Management of comminuted inferior patellar pole fractures with cerclage-wire-augmented separate vertical wiring: a retrospective clinical study.

Abstract

Comminuted inferior patellar pole fractures are challenging injuries and require effective treatment due to the extension mechanism of the knee. This study aims to evaluate the outcome of above fractures treated with a modified technique of cerclage-wire-augmented separate vertical wiring (SVW) with cerclage wiring passed through the proximal patella. Retrospective analysis (1/2017-1/2020) were performed for patients that were treated with three SVWs through the posterior margin of proximal fragment and directly to the anterosuperior border of patella, combined with a cerclage wiring passed through the proximal patella. Patients who experienced comminuted inferior patellar pole fractures within 3weeks were included, and the outcome was evaluated radiologically and clinically by Bostman score after a minimum of 12months following surgery. Further evaluation included the operation time and complication rate. A total of 20 patients (10 males, 10 females) with a mean age of 54 ± 14.5years (26-83years) and a follow-up of 18.9 ± 6.6months (12-36months) were evaluated. The average operation time was 45.7 ± 8.8min (30-60min). At final follow-up, the average range of motion was 131.3° ± 3.5° (125°-135°), and the mean Bostman score was 29.4 ± 0.7 points (28-30) and graded excellent in all cases. Two patients experienced occasional giving way of the knee. Radiologically no loss of reduction, implant breakage, nonunion or skin irritation was observed. The cerclage-wire-augmented SVW with cerclage wiring passed through the proximal patella appears to be a safe and simple technique which can effectively treat the comminuted inferior patellar pole fractures.