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Chen B, Wang Z, Qu X, Fang X, Chen Z, Qian Y, Wang X. A novel suture bridge anchor fixation technique to treat inferior pole fractures of patella: A retrospective clinical study. Medicine (Baltimore) 2023; 102:e34106. [PMID: 37390282 PMCID: PMC10313306 DOI: 10.1097/md.0000000000034106] [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: 03/18/2023] [Accepted: 06/05/2023] [Indexed: 07/02/2023] Open
Abstract
The traditional surgical methods to the fracture of the inferior patellar fracture include steel wire tension band fixation and inferior patellar resection, which have many disadvantages. In order to overcome the disadvantages of traditional surgery, we innovated and improved the double row anchor suture bridge technology to the treat the inferior patellar fracture. This study is to investigate the method, technique and clinical efficacy of double-row anchor suture bridge technique in the treatment of inferior pole fractures of patella. Between January 2019 and March 2021, 36 patients with inferior pole fractures of patella underwent the surgery with the double-row anchor suture bridge technique. 28 injury cases were caused by falls while 8 injury cases were from car crashes. The operation time, amount of intraoperative bleeding and complications were recorded. Radiological assessments and Bostman score were performed 1, 3, and 6 months post-operation and at the most recent follow-ups. The study sample consisted of 19 males and 17 females, aged 31 to 72 years old. The operation time was (54-76) minutes. All incisions healed in 1 stage. No complications such as incision infection, flap necrosis and nerve injury occurred. Patients in this group were followed up for 10 to 18 months, with an average follow-up of 12 months. All fractures healed in 10 to 20 weeks, with an average healing time of 12 weeks. At the last follow-up, the Bostman score was (27.5 ± 3.3), excellent in 32 cases and good in 2 cases, with an excellent rate of 94.4%. The range of motion of the knee joint was (-2.6 ± 2.0)° when the knee was extended and (122 ± 5.0)° when the knee was bent. The muscle strength of quadriceps femoris was grade 5. Double-row anchor suture bridge technique is applied to inferior pole fractures of patella by virtue of its various effects, such as the complete preservation of the inferior pole fragments during the operation, satisfactory fracture reduction, firm fixation, and meeting patients' requirements for early postoperative ambulation. In summary, double-row anchor suture bridge technique is an ideal surgical procedure for the treatment of the inferior pole fracture of patella with safety, reliability and high satisfaction.
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Affiliation(s)
- Bingqian Chen
- Department of Orthopaedics, Changshu Hospital Affiliated to Soochow University, First Peoples’ Hospital of Changshu City, Changshu, China
| | - Zhengfei Wang
- Department of Orthopaedics, Changshu Hospital Affiliated to Soochow University, First Peoples’ Hospital of Changshu City, Changshu, China
| | - Xiaohong Qu
- Department of Orthopaedics, Changshu Hospital Affiliated to Soochow University, First Peoples’ Hospital of Changshu City, Changshu, China
| | - Xiaowen Fang
- Department of Orthopaedics, Changshu Hospital Affiliated to Soochow University, First Peoples’ Hospital of Changshu City, Changshu, China
| | - Zhi Chen
- Department of Orthopaedics, Changshu Hospital Affiliated to Soochow University, First Peoples’ Hospital of Changshu City, Changshu, China
| | - Yufeng Qian
- Department of Orthopaedics, Changshu Hospital Affiliated to Soochow University, First Peoples’ Hospital of Changshu City, Changshu, China
| | - Xuesong Wang
- Department of Orthopedics, Affiliated Hospital of Jiangnan University, Wuxi, China
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Chang CH, Shih CA, Kuan FC, Hong CK, Su WR, Hsu KL. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop 2023; 10:58. [PMID: 37261559 DOI: 10.1186/s40634-023-00622-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE This study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques. METHOD This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. Studies were screened against predecided inclusion and exclusion criteria. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. The Methodological Index for Non-Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications. RESULTS A total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. Fourteen case-control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11-90). The follow-up period ranged from 6 to 300 months. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device; (2) tensile fixation device; (3) mixed device; and (4) extra-patella device. CONCLUSION Regarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The lowest functional score was also found in those using the patellotibial wire. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common.
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Affiliation(s)
- Chih-Hsun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-An Shih
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Fa-Chuan Kuan
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan
| | - Chih-Kai Hong
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Ren Su
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Kai-Lan Hsu
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, Taiwan, R.O.C..
- Skeleton Materials and Bio-Compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Division of Traumatology, National Cheng Kung University Medical Center, Tainan, Taiwan.
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
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Gao F, Yi M, Liu J, Zhang X, Xiang Z, Duan X. 3D reduction combined with the modified Kirschner-wire tension band for the treatment of comminuted patella fracture. Arch Orthop Trauma Surg 2023; 143:1957-1963. [PMID: 35254500 DOI: 10.1007/s00402-022-04400-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 02/18/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE A novel 3D reduction method combined with a modified Kirschner-wire tension band (3D MKTB) fixation method to treat comminuted patella fractures was introduced in this study. This study aims to evaluate the effectiveness and practicality of this novel technology. METHODS This study is a retrospective case series study. Twenty-eight patients with closed comminuted patella fractures were treated with the novel 3D MKTB fixation method. Radiographs of the knee were obtained at the routine follow-up to assess fracture healing and widening of the articular step-off. Clinical outcomes including the degree of pain on a visual analogue scale (VAS), range of motion, Lysholm, and Bostman grading scales were measured at the last follow-up. The mean follow-up was 39.8 ± 10.5 (range 26-62) months. RESULTS All patients had bony union at a mean of 11.4 ± 1.4 (range 9-14 weeks) weeks based on X-ray. No patient had evidence of internal fixation failure. Only two patients suffered from surgical complication. One patient suffered from postoperative superficial infection, and one patient suffered from internal fixation irritation. Articular step-off larger than 2 mm was not seen in any cases. The average VAS-related pain score was 0.5 ± 0.5 (range 0-1) points. The average range of motion was 0-138.6° ± 11.9° (range 90°-155°), all patients had full knee extension. The mean Lysholm and Bostman scores were 92.9 ± 3.5 (range 86-100 points) points and 28.5 ± 1.3 (range 24-30 points) points, respectively. CONCLUSION The novel 3D reduction technique combined with the modified Kirschner-wire tension band technique is an effective, safe, and simple treatment option for comminuted patella fractures. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Feng Gao
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Min Yi
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - JiaXin Liu
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xiang Zhang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhou Xiang
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xin Duan
- Department of Orthopedic Surgery, West China Hospital, West China Medical School, Sichuan University, #37 Guoxue Road, Chengdu, 610041, Sichuan, People's Republic of China.
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刘 晨, 胡 孙, 张 世. [Progress in surgical treatment of inferior patellar pole fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2023; 37:115-119. [PMID: 36708124 PMCID: PMC9883641 DOI: 10.7507/1002-1892.202210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 01/29/2023]
Abstract
Objective To summarize the surgical treatment methods and progress of inferior patellar pole fractures and provide reference for clinical application. Methods The literature on surgical treatment of inferior patellar pole fractures was extensively reviewed, and the relevant research progress, advantages, and limitations were summarized. Results The inferior pole of the patella is an important part of the knee extension device, which can strengthen the force arm of the quadriceps. Inferior patellar pole fractures are relatively rare and often comminuted, usually requiring surgical treatment. At present, there are various methods to treat inferior patellar pole fractures, including patellectomy of inferior pole, tension-band wiring technique, plate internal fixation, suture anchor fixation, claw-like shape memory alloy, separate vertical wiring technique. Different methods have their own characteristics, advantages, and disadvantages. The single internal fixation method has more complications and is easy to cause fixation failure. Therefore, the trend of combining various internal fixation methods is developing at present. Conclusion When the main fragment of the inferior patellar pole fracture is large and mainly distributed transversely, the combination protocol based on tension-band wiring technique can be regarded as an ideal choice. When the fragments are severely damaged and small, the comprehensive protocol based on suture fixation can result in a better postoperative functional recovery.
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Affiliation(s)
- 晨东 刘
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, P. R. China
| | - 孙君 胡
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, P. R. China
| | - 世民 张
- 同济大学附属杨浦医院骨科(上海 200090)Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, P. R. China
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Du B, Ma T, Bai H, Lu Y, Xu Y, Yang Y, Zhang K, Li Z, Li M. Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture. Front Bioeng Biotechnol 2022; 10:1010508. [PMID: 36324895 PMCID: PMC9618880 DOI: 10.3389/fbioe.2022.1010508] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/27/2022] [Indexed: 11/20/2022] Open
Abstract
Objective: This study aimed to compare the biomechanical stability and clinical efficacy of the Kirschner-wire (K-wire) tension band combined with patellar cerclage and an anchor-loop plate (ALP) in treating inferior-pole patellar fracture. Methods: The finite element model was established to analyze the mechanical properties of a K-wire tension band combined with patellar cerclage and ALP fixation in the treatment of inferior patellar pole fracture. The clinical data of 49 patients with patellar inferior-pole fracture (AO/OTA 34 A1) admitted to our hospital from January 2017 to July 2021 were retrospectively analyzed. Among these, 28 cases were fixed with ALPs (ALP group) and 21 cases were fixed with K-wire tension bands combined with patellar cerclage (K-wire group). By reviewing the medical records and follow-up results, we compared the operation time, final knee joint activity, incidence of secondary surgery, postoperative complications, and joint function recovery between the two groups. Results: The biomechanical analysis of the finite element model showed that the maximum displacement of the K-wire group was 1.87 times that of the ALP group. The maximum stress of the K-wire group was 1.34 times that of the ALP group. The maximum stress of the pole bone in the K-wire group was 13.89 times that of the ALP group. The average follow-up times of the K-wire group and ALP group were similar (p > 0.05), and the average ages of the two groups were similar (p > 0.05). The operation time of the ALP group was significantly shorter than that of the K-wire group (p < 0.05).The final knee joint activity of the ALP group was significantly greater than that of the K-wire group (p < 0.05). The Bostman patellar fracture function score of the ALP group was significantly better than that of the K-wire group at 3 and 9 months after operation (p < 0.05). Postoperative complications of the two groups included 1 case (3.6%) in the ALP group with internal fixation-stimulation complications and, in the K-wire group, 3 cases (14.3%) with internal fixation stimulation complications and 1 case (4.8%) with infection. Conclusion: The ALP and K-wire tension band combined with patella cerclage models were tested at 500 N, and no damage occurred, indicating that the newly designed ALP is safe in mechanical structure. The ALP has better therapeutic effect in biomechanical stability, postoperative complications, secondary surgery, and knee function. This technique is an effective method for the treatment of inferior-pole patellar fracture.
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Affiliation(s)
- Bing Du
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- Medical College of Yan’an University, Yan’an, China
| | - Teng Ma
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Huanan Bai
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yao Lu
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yibo Xu
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Yanling Yang
- Medical College of Yan’an University, Yan’an, China
| | - Kun Zhang
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
| | - Zhong Li
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Zhong Li, ; Ming Li,
| | - Ming Li
- Honghui Hospital, Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Zhong Li, ; Ming Li,
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Gao Z, Long N, Yao K, Cai P, Dai Y, Yu W, Xiao C. A Novel Technique for the Treatment of Inferior Pole Fractures of the Patella: A Preliminary Report. Orthop Surg 2022; 14:3092-3099. [PMID: 36196019 PMCID: PMC9627058 DOI: 10.1111/os.13518] [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: 11/07/2021] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Most inferior pole fractures of the patella are comminuted. Therefore, an ideal treatment method has not been determined. We have presented a modified tension band fixation technique—the Krachow suturing, Nice knot combined with tension band fixation—and reported the results of the procedure. Methods A total of 16 inferior patellar pole fractures were treated at our institution between January 2019 and October 2020, 15 of which underwent treatment with the modified tension band fixation technique consisting of Krachow suturing with Nice knots combined with tension band fixation. The primary measures: knee motion, Bostman score, anterior knee pain, fixation failure. Results Bone union occurred at a mean of 9 weeks postoperatively (range: 8–13). There were no cases of postoperative anterior knee pain, refracture of the inferior patellar pole or wire breakage. The patients regained full ROM of the knee joint without functional deficits during follow‐up; the mean ROM was 128.46° ± 7.07° (range: 113.4°–137.8°). At the last follow‐up, all patients had a mean Bostman score of 28.40 ± 1.29 (range: 26–30), with an excellent score in 11 patients and a good score in four patients. Conclusion The modified tension band fixation technique for the treatment of inferior patellar pole fractures is a simple and easy‐to‐perform surgical technique that provides stable fixation and good functional results.
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Affiliation(s)
- Zhixiang Gao
- Department of Orthopaedics, The Third Hospital of Mianyang· Sichuan Mental Health Center, Mianyang, China
| | - Nengji Long
- Department of Orthopaedics, The Third Hospital of Mianyang· Sichuan Mental Health Center, Mianyang, China
| | - Kai Yao
- Department of Orthopaedics, The Third Hospital of Mianyang· Sichuan Mental Health Center, Mianyang, China
| | - Peng Cai
- Department of Orthopaedics, The Third Hospital of Mianyang· Sichuan Mental Health Center, Mianyang, China
| | - Yixin Dai
- Department of Orthopaedics, The Third Hospital of Mianyang· Sichuan Mental Health Center, Mianyang, China
| | - Wei Yu
- Department of Orthopaedics, The Third Hospital of Mianyang· Sichuan Mental Health Center, Mianyang, China
| | - Cong Xiao
- Department of Orthopaedics, The Third Hospital of Mianyang· Sichuan Mental Health Center, Mianyang, China
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Chen R, Cao H, Sun Z, Jiang L, Li X, Zhao L, Liu X. The clinical outcome of the reduction of the patellar inferior pole fracture with wire cerclage through a generated bone hole, in combination with patellar concentrator: a retrospective comparative study. J Orthop Surg Res 2022; 17:117. [PMID: 35189926 PMCID: PMC8862354 DOI: 10.1186/s13018-022-03014-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The patellar inferior pole fracture is typically comminuted. Hence, achieving firm fixation and early activity is highly challenging. In this article, we employed the method of wire cerclage through a generated bone hole to reduce the fracture. Our objective was to compare the clinical efficacy of patellar concentrator alone with a combination of cerclage and patellar concentrator in the treatment of patellar inferior pole fracture. METHODS We conducted a retrospective review of patients with patellar inferior pole fractures, who underwent patellar concentrator fixation only (the control group) or cerclage combined with patellar concentrator fixation (the experimental group), performed by a single surgeon, between July 2015 and October 2019. Our analysis included surgical indexes like7 aspects (fracture gap after operation, operation time, intra-operative blood loss, intra-operative number of C-arm fluoroscopies conducted, Insall-Salvati ratio calculated immediately after operation, initial range of motion on the 7th day after operation, and fracture healing time), as well as the Bostman score and complications recorded on 1-, 3-, 6-, and 12-month follow up post operation. RESULTS A total of 94 patients with patellar inferior pole fracture and a minimum 1-year follow up were recruited. Following operation, the control group had 33 (71.74%) patients with a fracture gap of 0-2 mm and 13 (28.26%) patients with a fracture gap greater than 2 mm (P = 0.002). Conversely, the experimental group had 46 (95.83%) patients with a fracture gap of 0-2 mm and 2 (4.17%) patients with a fracture gap greater than 2 mm (P = 0.002). Compared to the control group, the experimental group did not experience enhanced operation time or intra-operative blood loss (P = 0.811, P = 0.823). The Insall-Salvati ratio and initial range of motion in the experimental group were larger than the control group (P = 0.037, P = 0.000). Alternately, the number of intra-operative C-arm fluoroscopies conducted and fracture healing time of the experimental group were considerably less than the control group (P = 0.003, P = 0.000). Moreover, at 1-, 3-, 6-, and 12-month follow ups after operation, the Bostman scores of the experimental group were remarkably higher than the control group (P < 0.05). At 12 months post operation, 23 cases (50%) were classified as excellent, 22 cases (47.83%) were good, and 1 case (2.17%) was poor in the control group (P = 0.005). In the meantime, in the experimental group, 38 cases (79.17%) were deemed as excellent and 10 cases (20.83%) were good (P = 0.005). Lastly, complications were detected in 3 cases (6.52%; 1 case of internal fixation loss, 2 cases of hematoma) within the control group, and in 1 case(2.08%; marginal wound necrosis) within the experimental group. There was no wound infection, implant discomfort, or broken fixation in either group. CONCLUSION Managing the patellar inferior pole fracture with wire cerclage through a generated bone hole is both simple and effective. Moreover, an additional step of patellar concentrator fixation facilitates early functional exercise, with satisfactory clinical outcome.
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Affiliation(s)
- Rong Chen
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Hong Cao
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Zhibo Sun
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Liangbo Jiang
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Xiangwei Li
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Lin Zhao
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Xinghui Liu
- Department of Traumatic Orthopedics, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei, China. .,Department of Anatomy, Hubei University of Medicine, No. 30 Renmin South Road, Maojian District, Shiyan, 442000, Hubei, China.
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Xie J, Fu Y, Li J, Yu H, Zhang Y, Jing J. Anchor and Krackow-"8" Suture for the Fixation of Distal Pole Fractures of the Patella: Comparison to Kirschner Wire. Orthop Surg 2021; 14:374-382. [PMID: 34964263 PMCID: PMC8867415 DOI: 10.1111/os.13124] [Citation(s) in RCA: 2] [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: 11/13/2020] [Revised: 05/04/2021] [Accepted: 06/03/2021] [Indexed: 12/01/2022] Open
Abstract
Objective The study aim was to evaluate the clinical outcomes, functional outcomes, and postoperative complications of anchor and Krackow‐“8” suture fixation (AS) and K‐wire fixation in patients with distal pole patellar fractures. Methods Twenty‐eight patients with distal pole patella fractures between January 2011 and December 2014 were reviewed retrospectively. The anchor and Krackow‐“8” suture fixation (AS group) was applied in 10 patients and 18 patients underwent K‐wire fixation (K‐wire group). The average age of patients was 46.000 ± 19.476 years in the AS group and 47.556 ± 15.704 years in the K‐wire group, with comparable demographic characteristics. All patients underwent regular follow‐up the operative data and postoperative functional and clinical outcomes were recorded. Complications were recorded by clinical and radiographic assessment. Bostman patellar fracture functional score was used to evaluate knee function after patellar fracture. Results A total of 28 eligible patients were included in this study. The mean follow‐up was similar for the AS and the K‐wire groups (P > 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The final follow‐up on the range of motion of the knee: the average extension lag was similar in two groups (P > 0.05); flexion and flexion–extension angle was slightly better in the AS group than in the K‐wire group. The Bostman patella fracture functional score of AS group were better than K‐wire group at 3 and 6 months after operation. Four kinds of postoperative complications in two groups, one patient (10%) in the AS group and two patients (11.1%) in the K‐wire group had infections. Two (11.1%) cases of nonunion in group K and three patients (16.7%) required re‐operation: one due to infection and two due to early implant failure. In the AS group, all distal pole fractures of the patella showed bony union, without loosening, falling, pulling out and nonunion of the fractures 6 months after operation. Conclusions Anchor and Krackow‐“8” suture fixation is an easily executed surgical procedure that can significantly reduce incision length and achieve better surgical outcomes than traditional procedures with regard to postoperative complications, knee function and without requiring a second operation. This technique is an effective operation method for the treatment of inferior patellar pole fractures.
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Affiliation(s)
- Jia Xie
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Yu Fu
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China.,Department of Orthopedics, Hefei Cancer Hospital, Chinese Academy of Sciences, Hefei, China
| | - Jun Li
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Hao Yu
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Yong Zhang
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
| | - Juehua Jing
- Department of Orthopedics, The Second Hospital of Anhui Medical University, Hefei, China
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"Fishing net" suture augmenting tension-band wiring fixation in the treatment of inferior pole fracture of the patella. Arch Orthop Trauma Surg 2021; 141:1953-1961. [PMID: 34342667 DOI: 10.1007/s00402-021-04089-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Inferior pole fracture of the patella (IPFP) is difficult to repair and stabilize clinically. Although various fixation techniques have been developed, fixation strength and mobility remain daunting challenges to orthopedic surgeons. The goal of this research is to evaluate the biomechanical strength and clinical outcomes of a novel "fishing net" suture fixation procedure. MATERIALS AND METHODS Four finite element models, modified tension-band wiring fixation, anchor suture fixation, basket plate fixation and "fishing net" suture fixation were built to compare the fixing efficacy of "fishing net" suture fixation with three other fixation methods during IPFP fixation. From January 2018 to February 2019, 17 patients who suffered IPFP and treated by "fishing net" suture (FNS) fixation were compared with 20 patients treated by tension-band wiring (TBW) fixation in database and the two groups were evaluated postoperatively using the modified Cincinnati knee rating system. RESULTS Biomechanical evaluation showed that the relative displacement values of proximal patella measured by three pairs of points on both sides of the fracture line were the lowest using the "fishing net" suture fixation, while fixation using tension-band wiring and basket plate showed similar levels of stability that were less desirable than the "fishing net" method. As to clinical outcomes, there were 17 (100%) patients exhibited excellent or good results with no internal fixation failures in the FNS group compared to three internal fixation failures in the TBW group. CONCLUSION The biomechanical and clinical results suggest that the "fishing net" suture fixation is a viable candidate for fixation of IPFP.
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