional method of patellar tension band wiring (TBW) is being done always with the help of two parallel Kirschner wires (K-wires). Objectives: Here in our prospective study, we intended to see whether the use of three parallel K-wires in comparison to the conventional one results in superior functional outcomes. Materials and Methods: A prospective cohort study was carried out in New Delhi from November 2016 to November 2019 in a total of 44 patients with patellar fractures operated by TBW with 22 patients in two parallel K-wires and three parallel K-wires groups, respectively. Patients were followed up postoperatively for 1 year and assessed by Lysholm knee score (LKS), pain status, working status, and other variables Normality of data was tested by Kolmogorov–Smirnov test and paired t test/Wilcoxon rank-sum test. Results: The total mean age was 40.27 years (41.86 in 2K-wire and 38.68 in 3K-wire) in this study. LKS (0.00 in both groups on first day; 99.23 and 99.45 after 1 year in 2K-wire and 3K-wire groups, respectively, pain status (was 5.0 in both groups on the first day and 1.0 after 6 month), and working status (was 5.0 in both groups on the first day and 1.09 after 1 year), were not significantly different throughout the mean to follow up periods for both groups (P > 0.05). Conclusions: No significant difference was observed between patellar TBW in 3K-wire and 2K-wire groups.

Patella fractures, epidemiology, anatomy, function, mechanisms of action, classification, clinical presentation, imaging presentation, treatment and complications

Abstract: Introduction: The patella has a great importance in the extension and flexion activities of the knee, being paramount in the patient's quality of life. Nowadays the surgical options that stand out the most are open reduction plus internal fixation and resection of the patella. The patella increases the leverage of the quadriceps. Management following patella injury has been based on preservation of bone and vascular supply, in addition to joint restoration and extensor function. In patella fractures, it is essential to reflect on the biomechanics of the bone and the fixation technique to be used. Objective: to detail the current information related to patella fractures, epidemiology, anatomy, function, mechanisms of action, classification, clinical presentation, imaging presentation, treatment and complications. Methodology: a total of 32 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 24 bibliographies were used because the other articles were not relevant for this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: patella, patellar fractures, knee trauma. Results: Patellar fractures comprise 1% of all fractures in humans, with a 2:1 male to female ratio. They occur more frequently in individuals between 20 and 50 years of age. The frequencies of pseudarthrosis and infection are relatively lower after the surgical procedure. Approximately 2 to 7% of patellar fractures are open fractures. Their classification is descriptive. Conclusions: The patella is the largest sesamoid bone in the human body with several important functions. Frequently, patellar fractures appear after falls on the knee, blows and unexpected and energetic muscular pulls. The diagnosis is made by means of clinical history, physical examination and complementary radiography. Anteroposterior and lateral projections of the knee should be performed. For conservative treatment it is essential that the knee extensor mechanism is intact. There are several methods of surgical treatment, in general the open reduction and internal fixation present good results. Complications include post-traumatic osteoarthritis, alteration or loss of mobility of the knee, refracture, fixation failure, osteonecrosis, intolerance to osteosynthesis material, loss of strength of the extensor mechanism, loss of extension, instability of the patella and pseudoarthrosis. KEY WORDS: patella, knee, fracture, treatment, osteosynthesis.

Closed Reduction and High-Strength Sutures for Transverse Patella Fractures: A Retrospective Analysis

Abstract: Abstract Objective This study aimed to investigate the clinical efficacy of closed reduction high-strength sutures combined with Nice knots in treating transverse patella fractures. Method We retrospectively analyzed the clinical data of 28 patients who underwent surgery for transverse patella fractures from January 2019 to January 2020. Twelve cases of the study group were treated with closed reduction high-strength sutures combined with Nice knots, and 16 cases in the control group were treated with tension band wiring. Observations included patellar healing, follow-up knee mobility with Böstman score, Lysholm score, surgical data, postoperative complications, and secondary surgery rate. Result No statistically significant difference was observed between the two groups in the Patient demographic data, with a mean follow-up of 13.14 ± 1.58 months. There was no delayed healing or deep infection in the two groups. In the control group, 2 cases of internal fixation failure and 1 case of superficial infection were observed. The differences in mean fracture healing time, follow-up Böstman score, Lysholm score and knee mobility between the two groups were not statistically different. However, the differences were statistically significant for the duration of surgery, Incision length, intraoperative bleeding and the secondary surgery rate was lower in the study group. Conclusion Closed reduction high-strength sutures have good clinical efficacy in treating transverse patella fractures, with the advantages of shorter duration of surgery and Incision length,less intraoperative bleeding and no secondary removal.

Management of severely comminuted fracture patella: a case report

Abstract: Fracture patella is a breach in the extensor mechanism of the knee and needs to be fixed. Comminuted fractures of patella are a challenge given the difficulty in restoring the extensor mechanism. Introduction: Treatment options have evolved over the years from sacrifice to salvage i.e., from total or partial patellectomy to patellar preserving surgery. The challenge remains to fix the fragments optimally and also to have a tailor-made physiotherapy and rehabilitation program for the patient to provide a satisfactory functional outcome. A 14-year-old female presented to the casualty with a history of domestic fall, injuring her right knee. X-ray was done which revealed a comminuted fracture of right patella, classified as 34C3 OA/OTA classification. Salvage procedure for severely comminuted patella fracture has a successful functional outcome following a stable fixation of fragment.

The effect of Ding's screws and tension band wiring for treatment of inferior pole patellar fractures.

Abstract: We developed a cannulated screw with holes in the tail, named the Ding's screw. The objective of this study was to evaluate the clinical effect of Ding's screw in the treatment of inferior pole patellar fracture.From March 2017 to October 2021, 68 patients with inferior pole patellar fracture in our department were retrospectively reviewed. According to different treatment methods, they were divided into Ding's screw and tension band wiring group (DSTBW) and cannulated screws and tension band wiring group (CSTBW). Radiological and clinical outcomes were evaluated and compared.There were 33 cases in DSTBW group and 35 cases in CSTBW group. The mean follow-up duration was 14.5 ± 2.6 months in the DSTBW group and 15.0 ± 2.3 months in the CSTBW group. No significant differences in age, sex, operative side or time to surgery were present between the two groups. Skin breakdown and infection were not significantly different among the groups (P > 0.05). At the last follow-up, the average Bostman score of the DSTBW group was 28.5 ± 1.3(excellent) and that of the CSTBW group was 27.8 ± 1.6(good), with statistical significance (P = 0.045). The average Lysholm score of the DSTBW group was 94.1 ± 3.4 (good), and that of the CSTBW group was 90.1 ± 4.4 (good), and the difference was statistically significant (P < 0.001). The average knee joint ROM of the DSTBW group was 135.6 ± 6.8˚, and that of the CSTBW group was 130.1 ± 6.7˚, and the difference between the two groups was statistically significant (P = 0.001).DSTBW is an effective method for the treatment of inferior pole patellar fractures with stable fixation and good functional effect.

A Double Cerclage and Tension band Wiring Technique Fixation for Comminuted Patellar Fractures

Abstract: Background: When the patella is fractured it should be repaired and patellectomy should be avoided as much as possible even in comminuted fractures. In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is confirmed to provide good mechanical stability. The objective of the present work was to find out the effectiveness of comminuted patellar fracture fixation with combined cerclage and tension band wiring technique. Method and patient: Forty- six patients underwent surgical stabilization for comminuted patellar fracture between year 1996 to 2016. All fractures were classified as 34-C3 according to the Orthopedic Trauma Association Classification. All the patients were underwent open reduction- internal fixation with combined Cerclage and tension band wiring technique. Result: Fracture healing was occurred within an average of 3- 5 months, while in bilateral cases it was 4 - 8 months. Full range of knee movements was seen in 42 (91.3 %) cases and knee flexion more than 120º was seen in 4 (8.7 %) cases. Quadriceps power was normal in 44 (95.6 %) cases, but 2 cases had quadriceps power of grade-IV. No extensor lag and no quadriceps atrophy were seen in any cases. Forty four (95.6 %) patients could squat fully and two (4.3 %) patients could squat up to half of the normal level. All patients were able to climb up and down stairs without any problem. Most patients have no subjective complaints like pain, difficulty in walking, difficulty in squatting and climbing. The clinical results after operation were evaluated by the clinical grading scales of Böstman including range of movement, pain, work, atrophy, assistance in walking, effusion, giving way, and stair-climbing during follow-up. There were no significant complications, such as infection, knee stiffness, and non-union or implant failure in any of the cases. The average follow-up period was 8 months (Ranged 6 – 18 months). Conclusions: This study had concluded that combined Cerclage and tension band wiring technique was a successful surgical treatment for comminuted fractures of the Patella.

Reinforced technique of tension band wiring for tibial tuberosity fracture in adolescents: a case report for surgical technique.

Abstract: Most of the fractures had been previously treated with open reduction and internal fixation. Although there are a number of fixation methods, a consensus on the treatment options has not been reached yet.We demonstrated the reinforced technique of tension band wiring and its surgical outcomes in the tibial tuberosity fracture of a 14-year-old male basketball player. For the modified technique, the wire was inserted between the patellar tendon and tibial tuberosity (insertion site of patellar tendon) and passed distally through the 2-mm-sized predrill cortical hole. Tightening the figure of the eight loops draws the fractured fragments together and anatomically reduces under appropriate compression. This technique can achieve the reduction and fixation of the fracture simultaneously. We confirmed the fixation stability with a range of knee joint motions. The patient was able to return back to the pre-injury level of sports activity at postoperative 2 months.The original technique of tension band wiring utilized the Kirschner wire to make a figure-of-eight loop. However, we used the patellar tendon and its insertion site of the tibial tuberosity for making a figure-of-eight loop. Moreover, the reduction and fixation of fracture were achieved simultaneously by tightening the tension band wire. This reinforced technique was firm enough for postoperative rehabilitation.The most certain advantage of this technique was to be able to reduce anatomically and fixate firmly with appropriate compression simultaneously. We recommend open reduction internal fixation with the reinforced technique of tension band wiring for displaced tibial tuberosity fracture in adolescent athletes.

Management and Outcome of Elderly Patients With Patellar Fracture Treated With Novel Modified Cerclage Wiring

Abstract: Introduction The purpose of this study is to assess the efficacy and security of a fixation method for fixing patellar fractures in elderly patients utilizing modified cerclage wire. Methods From January 2015 to December 2020, 31 cases (age≥65 years old) of closed patellar fracture were treated by modified cerclage wiring. Patients in these instances ranged in age from 65 to 87 (73.7 ± 7.2 years), with 15 men and 16 women. 4 instances were type 34-C1 (transverse fracture) according to the AO/OTA classification, 27 cases (87%) were comminuted fractures, including 11 cases that were type 34-C2 (3 fragments), and 16 cases that were type 34-C3 (more than 3 fragments). Postoperative problems such as fragment re-displacement, nonunion, internal fixation loosening, infection, and internal fixation rupture were evaluated. The clinical grading systems of Böstman were used to assess the postoperative clinical outcomes. Results Thirty one patients in all were monitored for 14 to 31 months (22.2 ± 4.5 months). After the procedure, the fracture took 2.5-3.5 months (2.92 ± .25 months) to heal. There were no postoperative issues like infection, dislocation, implant breakage, uncomfortable hardware, or post-traumatic osteoarthritis. According to the clinical grading scales of Böstman, the average score of the final follow-up was 28.6 ± 1.1 (range 26-30). 29 (94%) of the patients had excellent results, whereas just 2 (6%) had good results. The patient’s knee flexion activity ranged from 110 to 140°, making for a favorable prognosis. Conclusion Most patella fractures in the elderly are comminuted. Elderly patients with patellar fractures may be successfully treated with modified cerclage wire, with good results and no noticeable side effects.

Arthroscopically Assisted, Minimally Invasive Percutaneous Fixation of a Patellar Fracture

Abstract: Operative fixation of a patellar fracture can be accomplished through a variety of techniques. However, drawbacks have been associated with many of these techniques, including painful hardware, poor skin healing due to bruising and swelling, inadequate cartilage reduction, and eventual post-traumatic osteoarthritis. Throughout the orthopaedic field, minimally invasive approaches have become popular. We describe an arthroscopically assisted method for ensuring fracture reduction intraoperatively and addressing associated defects while the patella is stabilized using a minimally invasive percutaneous fixation technique with screws and a tension band construct.

Biomechanical Evaluation of Transverse Patella Fracture Fixation Using Headless Screws: A Comparison of Suture Versus Cable as a Tension Band

Abstract: Objectives: To explore the performance of headless screws with FiberWire Suture as a tension band and headless screws with a mini-cable tension band in patella fixation. Methods: A transverse osteotomy was created in six matched pairs of fresh-frozen cadaver knee joints. One knee was randomly assigned to receive fixation with headless screws plus a cable tension band (Synthes 1.3 mm cable with crimp), while the other was fixed with headless screws plus a suture tension band (#5 FiberWire). Using a servo-hydraulic material testing system, the specimens were first tested non-destructively under 20% of the reported mean failure load with standard technique of cannulated screws with tension band wiring. The specimen was then loaded to 1000 N to test the construct’s failure strength. All tests were run under displacement-control with loading threshold. A motion analysis system was used to track the interfragmentary motion to assess fixation stability. The correlation between fixation strength and score of bone density was also examined. Results: In the non-destructive loading test, gap displacement under 150N was 0.10 mm or less for 11 of 12 specimens, and the difference between the two groups was not statistically significant. In the destructive test, 3 of 12 specimens maintained reduction (gap<2mm) at the maximum load of 1000 N. Of the failed specimens, the mean strength was 648±185 N for suture and 784±228 N for cable (p=0.24). Regression analysis shows bone density was associated with the failure load of the tendon (R2=0.43, p=0.02). Conclusions: There was no significant difference in fixation strength or sub-failure fragment displacement between the suture and cable tension band techniques when using headless screws, but suture on average was weaker.

Achieving Rapid Healing and Low Complication Rates in Patellar Fracture Fixation: The Benefits of Cerclage and Figure-of-Eight Configuration

Abstract: Background and objective Patellar fractures account for around 1% of all fractures. Conservative treatment is advised in patients without any incompatibility of articular surfaces or those with intact extensor mechanisms. More than a 2-mm articular gap due to fracture warrants surgical intervention. Tension band wiring (TBW) is a commonly used practice for fixation, However, there is still controversy about its effectiveness and complications arising due to the hardware. Modification of this technique by using K-wires has been considered a method of choice, but this technique is associated with complications due to K-wires. The Pyrford technique is a method for patellar fracture fixation by circumferential cerclage and anterior TBW. We employed the figure-of-eight configuration over the circumferential wire. This study aimed to analyze the outcomes of TBW of the patella without K-wires by assessing the rate of complication and functional outcomes. Materials and methods A total of 38 patients with OTA 34C type, simple and comminuted type of patella fractures aged between 22 and 70 years were treated with circumferential cerclage and figure-of-eight TBW. All patients underwent patellar fixation with cerclage and through direct purchase of SS wire via quadriceps and patellar tendon. Patients were followed up for one to three years. We analyzed differences in the range of motion, fracture reduction, fracture healing time, Bostman score for knee function, and complications. Results The mean age of the patients was 45 years. After TBW without K-wires, fracture healing and functional outcomes were satisfactory according to patient feedback and clinocoradiological examinations. Of note, 35 out of 38 patients (92%) had gained up to 90 degrees of active flexion at the end of one week. One patient (2.42%) developed a superficial infection. All fractures had achieved union at the end of 16 weeks. Malunion or nonunion was not noted in any of the cases. There was no case of implant removal. The average Bostman score at the 12-month follow-up was 28.5 ±1.5. The incidence of complications due to K-wire was nullified. Conclusion Based on our findings, the described method leads to better functional outcomes, decreasing hardware-related complications, and can be used in simple as well as comminuted fractures. The fracture healing and functional outcomes and rate of complications were satisfactory.

Separate vertical wiring plus bilateral anchor girdle suturing fixation for the fractures of the inferior pole of the patella

Abstract: The fixation of inferior pole fractures of the patella (IPFPs) is still a great challenge for surgeons.We introduced a new fixation method for IPFP fixation, that is, separate vertical wiring plus bilateral anchor girdle suturing fixation (SVW-BSAG). Three finite element models including the anterior tension band wiring (ATBW) model, separate vertical wiring (SVW) model and SVW-BSAG model, were built to evaluate the fixation strength of different fixation methods. A total of 41 consecutive patients with IPFP injury were enrolled in this retrospective study, including 23 patients in the ATBW group and 18 patients in the SVW-BSAG group. The operation time, radiation exposure, full weight-bearing time, Bostman score, extension lag versus contralateral healthy leg, Insall-Salvati ratio, and radiograph outcomes were employed to assess and compare the ATBW group and SVW-BSAG group.The finite element analysis confirmed that the SVW-BSAG fixation method was as reliable as the ATBW fixation method in terms of fixed strength. Through retrospective analysis, we found that there was no significant difference between the SVW-BSAG and ATBW groups in age, sex, BMI, fracture side, fracture type, or follow-up time. There were no significant differences between the two groups in the Insall-Salvati ratio, 6-month Bostman score, and fixation failure. Compared with the ATBW group, the SVW-BSAG group showed advantages in intraoperative radiation exposure, full weight-bearing time, and extension lag versus the contralateral healthy leg.The finite element analysis and clinical results showed that SVW-BSAG fixation methods are a reliable and valuable for IPFP treatment.

Patellar fracture fixation using cannulated screws and Fiber Wire tension band

Abstract: Purpose This study aims to evaluate the results of patellar fracture fixation using cannulated screws and FiberWire tension band. Patients and methods A prospective study was held in Benha University Hospital that included 30 patients with transverse patellar fractures fixed with cannulated screws with FiberWire tension band. All of the patients were followed up for a minimum period of 12 weeks, and the maximum period of follow-up was 24 weeks. Postoperatively, these patients were assessed clinically by the Levack’s score. Fracture union was confirmed radiologically. All patients were evaluated and assessed using the questionnaires at 3 and 6 months after surgery. Subjective evaluation consisted of recording pain using (visual analog scale), with categorization of pain into five levels: none, mild, moderate, severe, and unbearable. Results The mean age of the studied patients was 32 ± 9 years, and there was a male predominance (70%). More than half of the patients had right-sided affection (56.7%). The mechanisms of injury were direct (30%), falling (46.6%), or road traffic accidents (RTA) (23.3%). The affected side was the right side in 56.7% and the left side in 43.3%. The median time from injury was 3 days, and it ranged from 1 to 6 days. The mean time of surgery was 41 ± 18 min. All patients showed radiological union at 8 weeks, passive range of motion (ROM) at 4 weeks, active ROM at 6 weeks, start of weight-bearing as tolerated within brace at 4 weeks, and start of weight-bearing and ROM without restrictions at 8 weeks. At the final follow-up at 3 months, the median total Levack’s score was 12, and it ranged from 9 to 12. At 6 months, the median was 12, and the range significantly increased (11–12) (P<0.001). The reported complications were skin infection (13.3%), stiffness (6.7%), and mild pain (53.3%). Conclusion The use of cannulated screws with FiberWire tension band technique is a successful efficient treatment of transverse patellar fractures.