Fixation Of Patellar Fractures Research Articles

Migration of a broken kirschner wire to the popliteal fossa following tension band wiring of a patellar fracture

Kirschner wires (K-wires) are commonly used in the orthopedic trauma practice and liable to breakage and migration. We report the case of a middle-aged man with the migration of K-wire to the popliteal fossa after 11 years of patella fracture fixation and describe the technique of removal of the migrated and retained K-wires. A regular radiographic follow-up should be done to identify the presence of hardware breakage or migration following the use of K-wires. Once the wire migration is identified, it should be removed on an urgent basis regardless of symptoms, to avoid any major or minor complications.

A precise navigation device for fixation of patella fractures with modified K-wire tension band:a comparative retrospective study

BackgroundTraditionally, the technique of modified tension band wires (MTBW) has been the most commonly used surgical procedure. The purpose of this study is to design a precise navigation device that can obtain a standard position of K-wires for (MTBW) and to compare the precise MTBW (P-MTBW) by a navigation device with the conventional MTBW (C-MTBW) by hands in a retrospective study.MethodsThe device was designed by solidworks2012 software (USA), which could provide a precise guidance for obtaining parallel K-wires. Besides, it could set the distance between two K-wires and the level of K-wires below patellar anterior surface. From June 2014 to August 2018, a total of 112 patients were employed in this retrospective study. The patients were divided into P-MTBW group and C-MTBW group according to the surgical technique with or without the precise navigation device. We needed to record and analyze the operation time and the number of fluoroscopy, postoperative internal fixation imaging, knee function and complications.ResultsThere were 54 patients in P-MTBW group and 58 patients in C-MTBW group. There were statistically significant differences (P < 0.001) in the operation time between P-MTBW group (39.5 ± 4.7; range, 32–49 min) and C-MTBW group (53.7 ± 6.8; range, 42–71 min). The number of intraoperative fluoroscopy was significantly less (P < 0.001) in P-MTBW group (4.2 ± 1.4) versus that of C-MTBW group (8.3 ± 2.7). According to Iowa knee score, there was no significant difference (P = 0.268 at 1 year) in function between the two groups. According to our own evaluation criteria for MTBW, anyone in the P-MTBW group was excellent and 26 patients were excellent, 20 patients were good, and 2 patients were fair in the C-MTBW group.ConclusionThe navigation device can reduce operation time and intraoperative fluoroscopy frequency. P-MTBW fixation is an accurate and effective surgical procedure for patella fractures.

Patella Fractures: Approach to Treatment.

Patellar fracture morphology varies based on the mechanism of injury. Most fractures are either a result of direct impact or through an indirect eccentric extensor contraction injury. Each fracture pattern requires appropriate preoperative planning and individualization of the fixation method. Displaced fractures affect the extension apparatus, and often require surgical fixation. Surgical treatment is recommended in fractures with any of the following features: articular step-off > 2 mm, > 3 mm of fracture displacement, open fractures, and displaced fractures affecting the extensor mechanism. Meticulous handling of the soft-tissue envelope is of the utmost importance, given the patella's tenuous blood supply and limited soft-tissue envelope. Incongruent articular surface can result in detrimental long-term effects; therefore, surgical treatment is directed toward anatomic reduction and fixation. The evolution of patellar fracture fixation continues to maximize options to balance rigid fixation with low-profile fixation constructs. Improving functional outcomes, minimizing soft-tissue irritation, and limiting postoperative complications are possible by using the therapeutic principles of rigid anatomical fixation and meticulous soft-tissue handling.

The Impact of Intraarticular Injection of Ropivacaine into Knee Joint on the Postoperative Analgesia and Local Inflammatory Response after Patellar Fracture Fixation

To explore the impact of intraarticular injection of ropivacaine into knee joint on the postoperative analgesia and local inflammatory response after patellar fracture fixation is the main objective. The subjects of this study are 136 patients with patellar fracture who received selective open reduction Kirschner wire tension band fixation of patellar fracture in our hospital from March 2018 to November 2020 were divided into two groups on the basis of random number table, each with 68 cases. After operation, both groups were given patient controlled intravenous analgesia for 48 h and the observation group was also administrated with intraarticular injection of ropivacaine into knee joint, while the control group with the same dosage of normal saline. Both groups were assessed with visual analogue scale at different time points and in both resting and active states after operation. The two groups were compared in the aspects of analgesic pump dosage and active knee flexion, 48 h after operation. The interleukin 6 and tumor necrosis factor alpha levels were tested using enzyme linked immunosorbent assay by drawing 2 ml of arthrohydrops, 48 h after operation. And statistical analysis was conducted on adverse reactions of the two groups. The observation group had much lower visual analogue scale scores at resting state 6 h, 12 h, 24 h and 48 h after operation (p<0.05) and remarkably lower visual analogue scale scores at active state 1 d, 2 d, 3 d and 4 d after operation (p<0.05), than the control group did at identical time points. 48 h after operation, the observation group used much less analgesic pump (p<0.05) and obtained more active knee flexion than the control group did (p<0.05). The concentration of interleukin 6 and tumor necrosis factor alpha of the observation group in arthrohydrops 48 h after operation was much lower than that of the control group over the same period (p<0.05). The observation group saw obviously lower incidence of nausea, vomiting and urinary retention as well than the control group did (p<0.05). The application of intraarticular injection of ropivacaine into knee joint can effectively relieve the pain patients suffer after patellar fracture fixation and alleviate local inflammatory response without significant adverse reactions.

Early Outcomes After Surgical Management of Geriatric Patella Fractures.

Objectives:To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture.Design:Retrospective database review.Setting:The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States.Patients/Participants:NSQIP patients over 65 years of age with patella fractures.Intervention:Surgical fixation of patella fracture including extensor mechanism repair.Main Outcome Measurements:Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications.Results:1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V.Conclusions:Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes.Level of Evidence:Prognostic level III.

Patella fracture fixation with a non-locked anterior plating technique: A biomechanical study.

The purpose of this study was to compare the biomechanical attributes of patella fracture fixation with either anterior plating utilizing two parallel, longitudinal 2.0 mm plates technique versus a cannulated screw tension band technique. Five matched pairs (ten specimens) of fresh frozen cadavers were utilized. A transverse patella fracture (OTA 34C1.1) was fixed using either two 4.0 mm cannulated screw anterior tension band (CATB) or with two 2.0 mm stainless steel non-locking plates along the anterior cortex secured with 2.4 mm cortical screws traversing the fracture site. Specimens underwent 1000 cycles of simulated active knee range of motion before load to failure destructive testing. During cyclic loading there were no failures in the plate fixation group, and 2 out of 5 specimens catastrophically failed in the CATB group (p=0.22). Average fracture displacement at the end of fatigue testing was 0.96 mm in the plate fixation group and 2.72 mm in the CATB group (p=0.18). The specimens that withstood cyclic testing underwent a destructive load. Mean load to failure for the plate fixation specimens was 1286 N, which was not significantly different from the CATB group mean of 1175 N (p=0.48). The mechanism of failure in the plate fixation cohort was uniformly via a secondary vertical patella fracture around the plates in all five specimens. In the CATB group, the mechanism of failure was via wire elongation and backing out of the screws. Patella fixation with anterior plating technique statistically performed equivalent to cannulated screw anterior tension band in ultimate load to failure strength and fatigue endurance under cyclical loading. No failures were observed cyclic simulated active range of motion in the anterior plate group. There was a trend towards improved fatigue endurance in the plate fixation group, however this did not reach statistical significance. We believe plate fixation technique represents a low-profile implant option for treatment of transverse patella fractures, which may allow for early active range of motion, and these data support biomechanical equivalency to standard of care.

Clinical outcomes of Ti-Ni shape-memory patella concentrator combined with cannulated compression screws in the treatment of C2 and C3 patella fracture: a retrospective study of 54 cases

BackgroundTi-Ni shape-memory patella concentrator (TNSMPC) has been designed as an alternative approach for fixation of patella fracture, which has some advantages like higher hardness, higher tenacity, better wearing resistance, excellent corrosion resistance and desired histocompatibility. The present study was to investigate the efficiency of TNSMPC combined with cannulated compression screws in the treatment of comminuted patella fractures.MethodsBetween January 2014 and December 2017, 54 patients of C2 and C3 patella fractures underwent open reduction and internal fixation with TNSMPC combined with cannulated compression screws. All the patients got standard postoperative rehabilitation programs and were regularly followed up for at least 12 months after the operation. X-rays, knee functions and life quality were evaluated during the follow-up.ResultsAll the patients achieved bone healing and recovery of knee function with low incidence of complications according to outcomes of X-rays and questionnaires. The average operation time and blood loss during surgery were 77.5 ± 25.12 min and 24.25 ± 4.70 ml respectively. The Knee Outcome Survey Activities of Daily Living Scale, the range of motion and the 36-item short-form heath survey after the operation were all improved. According to the Bostman’s criteria, the excellent to good rate was 92.6%.ConclusionTNSMPC combined with cannulated compression screws is an effective internal fixation method for C2 and C3 patella fracture with excellent clinical outcomes. In addition, the operation does not increase extra technique difficulty or tissue damage relatively, which is worth promotion.

A comparison of EFECE systems with tension band wiring for patella fracture fixation in cadavers

BackgroundEFECE systems are newly defined internal fixation systems, which are suitable for patella fracture fixation. The aim of this study was to compare the fixation strength of EFECE Systems with tension band wiring for transverse patellar fracture simulation on fresh frozen cadaver models.MethodsQuadriceps tendon-patella-patellar tendon (QT-P-PT) complex was prepared from human cadavers. After simulation of a transverse patella fracture, in group 1, 5 patella were fixed with a pair of 1.2 mm EFECE wires and 4 EFECE devices. In group 2, 5 patella were fixed with a pair of 1.2 mm Kirschner wires (K-wire) and a cerclage wire according to the tension band technique.Using a testing device with custom-made jaws, increasing distraction force was applied to these QT-P-PT complexes. Extension of these complexes with the distraction forces was observed. The maximum distraction force and the elongation during maximum force were evaluated.ResultsAfter 5 experiments with the EFECE systems, there was no EFECE wire breakage or EFECE wire-EFECE device catching failure. The median maximum force was 740 N (720-810 N). During maximum distraction force the median extension was 2.5 mm (1.6-2.5 mm). After 5 experiments with the tension band technique, there was no K-wire breakage. The median maximum force was 330 N (240-510 N). During this maximum distraction force the median extension was 3.4 mm (2.2-3.8 mm).ConclusionsBased on the biomechanical advantages, patella fracture treatment with EFECE systems may constitute a reasonable alternative in the treatment of patella fractures.

Early clinical outcome for transverse patellar fracture treated by tension band with 2 k-wires or 2 cannulated screws

Objectives: The goals of surgical treatment are to reestablish continuity of the extensor mechanism and to restore a smooth articular surface using stable internal fixation to permit early knee motion.&#x0D; Methods: a comparative prospective study was done in Baghdad during the period from January 2016 till November 2019, we evaluated 50 patients with closed displaced (more than 3 mm) transverse patellar fracture, but only 44 patients complete the follow up divided into two groups (group 1) 22 patients was operatively treated by k-wires with tension band and (group 2) 22 patients was operatively treated by 2 cannulated screws with tension band. Both groups were evaluated for first 6 months after operation We evaluated the patients radiological, clinically and functionally every 2 months period by using the modified hospital for special surgery (HSS) knee score based on 4 standards clinical outcomes in which pain assessed by visual analog scale (vas), range of motion by goniometry, displacement on x ray, and quadriceps strength.&#x0D; Results: in group1 male were (16 patients) 72% and female were (6 patients) 28%.in group2 male were(14patients) 64% and female were (8patients) 36% with a mean age of 32 year (20-55)year in group1 and 34year(26-57)year in group 2.The VAS scores showed that the group2 had lower pain scores and better&#x0D; range of motion (ROM) compared to group1. quadriceps strenghth more than 75% in group 2 and no fracture displacement as compared with group 1excellent and good results were (63%) in group1and (81%) in group 2.Poor and fair results were (36%) in group1 and (18%) in group2.&#x0D; Conclusion: fixation of patellar fracture(closed, transverse, in adult) by 2 cannulated screws and tension band is superior to tension band with 2 k-wires with less complications.

Treatment of Periprosthetic Patella Fractures Using a Lag Screw and Neutralization Plate Construct: A Novel Surgical Technique

There currently is no optimal technique for open reduction internal fixation of peri-prosthetic patella fractures which is likely due to the infrequent nature of these injuries. In this report, we present a novel fixation method for transverse peri-prosthetic patella fractures that was utilized in 3 knees with resurfaced patellas in 2 patients and has yielded good clinical results.

Patella Fracture Fixation Via Wide Awake Local Anesthesia No Tourniquet (Walant) Technique

Introduction:Fractures of the patella constitute an estimated 1% of all acute orthopaedic fractures. The fracture fixation is usually performed under general or spinal anesthesia with tourniquet use. We describe a novel approach of anaesthesia for patella fracture fixation using the WALANT technique.Methods:We presented a case of 22 years old male with right knee pain following a road traffic accident. Examination revealed tenderness on his right knee with extensor mechanism failure, and radiograph showed comminuted 3 parts patella fracture, requiring fixation. Adequate information regarding WALANT was given and he agreed.Results:Open reduction and internal fixation were done using tension band wiring (TBW) technique and screw fixation. WALANT mixture was given 30 minutes prior to skin incision. Visual analog score (VAS) was 0 throughout the surgery. He was able to do active range of movement (ROM) of the knee intraoperatively after the fixation.Discussion:The solution used was mixture of 50ml lignocaine 2% (for local anesthesia), 1ml of adrenaline 0.18% (for hemostasis), 10ml of sodium bicarbonate 8.4% (to buffer the solution) and diluted with 50ml normal saline for tumescent anesthesia effect. Safe dosage of lignocaine with adrenaline is 7mg/kg. 10ml of mixture injected subcutaneously over mid-axial longitudinal incision site and 30 ml of mixture injected at patella borders and fracture site subperiosteally. We waited 30 minutes to allow adrenaline to reach maximal vasoconstriction and provide dry operative field. Without usage of tourniquet, we avoid complications such as hematoma and post operation swelling. WALANT also permits active motion of knee intraoperatively, which is particularly helpful in post TBW patella patient.Figure 1 :Intraoperative viewFigure 2 :Intraoperative viewFigure 3 :Xrays post fixationFigure 4 :Xrays post fixationConclusion:WALANT is a safe option for patients undergoing patella fracture fixation. It gave a painless surgical experience to the patient and offer another option for high risk patients for general / spinal anaesthesia.

Novel techniques demonstrate superior fixation of simple transverse patella fractures - A biomechanical study

IntroductionTraditional tension band wiring (TBW) remains the gold standard treatment for simple transverse patella fractures. Challenges include appropriately siting and bending Kirschner wires without damaging surrounding soft tissues. Damage to soft tissues and malposition of metalwork can lead to complications. We propose three novel techniques for fixation of simple transverse patella fractures to ease application without additional resources to traditional TBW. We tested their biomechanical integrity against traditional TBW. MethodFour configurations were tested; two with longitudinal Kirschner Wires (LKW) and two with cross Kirschner Wires (CKW) fixed with either standard figure-of-eight (AO) or side TBW (STBW). An initial proof of concept human cadaveric study was conducted to ensure real world application of the constructs was feasible. The fracture fixations were tested in a biomechanical study using porcine knees. The knees were cyclically loaded in a specially designed test rig through flexion from 90 to 45 degrees. Fracture gap displacement was measured and data blindly analyzed for all tests reaching 100 cycles. Results17/22 specimens reached 100 cycles with peak loading ranging from 75 to 80 N. CKW with STBW performed best with average fracture displacement of 0.43 mm. LKW with STBW performed worst with average fracture displacement of 1.93 mm. The incremental displacement/cycle for both CKW configurations was 0.27 mm compared to 0.41 & 0.60 mm for both LKW constructs showing that the CKW configuration conferred greater fixation stiffness under cyclic loading. DiscussionPrevious studies have compared alternative methods of patella fracture fixation to TBW through biomechanical superiority often requiring new resources. The methods tested here utilize the same resources as those for standard AO TBW. Reorientating the plane of the wires and position of the cerclage TBW may reduce iatrogenic soft tissue injury; reduce operating time and the risk of complications. ConclusionThis study shows biomechanical superiority for CKW with either AO or STBW compared to LKW.

Patellar Fixation Following Fracture: A Retrospective Review of Outcomes Following Varying Surgical Interventions

Purpose: Patella fractures are a common injury in trauma patients and can be treated with a multitude of different fixation methods. With so many fixation techniques available, no current consensus exists on best practices for patients presenting with this injury. The purpose of this analysis is to review the multiple different patella fixation strategies and to evaluate the outcomes and complications associated with each. Methods: One hundred and fifteen patients who underwent patellar fracture fixation at an urban Level I-Trauma center were retrospectively reviewed. Operative treatment included open reduction and internal fixation with plate and screw devices, tension band wiring (TBW), cannulated screw tension band wiring (CS-TBW), isolated interfragmentary screw fixation, or partial patellectomy with soft tissue repair and tendon advancement. Patient demographics, fracture and injury characteristics, operative variables, radiographic information, and post-operative outcome measurements were recorded for each patient assessed in the study. Results: Results demonstrated that plating techniques had the highest overall rate of union. Furthermore, a significant decrease in implant removal with utilization of isolated suture/wire was appreciated compared to other fixation groups (p < 0.01). Conclusion: We conclude that plate utilization achieves high radiographic union compared with other fixation methods.

Management of comminuted patellar fracture fixation using modified cerclage wiring

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.

Patella fractures treated with cannulated lag screws and fiberwire® have a high union rate and low rate of implant removal

ObjectivesThe purpose of this study is to report the results of open reduction internal fixation of patella fractures (OTA 34 A-C) using cannulated lag screws and FiberWire® (Arthrex, Naples, FL, USA) with regard to union and symptomatic implant removal. DesignRetrospective review of prospectively collected database. SettingUrban Level 1 trauma center and Level 2 trauma center MethodsAll displaced intra-articular patella fractures (OTA 34 A-C) treated with ORIF by cannulated lag screws and FiberWire® tension band/cerclage between January 1, 2009 and August 1, 2018. Three hundred and eighty seven consecutive patients were identified. Fifty fractures were included in the final analysis. Main Outcome MeasurementAll patients were followed to clinical and radiographic union. Nonunion was defined as lack of clinical and radiographic union, fracture displacement, and/or return to OR for revision surgery. Rate of symptomatic implant removal was recorded. ResultsAverage age was 57.7 years (range 21–86). Average follow up was 20.6 months (range 6–98 months). Average time to clinical and radiographic union was 3.1 months (range 3–7 months). Four fractures were open. There was a 96% (48/50) rate of primary union, with one patients requiring revision surgery to achieve union, and one developing an asymptomatic radiographic nonunion. The rate of symptomatic implant removal was 8% (4/50). Only 1 of the 4 was operated for a prominent suture knot, and the remaining 3 were for prominent screw removal. Knee range of motion averaged 0.37° extension to 119° flexion (range, 0–150°). ConclusionPatella fractures can be treated with cannulated lag screws and FiberWire® with a high rate of primary union (96%) and a low rate of symptomatic implant removal (8%). The implant removal rate compares favorably with alternative constructs, with an equivalent rate of fracture union.

Cannulated Screw Prominence in Tension Band Wiring of Patella Fractures Increases Fracture Gapping: A Cadaver Study.

Transverse patella fractures are often treated with cannulated screws and a figure-of-eight anterior tension band. A common teaching regarding this construct is to recess the screws so that their distal ends do not protrude beyond the patella because doing so may improve biomechanical performance. However, there is a lack of biomechanical or clinical data to support this recommendation. In the treatment of transverse patella fractures, is there a difference between prominent and recessed cannulated screw constructs, supplemented by tension banding, in terms of gap formation from cyclic loading and ultimate load to failure? Ten pairs of fresh-frozen cadaver legs (mean donor age, 72 years; range, 64-89 years) were randomized in a pairwise fashion to prominent or standard-length screws. In the prominent screw group, screw length was 15% longer than the measured trajectory, resulting in 4 to 6 mm of additional length. Each patella was transversely osteotomized at its midportion and fixed with screws and an anterior tension band. Gap formation was measured over 40 loaded flexion-extension cycles (90° to 5°). Ultimate load to failure was assessed with a final monotonic test after cyclic loading. Areal bone mineral density (BMD) of each patella was measured with dual energy x-ray absorptiometry (DEXA). There was no difference in BMD between the recessed (1.06 ± 0.262 g/cm) and prominent (1.03 ± 0.197 g/cm) screw groups (p = 0.846). Difference in gap formation was assessed with a Wilcoxon Rank Sum Test. Ultimate load to failure and BMD were assessed with a paired t-test. Patella fractures fixed with prominent cannulated screws demonstrated larger gap formation during cyclic loading. Median gap size at the end of cyclic loading was 0.13 mm (range, 0.00-2.92 mm) for the recessed screw group and 0.77 mm (range, 0.00-7.50 mm) for the prominent screw group (p = 0.039; 95% confidence interval [CI] difference of geometric means, 0.05-2.12 mm). There was no difference in ultimate failure load between the recessed screw (891 ± 258 N) and prominent screw (928 ± 268 N) groups (p = 0.751; 95% CI difference of means, -226 to 301 N). Ultimate failure load was correlated with areal BMD (r = 0.468; p = 0.046). In this cadaver study, when using cannulated screws and a figure-of-eight tension band to fix transverse patella fractures, prominent screws reduced the construct's ability to resist gap formation during cyclic loading testing. This biomechanical cadaver study found that the use of prominent cannulated screws for the fixation of transverse patella fractures increases the likelihood of interfragmentary gap formation, which may potentially increase the risk of fracture nonunion and implant failure. These findings suggest that proximally and distally recessed screws may increase construct stability, which may increase the potential for bony healing. The findings support further laboratory and clinical investigations comparing recessed screws supplemented by anterior tension banding with other repair methods that are in common use, such as transosseous suture repair.

Miniplate Augmented Tension-Band Wiring for Comminuted Patella Fractures.

The aim of this study was to introduce various applications of miniplate augmented tension-band wiring (TBW) for comminuted patella fractures and to evaluate the clinical outcomes. Comminuted articular patella fractures were managed with anterior cortical miniplate fixation with a TBW technique from January 2014 to January 2016. The primary end point was radiographic union. Secondary end points were complications related to the procedure. Functional outcomes including range of motion were also evaluated. Thirty patients were followed up for a mean of 20 months (range, 12-28) postoperatively. The primary union rate was 96% (29 of 30 patients). Mean time to union was 3.2 months. One patient required additional surgery because of acute postoperative infection. Twenty-five patients recovered a full range of motion relative to the contralateral limb. The mean Bostman score at the last follow-up was 28.6 points (range, 26-30). In conclusion, miniplate augmented TBW is a versatile and useful technique for comminuted patella fracture fixation.

Contourable craniofacial mesh plate osteosynthesis of patellar fractures: A new, low-profile fixation technique

PurposePatellar fractures are challenging orthopaedic injuries that can be difficult to treat due to the complexity of fracture patterns, the high stresses at the patellofemoral joint, and subcutaneous location of the patella. Hardware prominence and need for hardware removal are two of the most common complications after surgical fixation of patellar fractures. There is an ever present need for low profile fixation constructs that are also biomechanically stable. Materials and methodsWe present an alternative technique of patella fixation with a low profile titanium mesh plate typically used in craniofacial skeletal trauma. Four patients at our institution underwent mesh plate fixation of patella fractures. ResultsAll four patients had union without any post-operative complications. All four patients regained preoperative range of motion without residual pain or disability. ConclusionsMesh plate fixation of patellar fractures is an alternative to standard tension band technique, especially in comminuted fractures. The craniofacial mesh plate is very low profile, provides stable fixation that allows for early range of motion, and has the potential to reduce post-operative complications like hardware removal.

Analysis of the risk factors for implant failure after open reduction and internal fixation of patella fractures

Analysis of the risk factors for implant failure after open reduction and internal fixation of patella fractures

Comparing 3 Different Techniques of Patella Fracture Fixation and Their Complications.

Introduction:Patella fractures managed by fixation with metal implants often cause local soft tissue irritation and necessitate implant removal. An alternative is to utilize suture-based fixation methods. We have adopted suture and hybrid fixation in the routine management of patella fractures. Here, we compare the results of 3 fixation techniques.Materials and Methods:Eighty-seven eligible patients underwent patella fracture fixation over a 3-year period. As determined by fracture configuration, patients received (1) suture fixation (transosseous sutures and figure-of-eight tension banding with FiberWire), (2) hybrid fixation (transosseous FiberWire sutures and metal tension banding), or (3) metal fixation. Primary outcome measures included reoperation rate and soft tissue irritation. Secondary outcomes included surgical complications, radiological, and functional parameters.Results:Reoperation rate was highest for metal fixation (25/57, 43.9%) and lowest for suture fixation (2/13, 15.4%). Soft tissue irritation necessitating implant removal was the predominant reason for reoperation and was significantly less prevalent following suture fixation (1/13, 7.7%, P < .01). Hybrid fixation resulted in similar rates of soft tissue irritation (6/17, 35.3%) and implant removal (7/17, 41.2%) as compared to metal fixation. There was a significant increase in patella baja (13/17, 76.5%) and reduction in Insall-Salvati ratio (0.742; 95% confidence interval: 0.682-0.802) following hybrid fixation as compared to the other 2 fixation methods (P < .05).Discussion:Suture fixation results in the least amount of soft tissue irritation and lowest reoperation rate, but these advantages are negated with the addition of a metal tension band wire. Hybrid fixation also unbalances the extensor mechanism.Conclusion:Patients should be counseled as to the expected sequelae of their fixation method. Suture fixation is the favored means to fix distal pole fractures of the patella. An additional metal tension band loop may confer additional stability but should be applied with caution.