Fractures Of Inferior Pole Research Articles

Study on the therapeutic effect of Kirschner wire tension band combined with anchor cross-stitch technique in the treatment of comminuted patellar inferopolar fractures.

Fractures of the inferior patellar pole, unlike other patellar fractures, present challenges for traditional surgical fixation methods. This article introduces the clinical technique and outcomes of using Kirschner wire tension band combined with anchor screw cross-stitch fixation for comminuted inferior patellar pole fractures. This retrospective case series study included 14 patients with comminuted inferior patellar pole fractures treated at our institution from September 1, 2020, to April 30, 2022. All patients underwent surgery using the Kirschner wire tension band with anchor screw cross-stitch technique. Follow-up assessments involved postoperative X-rays to evaluate fracture healing, as well as clinical parameters such as healing time, Visual Analog Scale (VAS) scores, range of motion (ROM), and Bostman scores. All patients were followed for an average of over 12 months, with no cases of internal fixation failure. Knee joint stability and function were excellent. X-rays revealed an average healing time of approximately 10.79 ± 1.53 weeks, hospitalization lasted 5.64 ± 1.15 days, surgery took approximately 37.86 ± 5.32 minutes, and intraoperative blood loss was 33.29 ± 8.15 ml. One patient experienced irritation from the internal fixation material. At the final follow-up, the Bostman score averaged 28.29 ± 0.83, knee joint flexion reached 131.07° ± 4.88°, all patients achieved full knee extension, and the VAS score was 0.36 ± 0.63. Kirschner wire tension band with anchor screw cross-stitch fixation for comminuted inferior patellar pole fractures delivered satisfactory clinical outcomes. This surgical method, characterized by its simplicity and reliability, is a valuable addition to clinical practice.

Fracture of the patella involving inferior pole is associated with postoperative patella baja - A retrospective multicenter study

BackgroundThe patella fracture involving of inferior pole fractures (IPF) may be associated with patella baja, However, the clinical impact of this condition remains unclear. This study aims to clarify 1) the incidence of patella baja following patellar fracture surgery, 2) the associated clinical outcomes with and without the presence of patella baja, and 3) the potential correlation between the detection of IPF on CT and the occurrence of patella baja. MethodsWe conducted a retrospective multicenter study involving 251 patients who underwent surgical treatment for patellar fractures. Patients were divided into the patella baja (PB; n = 49) group and patella norma (PN; n = 202) group. Data collected included demographics, radiographic findings, surgical details, and postoperative complications. We compared these items between PB group and PN group. Logistic regression analyses were used to identify risk factors for patella baja. ResultsImmediately following surgery, 36 (14.3%) patients presented with patella baja which increased to 49 cases (19.5%) at six months postoperatively. There is no statistically significant difference in the demographics, surgical details, clinical outcomes and complication between PB group and PN group. While, in the radiographical assessment, the prevalence of IPF on CT scan in the patella baja group was significantly higher than that in the patella norma group. By logistic regression analysis, IPFP on CT was identified as an independent risk factor for patella baja. (odds ratio 2.11, 95% confidence interval: 1.03–4.33, p = 0.042). ConclusionIn patients with patellar fractures, the incidence of patella baja increased from 14.3% immediately post-surgery to 19.5% at the six-month check-up. No significant differences were observed in clinical outcomes between the patella baja group and the norma group. The patella fracture involving IPF on CT emerged as a predictive factor for patella baja.

Comparison of Fixation Methods Between Transosseous Pull-Out Suture and Separate Vertical Wiring for Inferior Pole Fracture of Patella: A Systematic Review and Meta-Analysis.

To compare, in a systematic review, Krakow transosseous (KT) suturing and separate vertical wiring (VW) fixation methods in inferior pole fractures of the patella and to evaluate whether the supplementary fixation affected bone union. The MEDLINE, Embase, and Cochrane databases were searched from inception to January 15, 2023. The keywords were "patella inferior pole fracture", "patella distal pole fracture", "transosseous", "pull-out suture", "reattachment", and "vertical wiring". All clinical studies describing KT or VW techniques for inferior pole fracture of the patella and reporting bone union-related complications were included. This meta-analysis included 16 studies with 274 patellae. Demographic data, surgical techniques, clinical outcomes, and complication rates were recorded. The Methodological Index for Non-Randomized Studies criteria were used to assess their quality. A meta-analysis was performed using random-effects models and meta-regression. The meta-analytic estimate of bone union-related complications was 3.8% (95% CI, 1.6%-6.0%) for either PO or VW techniques in inferior pole fractures of the patella. The bone union-related complication rates did not differ significantly between the two techniques (KT, 5.7%; VW, 3.0%; P = .277). Meanwhile, supplementation fixation was significantly associated with decrease in bone union-related complication rates ( p = .013). Fixation of inferior pole fractures of the patella using either KT or VW techniques provided satisfactory and similar clinical results with minimal bone union-related complications. Supplementary fixation has a positive impact on reducing bone union-related complications in inferior pole fractures of the patella following KT and VW techniques. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparative Study of Inferior Pole of Patella Fracture Treated with Transosseous Technique using Modified Krackow's Technique Versus Traditional Anterior Tension Band Wiring.

The inferior pole of patella constitutes around 9.3-22% of all the patella fractures presenting to the hospital. The management of inferior pole fractures has been debated since a long from early day of partial or full patellectomy to the current dictum of open reduction and fixation because of the importance of extensor mechanism of the knee. There are various modalities of management of the inferior pole of patella fracture. The use of braided polyester wire has shown to have a higher load to failure and less implant fatigue, leading to the use of trams osseous repair technique with fiber wire as an alternative to tension ban wiring. Twenty patients were divided into two groups of 10 each: Group A comprised of patients operated with tension band wiring (TBW) and Group B with patient operated with transosseous repair. Both groups underwent the same physiotherapy postoperatively and the results were compared. Radiological outcomes and the WOMAC score of the patients are comparable in both groups. The return to full range of motion is also similar in both groups with similar physiotherapy given in both groups. This shows that with careful patient selection transosseous repair can be used as an alternative to TBW.

Morphological characteristics and a new classification system of the inferior pole fracture of the patella: A computer-tomography–based study

PurposeThe objective of this study was to measure the morphological characteristics of inferior pole fracture of the patella (IPFP) and develop a practical classification system to determine the corresponding treatment protocols for different IPFPs with specific patterns. MethodsA retrospective radiographic review was performed on a series of 71 patients with IPFP. The preoperative CT data were collected and measured using image processing software. The number of fragments, maximum fracture fragment anteroposterior length (MFFAL), maximum fracture fragment transverse length (MFFTL), fracture fragment coronal angle (FFCA), fracture fragment sagittal angle (FFSA), maximum fracture fragment height (MFFH) and maximum transverse sectional area (MTSA) were analysed. ResultsThe mean number of fracture fragments was 3.8. The average MFFAL was 14.9 mm, the average MFFTL was 23.5 mm, the average FFCA was 92.1°, the average FFSA was 93.0°, the average MFFH was 13.6 mm, and the average MTSA was 299.3 mm2. A new classification system was introduced to describe the varied patterns of IPFP, summarized as (I) simple IPFP; (II) comminuted IPFP; (III) simple IPFP with simple patellar body fracture; and (IV) comminuted patellar fracture involving the inferior pole. With the four-type classification system, 12 type I, 22 type II, 21 type III, and 16 type IV lesions were observed, each with specific morphological characteristics. ConclusionMost IPFPs exhibited a diversiform pattern, demonstrating that coverage fixation was likely needed. The four-type classification system might offer a valuable approach to help orthopaedic surgeons make individual treatment plans.

Clinical outcome of rim-plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole

Despite the variety of treatment methods, comminuted inferior pole fractures of the patella remain difficult and technically demanding to achieve stable internal fixation. The purpose of this study is to evaluate the clinical outcomes of rim plate-augmented separate vertical wiring with supplementary fixation in the management of comminuted inferior pole fractures, AO/OTA 34-A1, C2, and C3, which has the secondary horizontal fracture line on lower articular boundary. From our study, bony union was achieved in all patients at an average of 3.1 ± 1.4 months after surgery. There was no patient with loss of reduction, fixation failure, or infection during follow-up. The average final range of motion was 131.6° ± 7.2°. Lysholm knee scores gradually increased over 3, 6, 9, and 12 months postoperatively by 58.7, 74.0, 82.9, and 89.4, respectively. Isokinetic peak torque deficit of the knee extensor muscles in 3, 6, 9, and 12 months postoperatively was 59.9%, 49.7%, 35.7%, and 28.1%, respectively. The rim plate-augmented separate vertical wiring with supplementary fixation for the treatment of patellar fracture associated comminuted inferior pole is effective and can be safely applied AO/OTA 34-C2 or C3 with favorable outcomes.

A novel suture bridge anchor fixation technique to treat inferior pole fractures of patella: A retrospective clinical study.

The traditional surgical methods to the fracture of the inferior patellar fracture include steel wire tension band fixation and inferior patellar resection, which have many disadvantages. In order to overcome the disadvantages of traditional surgery, we innovated and improved the double row anchor suture bridge technology to the treat the inferior patellar fracture. This study is to investigate the method, technique and clinical efficacy of double-row anchor suture bridge technique in the treatment of inferior pole fractures of patella. Between January 2019 and March 2021, 36 patients with inferior pole fractures of patella underwent the surgery with the double-row anchor suture bridge technique. 28 injury cases were caused by falls while 8 injury cases were from car crashes. The operation time, amount of intraoperative bleeding and complications were recorded. Radiological assessments and Bostman score were performed 1, 3, and 6 months post-operation and at the most recent follow-ups. The study sample consisted of 19 males and 17 females, aged 31 to 72 years old. The operation time was (54-76) minutes. All incisions healed in 1 stage. No complications such as incision infection, flap necrosis and nerve injury occurred. Patients in this group were followed up for 10 to 18 months, with an average follow-up of 12 months. All fractures healed in 10 to 20 weeks, with an average healing time of 12 weeks. At the last follow-up, the Bostman score was (27.5 ± 3.3), excellent in 32 cases and good in 2 cases, with an excellent rate of 94.4%. The range of motion of the knee joint was (-2.6 ± 2.0)° when the knee was extended and (122 ± 5.0)° when the knee was bent. The muscle strength of quadriceps femoris was grade 5. Double-row anchor suture bridge technique is applied to inferior pole fractures of patella by virtue of its various effects, such as the complete preservation of the inferior pole fragments during the operation, satisfactory fracture reduction, firm fixation, and meeting patients' requirements for early postoperative ambulation. In summary, double-row anchor suture bridge technique is an ideal surgical procedure for the treatment of the inferior pole fracture of patella with safety, reliability and high satisfaction.

Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture

To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures. A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups ( P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up. There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups ( P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B ( P<0.05). There was no significant difference in the other items of Bostman scores between the two groups ( P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B ( P<0.05). Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.

A modified separate vertical fixation by wires and titanium cables for comminuted inferior patella fracture: A technique note and finite element analysis

PurposeComminuted inferior patellar pole fractures are challenging injuries and require adequate treatment due to the extension mechanism of the knee. MethodsA modified separate vertical fixation by wires and Titanium cables was established according to a finite element biomechanical study. Between September 2018 and May 2021, 18 patients with inferior pole fractures of the patella were retrospectively enrolled in this study. ResultsThe results of the finite element analysis showed the concentration of stress in the intermediate vertical wire and the cerclage wire. As a partial replacement for steel wires, Titanium cables provide less concentration of stress on the vertical wire (489.4 MPa vs 441.2 Mpa) and less cutting force on the bone (75.87 Mpa vs 53.27), which reduces the possibility of internal fixation failure and improves the stability of internal fixation. In the clinic study, No patients experienced non-union of the fracture, loss of fracture repositioning, malunion of wounds, or wire breakage. At the last follow-up, the average range of motion was 134.7°±11.2°, and the Lysholm Score was 90.7 ± 3.9. ConclusionsThe separate vertical fixation by wires and titanium cables is an effective fixation method for treating displaced, comminuted inferior pole fractures, which attributes to early exercise and better function.

Separate vertical wiring plus bilateral anchor girdle suturing fixation for the fractures of the inferior pole of the patella

BackgroundThe fixation of inferior pole fractures of the patella (IPFPs) is still a great challenge for surgeons.Materials and methodsWe introduced a new fixation method for IPFP fixation, that is, separate vertical wiring plus bilateral anchor girdle suturing fixation (SVW-BSAG). Three finite element models including the anterior tension band wiring (ATBW) model, separate vertical wiring (SVW) model and SVW-BSAG model, were built to evaluate the fixation strength of different fixation methods. A total of 41 consecutive patients with IPFP injury were enrolled in this retrospective study, including 23 patients in the ATBW group and 18 patients in the SVW-BSAG group. The operation time, radiation exposure, full weight-bearing time, Bostman score, extension lag versus contralateral healthy leg, Insall–Salvati ratio, and radiograph outcomes were employed to assess and compare the ATBW group and SVW-BSAG group.ResultsThe finite element analysis confirmed that the SVW-BSAG fixation method was as reliable as the ATBW fixation method in terms of fixed strength. Through retrospective analysis, we found that there was no significant difference between the SVW-BSAG and ATBW groups in age, sex, BMI, fracture side, fracture type, or follow-up time. There were no significant differences between the two groups in the Insall–Salvati ratio, 6-month Bostman score, and fixation failure. Compared with the ATBW group, the SVW-BSAG group showed advantages in intraoperative radiation exposure, full weight-bearing time, and extension lag versus the contralateral healthy leg.ConclusionThe finite element analysis and clinical results showed that SVW-BSAG fixation methods are a reliable and valuable for IPFP treatment.

Characteristics of multi-ligament knee injuries accompanied with patellar tendon disruption.

Patella tendon rupture with multi-ligament injury is a rare injury. We observed patients with patella tendon rupture (or patella inferior pole fracture) with multi-ligament injury. This study intends to inspect the mechanism of the injury and classify them. This is a case series involving patients from two hospitals. Twelve patients who had patella tendon rupture (PTR) with multi-ligament injury were studied. The incidence of multi-ligament injury in patella tendon rupture patients found to be 13% in retrospective search. Two types of injury were observed. First type is relatively low energy injury involving ACL and patella tendon which does not involve rupture of PCL. Second type is high energy injury involving PCL and patella tendon. Treatment differed among the patients, due to severity of trauma. Two-staged operation was the basis of treatment. Patella tendon was repaired in first stage. Reconstruction of ligaments was done in second stage. The patients who had infection or stiffness did not have a second surgery. Patella tendon rupture with multi-ligament injury can be classified into low energy rotational injury and high energy dashboard injury. Two-staged surgery is the basis of treatment.

Tension-band wiring through a single cannulated screw combined with suture anchors to treat inferior pole fracture of the patella

PurposeTo evaluate the feasibility and clinical outcomes of tension-band wiring through a single cannulated screw combined with two suture anchors in treating inferior pole fracture of the patella. MethodsBetween September 2018 and September 2021, a total of 22 patients with a mean age of 55 years who sustained inferior pole fracture of the patella and were treated by tension-band wiring through a single cannulated screw combined with two suture anchors were enrolled. X-ray radiographs were performed to observe the bone union time. The duration of each operation was recorded to reflect the complexity of surgical treatment. Functional measurements, comprising range of motion (ROM), the Böstman scale, and the Knee Injury and Osteoarthritis Outcome Score (KOOS), were taken. Postoperative complications including fixation failure, incision infection, loss of reduction, and malunion were evaluated. ResultsAll patients were followed up for an average of 17 months (range: 12–25 months). The average clinical bone union time was 8 weeks (range: 6–12 weeks), and the radiographic bone union time was 11 weeks (range: 8–12 weeks). At the final follow-up, the mean ROM was 136° (range: 115°-140°), the KOOS was 85 (range: 68–100) and the Böstman score was 28 (range: 20–30); these outcomes were classified as excellent in 17 cases and good in 5 cases, with no instances of poor results. Loss of reduction occurred in one case, while no cases of incision infection, fixation failure or malunion were observed. ConclusionFor inferior pole fracture of the patella, tension-band wiring through a single cannulated screw combined with suture anchors can offer sufficient fixation stability to achieve a satisfactory clinical outcome with reduced operational complexity; this procedure should be recommended in clinical practice.

Progress in surgical treatment of inferior patellar pole fractures

To summarize the surgical treatment methods and progress of inferior patellar pole fractures and provide reference for clinical application. The literature on surgical treatment of inferior patellar pole fractures was extensively reviewed, and the relevant research progress, advantages, and limitations were summarized. The inferior pole of the patella is an important part of the knee extension device, which can strengthen the force arm of the quadriceps. Inferior patellar pole fractures are relatively rare and often comminuted, usually requiring surgical treatment. At present, there are various methods to treat inferior patellar pole fractures, including patellectomy of inferior pole, tension-band wiring technique, plate internal fixation, suture anchor fixation, claw-like shape memory alloy, separate vertical wiring technique. Different methods have their own characteristics, advantages, and disadvantages. The single internal fixation method has more complications and is easy to cause fixation failure. Therefore, the trend of combining various internal fixation methods is developing at present. When the main fragment of the inferior patellar pole fracture is large and mainly distributed transversely, the combination protocol based on tension-band wiring technique can be regarded as an ideal choice. When the fragments are severely damaged and small, the comprehensive protocol based on suture fixation can result in a better postoperative functional recovery.

Neglected Patellar Fracture Treated Using Ipsilateral Hamstring Autograft Augmentation: A Case Report

Introduction: Inferior pole patellar fractures occur in relatively young patients after eccentric contraction of the quadriceps or direct trauma. Early diagnosis and adequate treatment lead to excellent outcomes and prevent tendon retraction and scarring. The aim of surgical treatment is to restore of extensor mechanism rather than anatomical articular reduction. We propose a cerclage wire technique using ipsilateral hamstring augmentation for the patellar tracking restoration. Case Description: A forty nine-year-old female, presented to our sport clinic with chief complaint of pain in the left knee and difficulty in walking and standing in long period of time following a direct trauma falling from the stairs to the knee one year back. Clinical examination revealed gap in the left knee cap and the patient could not able to straighten the knee actively. Plain radiographs of knee were taken in anteroposterior and lateral views show fracture of the inferior pole of the left patella. Magnetic resonance imaging (MRI) of the knee confirmed inferior pole patellar fracture with the proximal migration of patella with no other intraarticular injuries with partial tear of left patellar tendon. Patellar tendon reconstruction was planned using ipsilateral semitendinosus (ST) and Gracillis (G) autograft and ORIF cerclage wire augmentation. Follow-up was performed after one month post-operation. Patient was able to straighten the left knee and fully weight bearing mobilized without any pain. Range of motion was 0/100 compared to the contralateral knee. Muscle atrophy was not found. Xray was performed and shows callus formation with stable fixation. Conclusion: Neglected patellar fracture is a rare occurrence, the treatment of which is a difficult challenge for orthopaedic surgeons. Therefore, the goal of surgical treatment of inferior pole fractures is restoration of extensor mechanism rather than anatomical articular reduction. In inferior pole fracture of the patella, comminution in fractured distal fragment is common and secure fixation to allow early motion is difficult to achieve. The advantage of the described technique is the possibility of immediate weightbearing and early mobilization. A parallel could be drawn with the biological augment for patellar tendon repair, in which semitendinosus augmentation allows immediate postoperative mobilization with excellent functional results. This allows patients with early functional exercise and has a positive significance for the smooth recovery of the articular surface of the patella and recovery of knee extensor device function. Functional impairment of the extensor mechanism and postoperative complications triggers the quest for finding the ideal technique.

Transosseous suture versus suture anchor fixation for inferior pole fractures of the patella in osteoporotic bone: a biomechanical study

BackgroundThe surgical treatment of inferior patellar pole fractures can be a challenge, especially in geriatric patients, who are particularly frequently affected by osteoporosis. The objective of this biomechanical study was to compare the performance of suture anchor and transosseous suture fixation in fractures of the inferior patellar pole in context of bone mineral density.MethodsTwelve fresh-frozen human cadaveric knees received a transverse osteotomy, simulating an AO/OTA 34C1.3 inferior pole fracture of the patella. These fractures were fixated with either suture anchors (SA; Corkscrew® FT 4.5 mm) or transosseous suture (TS; #2 FiberWire®). Cyclic loading tests were performed by pulling the quadriceps tendon against gravity from 90° flexion to almost full extension (5°) for 1000 cycles. Motion and fracture gap displacement were tracked until failure occurred. Subsequently, loading to failure tests followed. Differences between groups were compared using unpaired t-tests, and correlations were calculated with Pearson’s correlation coefficient.ResultsThe suture anchor group showed significantly fewer cycles to failure than the transosseous suture group (SA: 539.0 ± 465.6 cycles, TS: 1000 ± 0 cycles, P = 0.04). Bone mineral density correlated positively with cycles to failure in the suture anchor group (Pearson’s r = 0.60, P = 0.02). No differences in fracture gap displacement could be proven after 100 cycles (SA: 4.1 ± 2.6 mm, TS: 6.5 ± 2.6 mm, P = 0.19); 500 cycles (SA: 6.4 ± 6.1 mm, TS: 9.6 ± 3.8 mm, P = 0.39); and 1000 cycles (SA: 4.0 ± 0.4 mm, TS: 11.0 ± 4.5 mm, P = 0.08). Furthermore, the mean destructive load to failure in the suture anchor group was also significantly lower than in the transosseous suture group (SA: 422.4 ± 212.2 N, TS: 825.7 ± 189.3 N, P = 0.04).ConclusionsSuture anchors may be a viable alternative to transosseous suture in younger patients for clinical advantages, but in osteoporotic bone, the more stable osteosynthesis with transosseous suture continues to prove superior. Therefore, trauma surgeons might consider the use of transosseous suture in elderly patients, especially in those presenting with low bone mineral density values.

Tension band wiring versus suture anchor technique in patellar inferior pole fracture: Novel double row suture anchor technique.

Patellar inferior pole fractures are challenging to obtain sufficient fixation. The purpose of this retrospective, case-controlled study was to compare the clinical and radiological outcomes between tension band wiring (TBW) and our novel double-row suture anchor (SA) technique in patellar inferior pole fractures. This retrospective study included patients who underwent TBW or SA fixation for patellar inferior pole fractures from 2015 to 2019. A total of 63 patients were divided into two groups according to the surgical procedure: the TBW group (n=35) and the SA fixation group (n=28). The visual analog scale score, range of motion of the knee, Lysholm score, Kujala patellofemoral score, and patient satisfaction score were evaluated for clinical and functional outcomes. Radiological outcomes included the time to radiological union, loss of reduction, and the Insall-Salvati (IS) ratio. Significant improvements in clinical outcomes were observed in both groups with no significant differences. Bone union was achieved in all patients, and there was no significant difference in the time to radiological union and the IS ratio between the two groups. All patients in the TBW group underwent additional surgeries for implant removal. However, none of the patients in the SA group underwent implant removal or experienced skin irritation. Our novel double-row SA technique could provide comparable fixation strength and good clinical outcomes, with fewer complications in patellar inferior pole fractures. This novel SA technique is a satisfactory alternative treatment for patellar inferior pole fractures.

Treating Inferior Pole Fracture of Patella with Hand Plating System: First Clinical Results.

Inferior pole fractures of patella are notorious fractures where it is difficult to obtain rigid internal fixation by conventional methods. The objective of the study was to introduce the Hand Plating System (HPS), which was a novel surgical technique for inferior pole fractures of patella, and to report the radiological and clinical outcomes following the application of the surgical technique. The study was designed as a retrospective cohort study. Between July 2017 and December 2018, 30 patients who were diagnosed with inferior pole fracture of the patella without additional orthopaedic injuries were enrolled in this case series. After X-ray and 3D-CT examinations, all patients underwent open reduction and internal fixation by HPS with or without supplementary cannulated screw and lag screw stabilization. The bony union time, final range of motion (ROM), Bostman score, visual analog scale (VAS), and complications were measured as the clinical outcomes under a minimum of 12months of follow-up. All of the operations went well with the mean operative time of 76.2 ± 15.3 min. Bony union achieved in all the cases at an average of 9.5 ± 1.4 weeks after surgery. There was no loss of reduction, fixative failure, or surgical implant removal during follow-up. The average range of motion 1 year postoperatively was 0°-123.3°. The mean Bostman Score at the last follow-up was 26.8 ± 2.1 with the satisfactory rate of 100%. The pain feeling during walking as measured by VAS averaged at 0.9 ± 1.3. No complications developed except for one case of poor incision healing, which healed eventually after surgical debridement. HPS was demonstrated as a secure fixation and as a kind of tension band for inferior pole fractures of the patella. Satisfactory recovery of knee function and low complication rate, including no need for hardware removal, could be expected.

Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture.

Objective: This study aimed to compare the biomechanical stability and clinical efficacy of the Kirschner-wire (K-wire) tension band combined with patellar cerclage and an anchor-loop plate (ALP) in treating inferior-pole patellar fracture. Methods: The finite element model was established to analyze the mechanical properties of a K-wire tension band combined with patellar cerclage and ALP fixation in the treatment of inferior patellar pole fracture. The clinical data of 49 patients with patellar inferior-pole fracture (AO/OTA 34 A1) admitted to our hospital from January 2017 to July 2021 were retrospectively analyzed. Among these, 28 cases were fixed with ALPs (ALP group) and 21 cases were fixed with K-wire tension bands combined with patellar cerclage (K-wire group). By reviewing the medical records and follow-up results, we compared the operation time, final knee joint activity, incidence of secondary surgery, postoperative complications, and joint function recovery between the two groups. Results: The biomechanical analysis of the finite element model showed that the maximum displacement of the K-wire group was 1.87 times that of the ALP group. The maximum stress of the K-wire group was 1.34 times that of the ALP group. The maximum stress of the pole bone in the K-wire group was 13.89 times that of the ALP group. The average follow-up times of the K-wire group and ALP group were similar (p > 0.05), and the average ages of the two groups were similar (p > 0.05). The operation time of the ALP group was significantly shorter than that of the K-wire group (p < 0.05).The final knee joint activity of the ALP group was significantly greater than that of the K-wire group (p < 0.05). The Bostman patellar fracture function score of the ALP group was significantly better than that of the K-wire group at 3 and 9months after operation (p < 0.05). Postoperative complications of the two groups included 1 case (3.6%) in the ALP group with internal fixation-stimulation complications and, in the K-wire group, 3 cases (14.3%) with internal fixation stimulation complications and 1 case (4.8%) with infection. Conclusion: The ALP and K-wire tension band combined with patella cerclage models were tested at 500N, and no damage occurred, indicating that the newly designed ALP is safe in mechanical structure. The ALP has better therapeutic effect in biomechanical stability, postoperative complications, secondary surgery, and knee function. This technique is an effective method for the treatment of inferior-pole patellar fracture.

A Novel Technique for the Treatment of Inferior Pole Fractures of the Patella: A Preliminary Report.

Most inferior pole fractures of the patella are comminuted. Therefore, an ideal treatment method has not been determined. We have presented a modified tension band fixation technique-the Krachow suturing, Nice knot combined with tension band fixation-and reported the results of the procedure. A total of 16 inferior patellar pole fractures were treated at our institution between January 2019 and October 2020, 15 of which underwent treatment with the modified tension band fixation technique consisting of Krachow suturing with Nice knots combined with tension band fixation. The primary measures: knee motion, Bostman score, anterior knee pain, fixation failure. Bone union occurred at a mean of 9 weeks postoperatively (range: 8-13). There were no cases of postoperative anterior knee pain, refracture of the inferior patellar pole or wire breakage. The patients regained full ROM of the knee joint without functional deficits during follow-up; the mean ROM was 128.46° ± 7.07° (range: 113.4°-137.8°). At the last follow-up, all patients had a mean Bostman score of 28.40 ± 1.29 (range: 26-30), with an excellent score in 11 patients and a good score in four patients. The modified tension band fixation technique for the treatment of inferior patellar pole fractures is a simple and easy-to-perform surgical technique that provides stable fixation and good functional results.

Design and Validation of a Smile-Necklace Plate for Treating Inferior Patellar Pole Avulsion Fractures: A Review and Hypothesis.

The patella's inferior pole transmits force generated by contraction of the quadriceps muscle to the tibial tuberosity through the attached patellar ligament, thus completing knee extension. Therefore, fractures of the patella's inferior pole disrupt the coherence of mechanical transmission in the lower extremities. There appears to be no consensus among trauma centers regarding the treatment of infrapatellar pole fractures, primarily because there is no consistent design or application of internal fixation for this type of fracture. We designed a new internal implant similar to the smile necklace based on our previous study. This smile-necklace plate (SNP) has the advantage of both plate fixation and tension-band wiring fixation, permitting early rehabilitation, especially in osteoporotic comminuted infrapatellar pole fractures. Finite element analysis helped verify the biomechanical advantages of the SNP in comparison with existing studies. Hence, this novel implant is a promising treatment option for inferior pole patellar fractures.