Abstract
ObjectiveThe 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.MethodsWe 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.ResultsA 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.ConclusionManaging 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.
Highlights
Patella is the largest sesamoid bone in the human body, the inferior pole of which connects to the patellar ligament
Managing the patellar inferior pole fracture with wire cerclage through a generated bone hole is both simple and effective
The inclusion criteria were as follows: X-ray or CT examination depicting unilateral patellar inferior pole fracture, patients aged 30–80 years old, patients who either received only patellar concentrator fixation or cerclage combined with patellar concentrator fixation, performed by the same surgeon, with minimum of 1-year follow-up, patients who provided signed informed consent forms and who cooperated with medical staff to complete relevant diagnosis and treatment protocols
Summary
Patella is the largest sesamoid bone in the human body, the inferior pole of which connects to the patellar ligament. The inferior patellar pole fracture is typically comminuted, with low bone mass, thereby making it is difficult to fix [2, 3]. The first method removes the comminuted inferior pole of the patella and reconstructs the insertion point of the patellar ligament via a suture anchor or drilling hole. This method often leads to bone defect, high tension within the patellar ligament, dislocation of the patella femoral joint, and so on [4]. Internal fixation loosening, internal fixation cutting, difficult fixation of the comminuted bone mass, symptomatic implants, and so on [10, 11]
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