Abstract
BackgroundAlthough there are several different kinds of fixation techniques for displaced comminuted patellar fracture, the treatment remains a challenge for orthopaedic surgeons. The purpose of this study is to evaluate the effectiveness and safety of a fixation technique for comminuted patellar fracture fixation using modified cerclage wiring.MethodsFrom February 2016 to April 2018, 38 cases of simple unilateral closed comminuted patellar fracture were treated by modified cerclage wiring. Among these cases, 16 patients were males and 22 were females, aged 23–68 years (average 40.4 ± 9.1 years). Comminuted patellar fractures were classified according to the AO/OTA classification: 10 cases were type 34-C2 (three fragments), 28 cases were type 34-C3 (more than three fragments). Postoperative complications including loosening of internal fixation, fragment re-displacement, nonunion, infection, breakage of internal fixation and traumatic osteoarthritis were assessed. 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.ResultsA total of 38 patients were followed up for 6–36 months (mean time 16.1 ± 5.8 months). The bone union radiographically occurred at approximately 2.5–3.5 months (mean time 2.92 ± 0.25 months). No postoperative complications, such as infection, dislocation, breakage of the implants, painful hardware, and post-traumatic osteoarthritis, were observed. According to the clinical grading scales of Böstman, satisfactory results were obtained, and the mean score at the final follow-up was 28.7 (range 20–30) points. Thirty-two patients (84.2%) with excellent results had a mean score of 29.5 ± 0.7 (range 28–30) points, and six patients (15.8%) with good results had a mean score of 24.5 ± 2.2 (range 20–27) points. The patients with excellent and good scores had active flexion of 130° (110–140).ConclusionsModified cerclage wiring can effectively treat comminuted patellar fracture and offers a new strategy resulting in satisfactory results without obvious complications.
Highlights
Displaced comminuted patellar fracture requires surgical treatment [1, 2]
Open reduction and internal fixation is the first choice for the treatment of comminuted patellar fracture [12]
Circumferential cerclage wire fixation is suitable for the treatment of a comminuted patellar fracture
Summary
Displaced comminuted patellar fracture requires surgical treatment [1, 2]. The purpose of surgical treatment is to restore the patellar articular surface and the disrupted knee extensor mechanism [3]. The treatment methods of patellar comminuted fracture include the following: circumferential cerclage wire fixation [2], modified tension band fixation [4, 5], nickel-titanium patella concentrator [6], cable-pin system [7], titanium cable cerclage [8], plate and screw fixation [9] and partial or total patellectomy [2, 10]. Partial or total patellectomy results in the destruction of the extensor mechanism and normal patellofemoral joint contact surface, which reduces knee joint function [1, 10, 11] This treatment can only be used as a remedy when the comminuted bone cannot be reduced. External fixation was often needed for 6–8 weeks or longer, and quadriceps femoris atrophy was formed Complications, such as contraction and stiffness of knee joint, contribute to poor long-term recovery of joint function. The purpose of this study is to evaluate the effectiveness and safety of a fixation technique for comminuted patellar fracture fixation using modified cerclage wiring
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