Abstract
Objective To evaluate the efficacy of suture anchor combined with double-pulley technique for subpatellar comminuted fractures compared with wire vertical suture and Krachow in the treatment of subpatellar fractures. Methods Retrospectively selected 48 patients with subpatellar pole comminuted fracture admitted in our hospital from February 2013 to July 2019, 25 patients with double-pulley technique (group A), and 23 patients with vertical wire suture with Krachow suture. Patient age, gender, AT/OTA typing, injury mechanism, follow-up time, surgical time, bleeding volume, mean fracture healing time, and postoperative complications were recorded. The Insall-Salvati index immediately and 6 weeks after surgery. Bostman scores and knee activity were recorded at each follow-up, and month 12 was taken as the final result. Results Time of surgery in group A (46.52 min) was significantly shorter than in group B (76.30 min). Intraoperative bleeding in group 15.1 ml, B, group 15.9 ml. Both incisions healed in stage I, averaging clinical healing of patella fracture within 10 weeks. There was no significant difference in mean Bostman score and knee activity at month 12 (group A: 28.4, 124.8°; group B: 28.1, 125.7°). There was no significant statistical difference in the Insall-Salvati index immediately or 6 weeks between the two groups. Group B patients had two wire fractures, fracture healing and the wire removed one year after surgery, and the remaining patients had no complications such as internal fixation loosening, fracture, delayed healing, or nonhealing of fracture. Conclusion Compared with the treatment of subpatellar fracture with wire vertical suture and Krachow method, suture anchor with double-pulley technique has short operation time, reliable fixation, and less complications. Patients can have early functional exercise and good knee function recovery without secondary surgery. It can be considered as an alternative therapy for this fracture and deserves clinical adoption and promotion.
Highlights
The patella is the largest seed bone in the human body and is an important part of the knee extension device
Knee extension dysfunction due to patella fractures accounts for about 1% of all fractures [1]
The occurrence of fractures is often caused by indirect violence, accounting for 9%-22.4% of all patellar fractures [2]
Summary
The patella is the largest seed bone in the human body and is an important part of the knee extension device. Knee extension dysfunction due to patella fractures accounts for about 1% of all fractures [1]. The occurrence of fractures is often caused by indirect violence, accounting for 9%-22.4% of all patellar fractures [2]. Most of them are completely comminuted fractures, and the vertical length is generally less than 15 mm. This comminuted avulsion fracture, often due to obvious displacement or combined extensor structural fracture, may cause the loss of continuity of the knee extension device and the loss of coordination of the patellar-femoral joint. There is a proposition of early surgical treatment, to realize the functional recovery of the femoral quadriceps extensor muscle and fracture anatomical reduction and parallel strong internal fixation, to provide conditions for early functional exercise
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