Comminuted Patella Fractures Research Articles

The 'hashtag' K-wires configuration for the management of severe comminuted patellar fracture: the combination of tension band technique and cerclage wiring.

The 'hashtag' K-wires configuration for the management of severe comminuted patellar fracture: the combination of tension band technique and cerclage wiring.

The Greco-Nice-Lag: Lag Screw and Double Nice Knot Fixation for Spiral Proximal Phalanx Fractures-Connecting the Shoulder to the Finger.

A colorful array of fixation options exists for the management of operative long oblique or spiral proximal phalanx fractures. These include lag screws, intramedullary devices, Kirschner wires, dorsal or lateral plating, and cerclage wiring. The "Nice double-suture knot," described by Boileau and colleagues, is a sliding, self-stabilizing knot initially created for tuberosity fixation in the shoulder. Nice knot cerclage has been described in shoulder arthroplasty, as well as for comminuted patella fractures. Here we describe a technique utilizing a single lag screw with 2 Nice knot cerclage sutures for the treatment of a spiral proximal phalanx fracture in a 65-year-old active smoker with osteopenia.

Patella Fractures outcome after Tension Band Wiring; a Cross-sectional Study

Objective: The most common technique for fixing patella fractures is tension band wiring (TBW). The current study aimed to assess the functional and radiological outcomes of the patellar fractures treated by TBW. Patients and Methods: This retrospective cohort study was performed on 78 patients who underwent TBW of patellar fracture in Akhtar Orthopedic Hospital, Tehran, Iran, from September 2015 to April 2018 and had completed a two-year follow-up. A surgical intervention consisting of open reduction and internal fixation was performed on all patients using TBW. Patients were evaluated two years postoperatively by clinical examination, radiographic investigation, and three scales (Tegner activity score [TAS], Lysholm knee score [LKS], and lower extremity functional scale [LEFS]). Result: Of the 78 patients, 48 (61.5%) were male, with a mean age of 36.7 13.1 years. Postoperatively, 41 (52.6%) patients had anterior knee pain, and four (5%) patients had an infection. Knee range of motion was limited in 20 (25.6%) patients. The mean postoperative TAS, LKS, and LEFS mean scores were 4.3 1.34, 85.97 9.21, and 69.62 6.68, respectively. Age was inversely correlated with LKS and LEFS, as both scores decreased with increasing age (p 0.001, r:-0.4). Younger patients (under 30 years old) were more likely to reach their pre-injury TAS score than older patients (p 0.001). In addition, patellofemoral osteoarthritis and patella baja were significantly higher in patients with comminuted fractures than in those with simple fracture patterns (p 0.001). Conclusion: We found acceptable outcomes after fixation with TBW, especially in younger patients; LKS and LEFS scores were lower in the elderly, and younger patients were more likely to reach closer to their pre-injury TAS score. Furthermore, patellofemoral osteoarthritis and patella baja were associated with comminuted patella fractures.

Outcome Analysis of Fixed angle Locking Plate in Comminuted Patella Fractures : A Single Centre Prospective study from South India with Early Results.

Comminuted patella fractures pose a challenge to orthopaedic surgeons , since tension band wiring and cerclage is not effective and often lead to loosening of wires, hardware problem, dislocation of fracture and failure of osteosynthesis resulting in post-traumatic osteoarthritis and knee stiffness. The aim of this study is to evaluate the clinical outcome in patients with AO 34C2 and 34C3 highly comminuted patella fractures treated with unidirectional fixed angle titanium patella locking plate. Twelve patients who presented with AO 34C2 and 34C3 comminuted patella fractures, aged between 18-79 years were included in the study. All fractures were reduced and fixed with unidirectional angle fixed stable titanium patella locking plate. Knee range of motion and knee outcome survey activities of daily living scale (KOS-ADL) was used to evaluate the outcome. Union of fracture was achieved in all twelve patients. Mean flexion at final follow-up was 123° (110°-130°). None of the patients had extensor lag. One patient had hardware irritation which resolved at final followup. This technique serves as an effective option in highly comminuted patella fractures by providing excellent mechanical stability resulting in anatomical reduction , excellent functional outcome , lower incidence of hardware irritation or failure of osteosynthesis.

Articular Fragment Detachment and Separate Fixation for the Treatment of Comminuted Patellar Fractures with Coronal Split Articular Fragments: Articular Detachment Technique.

Treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments is a challenge. To treat this difficult fracture, we perform articular fragment detachment and separate fixation for coronal split articular and inferior pole fragments. We aimed to evaluate the radiological and clinical outcomes of our technique in comminuted patellar fractures at least 1 year after surgery. Between January 2019 and June 2022, 15 patients diagnosed with comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments based on preoperative computed tomography underwent surgery using the articular detachment technique. The key point of this technique was anatomical reduction and subchondral fixation of the coronal split articular fragment to the superior main fragment after complete detachment of the coronal split fragment from the inferior pole. The remaining inferior pole was fixed using a separate construct. Postoperative articular gap, articular step-off, and complications, including resorption, reduction loss, and avascular necrosis of fixed articular fragments, were evaluated as radiological outcomes. Range of motion and the Lysholm scores were used to evaluate clinical outcomes. Among the 15 patients, the coronal split articular fragments were fixed using Kirschner wires in 13 patients and headless screws in 2 patients. The inferior poles were fixed using separate vertical wiring in 13 patients and tension-band wiring in 2 patients. A postoperative articular gap was noted in 7 patients, with an average articular gap of 1.0 mm (range, 0.7-1.6 mm). No articular step-off was observed. Bone union and normal range of motion were achieved in all patients. On the 1-year postoperative lateral radiograph, resorption of the articular fracture site was seen in 5 patients. There was no loss of reduction or avascular necrosis of the coronal split articular fragments. The average postoperative Lysholm score at 1 year was 89.3 ± 4.1 (range, 82-95). The technique would be a reliable and safe option for the surgical treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments in terms of anatomical reduction and stable fixation of articular fragments without risk of avascular necrosis.

Clinical Outcomes of Triple Tension Band Wirings in Comminuted Patellar Fracture: A Comparison with Conventional Tension Band Wiring

Clinical Outcomes of Triple Tension Band Wirings in Comminuted Patellar Fracture: A Comparison with Conventional Tension Band Wiring

Astudy of fracture lines distribution characteristics in complete articular fractures of the patella.

The objective of this study was to unveil the characteristics of fracture lines distribution and explore its clinical significance of complete articular fractures of the patella. A consecutive series of image data from 88 patients with complete articular patella fractures were retrospectively included. Three-dimensional reconstruction images of the patella fractures were created and collected. Subsequently, these reconstructed images were visually overlaid onto a standard anterior and posterior patella template. The fracture lines were then identified, traced onto the template, and utilized to generate patella fracture maps. Furthermore, the incidence rate of patella fracture lines involving the distal pole was analyzed. The maps depict the fracture lines of complete articular patella fractures. For simple and complex patella fractures, the primary fracture lines primarily converge within the Middle and Lower regions, exhibiting a transverse pattern. Conversely, the primary fracture lines in comminuted patella fractures are randomly dispersed across the patella. Examining the maps, approximately 63.6% (56/88) of complete articular patella fractures exhibited involvement of the distal pole in the anterior view, while 48.9% (43/88) displayed distal pole fractures in the posterior view. The incidence of distal pole injury increased progressively with the severity of patella fractures. The patterns and distribution of fracture lines in cases of complete articular patella fractures are prominently illustrated on the constructed fracture maps. Familiarity with these common characteristics of complete articular patella fracture, especially with the distal pole injury, can aid surgeons in developing preoperative planning, executing surgical strategies effectively, and reducing inappropriate treatment.

Management of comminuted patellar fractures using suture reduction technique combined with the modified Kirschner-wire tension band

ObjectivesSurgical management of comminuted patella fractures remains a major challenge for the surgeon. We developed a suture reduction (SR) technique to better preserve the comminuted patella. The study aimed to compare the suture reduction technique with conventional reduction (CR) technique in the management of comminuted patellar fractures using the modified Kirschner-wire (K-wire) tension band.MethodsFrom May 2016 to September 2020, a total of 75 patients with comminuted patellar fracture were reviewed retrospectively. Among these cases, 35 patients were in the suture reduction group with a mean age of 52 years, while 40 patients were in the conventional reduction group with a mean age of 53 years. All cases were closed fractures. Comminuted patellar fractures were classified as type 34-C3 according to the AO/OTA classification. Radiographs of the knee were obtained at routine follow-up to evaluate the reduction quality and fracture union. Clinical outcomes including range of motion (ROM), visual analog scale (VAS), Lysholm, and Böstman grading scales were measured at the last follow-up. Postoperative complications were also recorded.ResultsThe average time from injury to surgery was 5.4 days in suture reduction group and 3.7 days in conventional reduction group (p < 0.05). The surgical time of suture reduction group was less than that of conventional reduction group, but there was no significant difference (p = 0.110) regarding surgical time between the two groups. The average blood loss in suture reduction group was 42.9 ml, while the average blood loss in conventional reduction group was 69.3 ml (p < 0.001). There was no difference regarding fracture union, ROM and knee function score (Lysholm score and Böstman scale) between the two groups. The complication rates were 17.1% in suture reduction group and 12.5% in conventional reduction group respectively (p > 0.05).ConclusionsIn the treatment of comminuted patellar fractures with modified K-wire tension band, the use of suture reduction technique can shorten the surgical time, reduce the surgical trauma, and obtain satisfactory results. This new surgical technique may be particularly effective in management of comminuted patellar fractures when patellectomy would otherwise be considered.

Management of severely comminuted fracture patella: a case report

Fracture patella is a breach in the extensor mechanism of the knee and needs to be fixed. Comminuted fractures of patella are a challenge given the difficulty in restoring the extensor mechanism. Introduction: Treatment options have evolved over the years from sacrifice to salvage i.e., from total or partial patellectomy to patellar preserving surgery. The challenge remains to fix the fragments optimally and also to have a tailor-made physiotherapy and rehabilitation program for the patient to provide a satisfactory functional outcome. A 14-year-old female presented to the casualty with a history of domestic fall, injuring her right knee. X-ray was done which revealed a comminuted fracture of right patella, classified as 34C3 OA/OTA classification. Salvage procedure for severely comminuted patella fracture has a successful functional outcome following a stable fixation of fragment.

Anterior hook plating of patella fractures: A biomechanical analysis and clinical series.

Compare anterior hook plating to established fixation constructs biomechanically and report outcomes and complications in a cohort of patella fractures treated with the technique. Lab based biomechanical study and clinical multicenter retrospective cohort study. Two US level one trauma centers.Patients/Participants: 51 patients (28M, 23F) with 30 simple transverse and 21 comminuted patella fractures. 36 cadaveric patellae for the biomechanical study. Biomechanical- Compared dorsal plating with cerclage wiring and modified tension band cable fixation in a comminuted patella fracture model in 36 cadaveric patellae. Constructs were tested in 0° and 45° of flexion. Clinical - We reviewed a consecutive series of patella fractures in two centers for outcome and complications. Biomechanical - construct stiffness. Clinical - reduction, union, complications, range of motion. Stiffness greatest in dorsal plating in both 0° and 45°. Dorsal plating (976 N, 1643 N) > modified tension band (317, 297) > cerclage (89.8, 150.3). 51 patients with patella fractures fixed with dorsal 2.7 mm mini-fragment plates including a distal to proximal lag screw through the plate from the nose of the patella. 9 Cases were small distal fragments not easily managed with screws and cables. All patients were followed to union. There were 2 infections (1 superficial, 1 deep with nonunion) and 5 had hardware removal (9.8%). Dorsal plating is biomechanically and clinically superior to modified tension band and cerclage techniques in comminuted patella fractures. This method allows for fixation of small distal pole fractures.

ANTERIOR VARIABLE-ANGLE LOCKED PLATING VERSUS TENSION BAND WIRING OF SIMPLE AND COMPLEX PATELLA FRACTURES: A BIOMECHANICAL STUDY

Treatment of simple and complex patella fractures represents a challenging clinical problem. Controversy exists regarding the most appropriate fixation method. Tension band wiring, aiming to convert the pulling forces on the anterior aspect of the patella into compression forces across the fracture site, is the standard of care, however, it is associated with high complication rates. Recently, anterior variable-angle locking plates have been developed for treatment of simple and comminuted patella fractures. The aim of this study was to investigate the biomechanical performance of the novel anterior variable-angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures.Sixteen pairs of human cadaveric knees were used to simulate either two-part transverse simple AO/OTA 34-C1 or five-part complex AO/OTA 34-C3 patella fractures by means of osteotomies, with each fracture model created in eight pairs. The complex fracture pattern was characterized with a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral and an inferior fragment mimicking comminution around the distal patellar pole. The specimens with simple fractures were pairwise assigned for fixation with either tension band wiring through two parallel cannulated screws, or an anterior variable-angle locking core plate. The knees with complex fractures were pairwise treated with either tension band wiring through two parallel cannulated screws plus circumferential cerclage wiring, or an anterior variable-angle locking three-hole plate. Each specimen was tested over 5000 cycles by pulling on the quadriceps tendon, simulating active knee extension and passive knee flexion within the range from 90° flexion to full knee extension. Interfragmentary movements were captured by motion tracking.For both fracture types, the articular displacements, measured between the proximal and distal fragments at the central aspect of the patella between 1000 and 5000 cycles, together with the relative rotations of these fragments around the mediolateral axis were all significantly smaller following the anterior variable-angle locked plating compared with the tension band wiring, p &lt; 0.01From a biomechanical perspective, anterior locked plating of both simple and complex patella fractures provides superior construct stability versus tension band wiring.

A Double Cerclage and Tension band Wiring Technique Fixation for Comminuted Patellar Fractures

Background: When the patella is fractured it should be repaired and patellectomy should be avoided as much as possible even in comminuted fractures. In comminuted patellar fractures, a combination of cerclage wiring and tension band fixation is confirmed to provide good mechanical stability. The objective of the present work was to find out the effectiveness of comminuted patellar fracture fixation with combined cerclage and tension band wiring technique. Method and patient: Forty- six patients underwent surgical stabilization for comminuted patellar fracture between year 1996 to 2016. All fractures were classified as 34-C3 according to the Orthopedic Trauma Association Classification. All the patients were underwent open reduction- internal fixation with combined Cerclage and tension band wiring technique. Result: Fracture healing was occurred within an average of 3- 5 months, while in bilateral cases it was 4 - 8 months. Full range of knee movements was seen in 42 (91.3 %) cases and knee flexion more than 120º was seen in 4 (8.7 %) cases. Quadriceps power was normal in 44 (95.6 %) cases, but 2 cases had quadriceps power of grade-IV. No extensor lag and no quadriceps atrophy were seen in any cases. Forty four (95.6 %) patients could squat fully and two (4.3 %) patients could squat up to half of the normal level. All patients were able to climb up and down stairs without any problem. Most patients have no subjective complaints like pain, difficulty in walking, difficulty in squatting and climbing. 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. There were no significant complications, such as infection, knee stiffness, and non-union or implant failure in any of the cases. The average follow-up period was 8 months (Ranged 6 – 18 months). Conclusions: This study had concluded that combined Cerclage and tension band wiring technique was a successful surgical treatment for comminuted fractures of the Patella.

Treatment of a comminuted patella fracture with a patella rim plate- a case report.

Patella fractures with comminution present a difficult challenge to the orthopedic surgeon. The use of a rim plate technique as a novel low profile method for the surgical management of comminuted patellar fractures provides the ability to minimize soft tissue irritation, hardware prominence, stable construct, and preservation of the patella in cases of comminution while achieving post operative goals of attainment of knee range of motion and ambulatory function.

Pin and Wire System Fixation for the Treatment of Comminuted Patella Fractures.

We describe the wiring technique and evaluate the radiographic and clinical outcomes of treatment with a pin and wire system (PWS) for comminuted patella fractures. From June 2013 to October 2018, 33 patients with comminuted patella fractures were treated using a PWS. Open reduction and internal fixation was performed with multiple pins and a wire. All patients were allowed full weight bearing without a brace. Radiographs were obtained to evaluate bone union, implant breakage, back-out of pins, and intra-articular gaps and step-off. Clinical outcomes and postoperative complications were assessed at final follow-up examination. All fractures were united. Thirteen cable wires in 13 patients were partially broken without displacement of fracture at an average of 7.4 months (range, 1-19 months) postoperatively. The average preoperative, postoperative, and final follow-up intra-articular gap and step-off were 11.7 mm, 0.5 mm, and 0.03 mm and 6.6 mm, 0.4 mm, and 0.2 mm, respectively. The average postoperative pin displacement was 0.1 mm (range, 0-0.8 mm). Deep infection was not observed after the surgery. The implant removal rate was 21% (7 of 33). Among these, the symptomatic implant removal rate was 9% (3 of 33). Additionally, 3 of 7 patients with implant removal had broken wires. The average flexion and extension of knee joints were 139.7° (range, 120°-150°) and -0.9° (range, -10° to 0°), respectively. A PWS prevents back-out of the pins and reduces intra-articular gaps and step-off distances to acceptable levels, even if the cable wire is partially broken. Therefore, a PWS is a good treatment option for comminuted patella fractures. [Orthopedics. 2023;46(5):291-296.].

A double-suture cerclage reduction technique with Nice knots for comminuted patella fractures (AO/OTA 34-C3)

BackgroundComminuted patella fractures place high demands on surgeons’ surgical skills. We used a double-suture cerclage reduction with Nice knots as an intra-operative reduction technique to displaced comminuted patella fractures.MethodsPatients were divided into two groups by whether or not an intra-operative suture cerclage reduction technique was used. Fragments count, surgical time, quality of the reduction, and fracture healing time were recorded. The postoperative function was assessed by Böstman score and range of motion.ResultsWith the inclusion and exclusion criteria, 48 patients we included in the cohort between Sept. 2016 and Oct. 2021. The double-suture cerclage reduction technique with a Nice knot achieved a satisfactory reduction. When the number of fragments was over 5, this technique showed significant advantages in saving surgery time.ConclusionsIn this study, the double-suture cerclage reduction technique combined with the Nice knot shows significant advantages for displaced highly comminuted patella fractures. This technique simplifies the operation and saves surgical time, which is helpful for clinical practice.

A Novel Technique in Comminuted Patella Fractures: Minimally Invasive Pericerclage Osteosynthesis Using Drainage Trocar

A Novel Technique in Comminuted Patella Fractures: Minimally Invasive Pericerclage Osteosynthesis Using Drainage Trocar

To study the treatment of comminuted patellar fractures using modified cerclage wiring

Aim: To study the treatment of comminuted patellar fractures using modified cerclage wiring. Methods: This study was done in the department of Orthopedics, after taking the permission from the ethical committee. 50 cases of simple unilateral closed comminuted patellar fracture were treated by modified cerclage wiring. During follow-up, the Böstman clinical grading measures were used to evaluate the effects of the surgery in eight areas: range of mobility, discomfort, work, atrophy, assistance in working, effusion, giving way, and stair-climbing. 28–30 points were outstanding, 20–27 points were decent, and fewer than 20 points were low on these measures. Results: Using Böstman's clinical grading systems, the ultimate follow-up average score was 29.2 (range 19–30). The average score of 41 (82%) exceptional patients was 29.2±0.6, while the average score of 9 (18%) good patients was 25.11±1.9. Patients' knee flexion activity range was 130° (range 110–140), and the prognosis was favourable. Conclusion: A unique and successful strategy for treating a comminuted patellar fracture is modified cerclage wiring. This approach can give a firm and secure fixation, allow patients to do early functional exercises, and has a positive therapeutic impact.

3D reduction combined with the modified Kirschner-wire tension band for the treatment of comminuted patella fracture.

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. 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. All patients had bony union at a mean of 11.4 ± 1.4 (range 9-14weeks) 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 2mm 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. 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. IV.

Outcome of Patients with Comminuted Fractures of Patella Treated with Claw Shape Plate, a case Series at a Tertiary Care Hospital

Introduction: Comminuted fractures of patella are usually dealt with partial or complete patellectomy which compromise the extensor mechanism. Claw plate is newly introduced device to fix comminuted fractures, which provide easy and efficacious method of preserving patella and is used in selected cases. Methods: This prospective observational case series was conducted at orthopaedic department Chandka Medical College (SMBBMU) Larkana from March 2020 to May 2021. Twenty one cases were selected via consecutive sampling with comminuted fracture of patella who were treated with newly introduced claw shape patellar plate. Age of patients was ranging from 18 years to 70 years. All patients were admitted in tertiary care hospital and were operated by senior surgeon. During procedure patella was approached through anterior mid line incision over knee, fracture reduced and fixed with claw shape patella plate. Post operatively patients were assessed on subsequent follow up visits and outcome of procedure was observed on the basis of functional (Clinical) and radiological results. The functional (clinical) outcome was measured on basis of Lysholm knee score and radiologically x-rays of knee were done to see union pattern. Final outcome of procedure was concluded after 6 month of operation. Results of all patients were compiled and analysed by using statistical package for Social Sciences (SPSS) Version 21 Results: Twenty one patients were enrolled in our study, among them 15(71.4%) were male and six (28.6) were female; the mean age of patients was 42.52 years. The mean length of operation was 55 minutes (40 to 72 minutes). Bone union on radiograph was observed at 20th weeks after surgery in all patients, mean age of fracture healing was 11.5 weeks, (Ranges from 6th to 20th week). At final evaluation found excellent results in 12 (71%) patients, five (29%) patients obtain good results, while four patients lost follow up. Conclusions: Partial or complete patellectomy can be avoided in comminuted patella fractures and patella can be preserved in these fractures by using claw shape patella plate. Keywords: Comminuted fractures, Patella, Claw plate.

A Case Report of Comminuted Patella Fracture with Open Reduction

Introduction: Patellar injuries are usually caused while a person slips or falls on a flexed knee and when the forces from the extensors surpass the inherent strength of patella. As the bony failure advances, it concurs or follows injury to medial and lateral extensions of quadriceps mechanism. This happens by pulling mechanism of the muscles. The patient is unable to extend the affected knee actively. This is indicative of disruption of the extensor mechanism and a torn retinaculum. This requires repair or reconstruction through operative means.&#x0D; Case Presentation: To find out complications of comminuted fracture of patella and open reduction after 15 years of surgery. Case Report: A 32-year-old man had a history of fall on ground due to slipping of the wheelchair over wet floor while taking a patient on wheelchair which led to comminuted fracture of left patella with shift knee and had undergone Open reduction and Tension band Osteosynthesis. After this surgical intervention, the patient presented with knee stiffness and pain (rated 6 on numerical pain rating scale) and was referred to physiotherapy.&#x0D; Conclusion: This case study concluded that there is evident stiffness and muscle wasting observed after 15 years of post-fracture surgery of patella, which was managed with the physiotherapeutic rehabilitations.