Nice Knot Research Articles

Nice knots assistance in comminuted and displaced clavicle fractures reduce intraoperative blood and shorten operation time with a satisfactory postoperative clinical outcome

BackgroundThis study aims to evaluate the efficacy and clinical outcomes of Nice knot-assisted fixation in the management of comminuted and displaced clavicle fractures.MethodsA systematic search was conducted across multiple electronic databases, including PubMed, Embase, Cochrane Library, China Biology Medicine (CBM) database, CNKI, Wanfang, and VIP database, to identify studies comparing Nice knot-assisted fixation with traditional surgical treatment for displaced midshaft clavicle fractures. The primary outcomes assessed included fracture healing times, hospitalization days, complications, and functional outcomes. Secondary outcomes such as intraoperative blood loss, operative time, incision length, and fluoroscopy time were also evaluated. Data were analyzed using random-effects models, and summary statistics including Mean Difference (MD), risk ratios (RRs) and theirs’ 95% confidence intervals (CIs) were calculated.ResultsScreening of the literature yielded a total of 11 studies meeting the inclusion criteria, involving 754 patients. Meta-analysis of the pooled data demonstrated a significant advantage of Nice knot-assisted fixation over traditional surgical treatment in terms of operative time (MD = -11.53, 95% CI: -18.16 to -4.91, p = 0.0006) and blood loss (MD = -14.19, 95% CI: -20.93 to -7.45, p = 0.00001). Additionally, Nice knot-assisted fixation was associated with reduced fracture healing time (MD = -0.63, 95% CI: -1.12 to -0.14, p = 0.01) rather than hospitalization days (MD = -0.47, 95% CI: -1.14 to 0.21, p = 0.18) and complications (RR = 0.48, 95% CI: 0.23 to 1.01, p = 0.05) compared to traditional surgical treatment. Moreover, nice knot-assisted fixation was associated with increased constant-murley score and Neer score, and reduced visual analogue scale (VAS) score compared to traditional surgical treatment.ConclusionThis study highlights that Nice knot assistance offers advantages in reducing intraoperative blood loss, shortening operation time, and achieving favorable postoperative outcomes.

The modified Nice knot has improved mechanical performance compared to the cinch stitch for meniscal root repair.

According to previous biomechanical studies, the success of meniscus root repair depends on the suture-meniscus interface and optimisation of this procedure seems to be critical. A progressive, reliable and adjustable knot has numerous advantages in meniscal repair since the surgeon can adapt and meticulously tune the final strength of the fixation. We hypothesised that a single passage of one tape at two different points of the posterior meniscal root with a modified Nice knot configuration may allow similar or superior fixation for root repair compared to the cinch stitch suture technique. Posterior root repair of medial and lateral meniscus was performed on 26 porcine knees. In group (A), two simple cinch stitches were applied, and in group (B), a modified Nice knot was used in a crossmatch configuration. For both groups, two passages through the meniscus with a 2-mm braided tape were used, and a single transosseous tibial tunnel technique was performed and tested in pull-out conditions. The modified Nice knot showed an improved biomechanical performance considering the maximum failure load for both the medial (600.7 ± 77.5 N) and lateral (686.1 ± 83.5 N) (p = 0.006) posterior root fixation when compared to a double cinch stitch (558.0 ± 123.9 N) and (629.0 ± 110.2 N) (p = 0.178) for medial and lateral fixation, respectively. The maximum stiffness was also higher for the modified Nice knot configuration for both medial (17.1 ± 1.5 vs. 13.3 ± 1.6 N/mm) and lateral meniscus (20.0 ± 2.6 vs. 13.8 ± 2.3 N/mm), being this difference statistically significative (p = 0.001). The modified Nice knot allowed better adaptation in the pull-out tests and presented higher fixation strength, stiffness and reproducibility, with lower standard deviation, being at the same time economically advantageous, since only one tape is needed. Level III.

Using a Nice knot to simplify and strengthen closed reduction in displaced distal clavicle fracture: a technical note.

A displaced distal clavicle fracture often necessitates surgical intervention, with various open and closed reduction options. Open reduction is easier but raises blood supply concerns, while closed reduction can involve complex deforming forces with differing displacement vectors. Herein, we demonstrate how a Nice knot with its sliding and self-locking qualities can be used to make closed reduction easier and the alignment more secure. A case report illustrates this Nice knot application in a 61-year-old male with a distal clavicle fracture. The Nice knot's ability to be loosened and retightened ensured more precise alignment in this case. The Nice knot technique is a versatile option for easier and more secure distal clavicle fracture management.

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.

A New Method of Krackow Suture Combined with Nice Knot for the Treatment of Inferior Patellar Fractures.

We present a new surgical technique of Krackow suture combined with vertical Nice knot for the treatment of inferior patellar fractures and report the clinical results. Seventeen consecutive patients admitted with inferior patellar fractures over a 2-year period from June 2019 to February 2022 were prospectively enrolled. The AO classification was 34-A1. All patients underwent open reduction and fixation with Krackow sutures in combination with vertical Nice knot. Postoperative follow-up was performed for at least 1 year to evaluate knee function. The mean age of seventeen patients was 53.2 ± 9.5years (39-68years), and all patients were followed up for more than 12 months. The operation time was 54.6 ± 7.7min (42-68min). No patients had nonunion, joint stiffness, and joint pain. All cases achieved bony union at an average of 9.9 ± 1.5weeks (8-13weeks) after surgery. At the last follow-up, there was no significant difference in range of motion between the injured knee (129.7 ± 3.3°, range 125-135°) and the unaffected knee (130.8 ± 3.8°, range 126-137°) (t = 0.28, P > 0.05). The mean Bostman score of the knee joint was 29.6 ± 0.7, including 15 excellent cases (88.2%) and two good case (11.8%). Krackow sutures combined with vertical Nice knots are stable and reliable in the treatment of inferior patellar fractures. Knee rehabilitation can be performed immediately after surgery and satisfactory knee function can be achieved. It is a safe, simple, and reliable alternative surgical method, and patients do not need to bear the secondary surgical injury of removing the internal fixation material. Therefore, it is suitable for the application of clinical promotion. The online version contains supplementary material available at 10.1007/s43465-023-01093-0.

Application of Nice knot technique in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures

To explore the effectiveness of Nice knot technique for wound closure in Gustilo type ⅢA and ⅢB open tibial fractures. A retrospective study was performed on 22 patients with Gustilo type ⅢA and ⅢB open tibial fractures, who underwent wound closure using the Nice knot technique and were admitted between June 2021 and June 2022. There were 15 males and 7 females. The age ranged from 18 to 67 years, with an average of 41.9 years. The causes of injury included traffic accident in 11 cases, falling from height in 7 cases, and heavy object injuries in 4 cases. Fractures were located on the left side in 9 cases and on the right side in 13 cases. And 9 cases were type ⅢA fractures and 13 were type ⅢB fractures according to Gustilo classification. All patients had extensive soft tissue injuries, and no vascular or neurological damage was observed. The time from injury to debridement was 3-8 hours (mean, 6.5 hours). The sizes of wounds before operation and at 2 weeks after operation were measured and wound healing rate at 2 weeks after operation were calculated. The wound healing time and wound healing grading were recorded. The Vancouver Scar Scale (VSS) score was used to assess the wound scar after wound healed and the excellent and good rate was calculated. The wound area was 21.0-180.0 cm 2 (mean, 57.82 cm 2) before operation, and it was 1.2-27.0 cm 2 (mean, 6.57 cm 2) at 2 weeks after operation. The wound healing rate at 2 weeks after operation was 76%-98% (mean, 88.6%). After operation, 2 cases needed to adjust Nice knot due to skin cutting and 1 case occurred soft tissue infection on the wound. The other patient's wounds healed. The average wound healing time was 27.8 days (range, 18-44 days). And the wound healing were grade A in 13 cases and grade B in 9 cases. VSS score was 2-9, with an average of 4.1; 10 cases were rated as excellent, 10 as good, and 2 as poor, with an excellent and good rate of 90.9%. All patients were followed up 9-24 months (mean, 14.6 months). During follow-up, no deep infection or osteomyelitis occurred. Two cases experienced fracture non-union, and were treated with compression fixation and bone grafting. The fractures of the other patients all healed, with a healing time of 85-190 days (mean, 148.2 days). Nice knot technique can be used in wound closure of Gustilo type ⅢA and ⅢB open tibial fractures effectively, which is easy to operate.

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.

Arthroscopic Modified Elbow Lateral Collateral Ligament Imbrication: An Operative Technique

When the lateral collateral ligament (LCL) complex fails to support the radiocapitellar and ulnohumeral joints in advanced stages of insufficiency, the patient experiences posterolateral rotatory instability (PLRI). Open lateral ulnar collateral ligament repair with a ligamentous graft has been the standard treatment for PLRI. Despite producing good clinical stability rates, this method is associated with significant lateral soft-tissue dissection and a lengthy recovery period. By fastening the LCL to its humeral insertion, arthroscopic imbrication of the LCL can increase stability. The senior author modified this technique. With the aid of a passer, the LCL complex, lateral capsule, and anconeus may be weaved with a single (doubled) suture, secured with a Nice knot. LCL complex imbrication may be used to restore stability and improve pain and function in patients with grade I and II PLRI.

Medial Meniscal Posterior Root Avulsion Fracture Repair Using the Nice Knot

Meniscal root tears have recently seen an increase in diagnosis. As we understand more about the biomechanical relationship between the meniscus and tibiofemoral articular surface, it becomes more important to promptly identify and repair these lesions. Root tears may cause up to a 25% increase in forces in the tibiofemoral compartment, potentially leading to hastened degenerative changes visible on radiographs and decreased patient outcomes. The anatomic footprint of the meniscal roots has been described, as well as multiple iterations of repair techniques, with the most popular being the arthroscopic-assisted transtibial pullout technique for repair of the posterior meniscal roots. The tensioning technique varies and has been a surgical step that can lead to error during the procedure. We use a transtibial technique with modifications in the method of suture fixation and tensioning. To begin, we use 2 doubled-over sutures that are passed through the root to create a looped end and a twin-tailed end. This is followed by the use of a locking, tensionable and, if needed, reversible Nice knot that is tied on the anterior tibial cortex over a button. This technique provides controlled and accurate tension to the root repair when tied over a suture button on the anterior tibia with stable suture fixation to root.

Arthroscopically Assisted Anterior Bone Block for Shoulder Instability

Background: Shoulder instability is a common complaint, with treatment depending on the severity of the bony defect. Advancements in arthroscopic techniques have allowed for a less invasive surgery with decreased postoperative pain, improved graft placement, and better visualization. Indications: Large bony defects of the glenoid require bone block augmentation to reduce recurrent instability. In this presentation, arthroscopically assisted anterior bone block was performed with a distal tibial allograft to address recurrent anterior shoulder instability with a large glenoid defect. Technique Description: The patient is placed in a lateral decubitus position. Standard arthroscopic portals are made. The bone block is fashioned from a distal tibial allograft. Using a guide, drill holes are placed in the bone block. The guide is inserted from the posterior portal and placed parallel to the joint surface. Using drill sleeves, superior and inferior screw holes are drilled and a metal cannula is left in place to allow for shuttling of suture. Two anchors are placed on the glenoid to allow for capsule labral junction to be brought up to the graft once the graft is in place. The bone block is delivered through a dilated anterior portal and reduced. The sutures are tensioned. A button is placed on each set of looped sutures, a Nice knot is placed into each, and a tensioning device is tensioned. Once compression is achieved, knots are tied to perform final fixation over the buttons. A suture passing device is used to grab inferior capsule and labrum to the priorly placed anchor on the inferior glenoid and tied. Results: Arthroscopically assisted anterior bone block for shoulder instability has been demonstrated to have similar clinical and radiographic outcomes when compared with open treatment. However, arthroscopically assisted Latarjet has been shown to have decreased soft tissue disruption and possible improvements in graft placement. Discussion/Conclusion: Arthroscopically assisted anterior bone block is a technically demanding surgery but has been shown to have similar outcomes when compared with open treatment. In this video, we demonstrate an arthroscopically assisted anterior bone block for recurrent anterior shoulder instability. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Closed Reduction and High-Strength Sutures for Transverse Patella Fractures: A Retrospective Analysis

ObjectiveThis study aimed to investigate the clinical efficacy of closed reduction high-strength sutures combined with Nice knots in treating transverse patella fractures.MethodWe retrospectively analyzed the clinical data of 28 patients who underwent surgery for transverse patella fractures from January 2019 to January 2020. Twelve cases of the study group were treated with closed reduction high-strength sutures combined with Nice knots, and 16 cases in the control group were treated with tension band wiring. Observations included patellar healing, follow-up knee mobility with Böstman score, Lysholm score, surgical data, postoperative complications, and secondary surgery rate.ResultNo statistically significant difference was observed between the two groups in the Patient demographic data, with a mean follow-up of 13.14 ± 1.58 months. There was no delayed healing or deep infection in the two groups. In the control group, 2 cases of internal fixation failure and 1 case of superficial infection were observed. The differences in mean fracture healing time, follow-up Böstman score, Lysholm score and knee mobility between the two groups were not statistically different. However, the differences were statistically significant for the duration of surgery, Incision length, intraoperative bleeding and the secondary surgery rate was lower in the study group.ConclusionClosed reduction high-strength sutures have good clinical efficacy in treating transverse patella fractures, with the advantages of shorter duration of surgery and Incision length,less intraoperative bleeding and no secondary removal.

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 New Method of Nice Knot Elastic Fixation for Distal Tibiofibular Syndesmosis Injury

The distal tibiofibular syndesmosis (DTS) is a fretting joint and it is still a hot issue how to satisfy strong internal fixation while allowing fretting. This study described and evaluated a new method for elastic fixation of DTS injury with Nice Knot. The study was designed as a retrospective study. Between June 2020 and June 2021, 31 patients who were diagnosed with ankle fracture and DTS injury without additional orthopedic injuries were enrolled in this case series. The study included 22 males and nine females, with an average age of 34.71 ± 14.66 years. All patients were treated with Nice Knot binding for DTS. Surgical time, length of stay, time of DTS fixation, total weight-bearing time, complications, imaging parameters, and functional scores at follow-up were recorded. Paired sample t-tests or single factor analyses of variance were used at intra-group comparison. All patients completed surgery with normal syndesmotic parameters. The recovery of DTS injury was verified by Hook and lateral malleolus rotation tests. The average follow-up time was 15.97 ± 3.30months. Only one case showed superficial infection after surgery, and the wound healed after symptomatic treatment. In terms of imaging, there were no significant differences in tibiofibular clear space (TFCS), tibiofibular overlap distance (TFOS), medial clear space (MCS), and superior clear space (SCS) immediately and at different follow-up points after surgery. All obtained excellent and good outcomes according to the AOFAS score at least follow-up after surgery. Nice Knot elastic fixation of DTS injury is firm and stable while maintaining the physiological micromotion of the ankle joint.

Transosseous Repair With Nice Knot Augmentation Versus Knotless Suture Anchor Repair With Suture Tape for Quadriceps Tendon Rupture: A Cadaveric Study.

Quadriceps tendon rupture is typically repaired using either transosseous tunnels or suture anchors. Recent literature has suggested that suture anchor repair is biomechanically superior to the use of transosseous tunnels. Augmentation of the transosseous technique with Nice knots may result in improved biomechanical properties as compared with a suture anchor construct. To compare biomechanical properties of a novel transosseous quadriceps tendon repair technique with Nice knot augmentation to those of knotless suture anchor repair, an artificial quadriceps tendon rupture was created in 10 matched pairs of cadaveric knees (n=20). Each cadaver was subjected to biomechanical testing to calculate the average ultimate load to failure, repair site gapping after early and late cyclic loading, and stiffness. Transosseous repair augmented with Nice knots as compared with knotless suture anchor repair had greater load to failure (mean±SD, 1489.5±297.6 N vs 717.7±191.4 N, P<.001), decreased gapping after early and late cyclic loading (cycles 1-20: mean±SD, 0.59±0.4 mm vs 2.1±1.2 mm, P=.008; cycles 21-250: mean±SD, 1.2±0.7 mm vs 3.9±1.7 mm, P=.002), and greater construct stiffness (mean±SD, 80.7±15.7 N/mm vs 44.4±13.4 N/mm, P=.001). The transosseous quadriceps tendon repair technique with Nice knot augmentation is biomechanically better than knotless suture anchor repair with regard to ultimate load to failure, gap formation after cyclic loading, and construct stiffness in cadaveric specimens. [Orthopedics. 2023;46(3):135-140.].

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.

CORR Insights®: Does the Nice Knot Offer Less Elongation Than the Modified Prusik Knot? An In Vitro Study in Cadaver Quadriceps Tendons.

CORR Insights®: Does the Nice Knot Offer Less Elongation Than the Modified Prusik Knot? An In Vitro Study in Cadaver Quadriceps Tendons.

Does the Nice Knot Offer Less Elongation Than the Modified Prusik Knot? An In Vitro Study in Cadaver Quadriceps Tendons.

ACL graft-suture fixation can be constructed with needle or needleless techniques. Needleless techniques have the advantage of decreased injury, preparation time, and cost. The Nice knot is common among upper extremity procedures, and has been shown to have higher load to failure and less elongation compared with other double loop knots; however, there are no studies that have looked at its use for ACL graft-suture construct to determine whether it offers less elongation relative to other needleless techniques. In a cadaver quadriceps tendon model, we asked: (1) Does the Nice knot have less elongation than the Prusik knot? (2) Does the Nice knot have increased peak load and stiffness compared with the Prusik knot? (3) What were the modes of failure of each knot? Sixteen quadriceps tendon grafts were harvested from 16 cadaver knee specimens. The median (range) age of the donors was 80 years (70 to 96) and included three male and five female donors. Eight grafts were prepared with the Prusik knot and eight with the Nice knot using a braided polyblend suture. The graft-suture constructs were mounted in a materials testing machine and subjected to a tensile loading protocol beginning with pretensioning of three cycles from 0 to 100 N at 1 Hz followed by a constant load of 50 N for 1 minute then cyclic loading of 200 cycles from 50 to 200 N at 1 Hz. The constructs were loaded to failure as the final step of the loading protocol. Elongations of the construct after each loading step, peak load, stiffness, and graft cross-sectional area were compared. Construct elongations (median [IQR]) for the Nice knot were lower than that of the Prusik knot after pretensioning (4.4 mm [0.8] versus 5.7 mm [1.4]; p = 0.02), preloading (0.6 mm [0.3] versus 1.0 mm [0.3]; p = 0.005), and cyclic loading (7.4 mm [1.4] versus 10.9 mm [2.1]; p = 0.005). Peak load was not different for the Prusik knot construct compared with the Nice knot (334 N [43] versus 312 N [13]; p = 0.08). Stiffness of the Prusik knot construct (103 N/mm [17]) was no different than the Nice knot construct (110 N/mm [13]; p = 0.13). Graft cross-sectional area of the Prusik knot constructs (85 mm2 [35]) were similar to the grafts of the Nice knot constructs (97 mm2 [31]; p = 0.28). Failure mode of the constructs did not differ between groups; it was caused by suture rupture near the knots that secured the free suture ends to the machine and was seen in all 16 tests. The results of this biomechanical study show that the Nice knot construct has similar or greater biomechanical properties compared with the Prusik knot in the graft suture construct, although the magnitude of the differences are not likely to the level of clinical importance. The Nice knot offers an attractive alternative option for needleless ACL graft preparation technique. Future studies should consider comparison to established needle techniques such as Krackow or whipstitch and testing in an intraarticular component in an in vivo model.

Percutaneous minimally invasive treatment of transverse patellar fracture using cannulated screws combined with high-strength sutures and Nice knots: a retrospective study.

Patella fractures treated with traditional open approach and tension band fixation are associated with a significant rate of soft tissues complications, including hardware irritation, postoperative adhesions and non-cosmetic scar. An alternative is to utilize cannulated screws and high-strength sutures by the minimally invasive technique. This retrospective study comprised 48 patients who had been treated for unilateral closed transverse patellar fracture, type 34C1 according to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, between June 2018 to June 2020. All patients were treated either by closed reduction and internal fixation using cannulated screws combined with high-strength sutures and Nice knots (the CRIF-NK group, n=24), or traditional open reduction and internal fixation using cannulated screws and tension band wiring (the ORIF-TBW group, n=24). The operative time and intraoperative blood loss for each patient were recorded. All the patients were underwent a regularly clinical and radiological follow-up. The clinical evaluation was performed using the Böstman scale and the Visual Analogue Scale (VAS) for pain. Average follow up was 21.9 months (range, 16-29 months). The mean intraoperative blood loss of the CRIF-NK group (35.21±6.16 mL) was significantly less than that of the ORIF-TBW group (75.42±7.92 mL; P<0.001). The mean VAS scores at 4 and 8 weeks and the mean Böstman scale score at 8 weeks after surgery were significantly better in the CRIF-NK group (3.52±0.42, 1.47±0.40 and 28.13±0.94, respectively) than the ORIF-TBW group (5.16±0.68, 3.14±0.72 and 26.33±1.00, respectively; all P<0.001). No significant differences were observed between the two groups in terms of operative time, Böstman scale score at 1-year follow-up, or fracture healing time. The union rate was 100% (24/24) in both groups. One patient (1/24) in the CRIF-NK group, and all patients (24/24) in the ORIF-TBW group required internal fixation removal. The percutaneous minimally invasive technique using cannulated screws combined with high-strength sutures and Nice knots exhibited some superiority to traditional open reduction with cannulated screws and tension band wiring for treatment of transverse patellar fractures in terms of efficacy and safety by reducing soft-tissue stimulating complications and promoting functional recovery.

Effectiveness analysis of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicle fractures

To investigate the effectiveness of Endobutton plate coracoclavicular fixation combined with fracture site high-strength suture Nice knot cerclage fixation in the treatment of distal clavicle fracture with coracoclavicular ligament injury. The clinical data of 33 cases of distal clavicular fracture with coracoclavicular ligament injury treated by Endobutton coracoclavicular plate fixation between January 2017 and December 2020 were analyzed retrospectively. According to the fixation methods of fracture site, they were divided into two groups: the high-strength suture Nice knot fixation group (study group, 16 cases) and the transacromial Kirschner wire fixation group (control group, 17 cases). There was no significant difference between the two groups in common data such as age, gender, injury side, cause of injury, Craig type, combined injury, time from injury to operation, and preoperative visual analogue scale (VAS) score and Constant-Murley score ( P>0.05). Postoperative fracture healing and complications were observed, and the increase rate of coracoclavicular space on the affected side was calculated at last follow-up. VAS score was used to evaluate shoulder pain before operation, at 1 week, 1 month, 3 months after operation, and at last follow-up. The shoulder function was evaluated according to Constant-Murley shoulder score before operation, at 1 month, 3 months after operation, and at last follow-up. The operations were successfully completed in both groups without severe complications such as vascular nerve injury and coracoid fracture. In the control group, 1 case (5.9%) had slight pin tract infection and 1 case (5.9%) had Kirschner wire displacement; there was no obvious complication in the study group. The patients in both groups were followed up 9-36 months (mean, 22.9 months). The fracture healing time of the study group and the control group were (12.56±0.73) weeks and (13.59±0.87) weeks, respectively, and the difference was significant ( t=-3.661, P=0.001). At last follow-up, the increase rates of coracoclavicular space on the affected side of the study group and the control group were 8.88%±1.19% and 8.55%±1.07%, respectively, showing no significant difference ( t=0.837, P=0.409). The postoperative VAS score and Constant-Murley score of the two groups significantly improved when compared with those before operation, and the two scores gradually improved with the extension of time after operation ( P<0.05). Except that the VAS score at 1 week and 1 month after operation and the Constant-Murley score at 1 month after operation in the study group were significantly better than those in the control group ( P<0.05), there was no significant difference between the two groups at other time points after operation ( P>0.05). For oblique fracture or combined with butterfly fracture in the distal clavicle fracture with coracoclavicular ligament injury, the fracture site high-strength suture Nice knot fixation is a good supplement to the Endobutton plate coracoclavicular fixation. It can stabilize the fracture end, reduce the complications of Kirschner wire fixation, and is more conducive to fracture healing. The effectiveness is satisfactory.

A modified single-endobutton technique combined with nice knot for treatment of Rockwood type III or V acromioclavicular joint dislocation

PurposeDouble-endobutton technique, as a widely accepted strategy for the treatment of acromioclavicular joint dislocation, is undergoing constant improvement. This study aims to assess the clinical effect of a modified single-endobutton combined with the nice knot in the fixation of Rockwood type III or V acromioclavicular joint dislocation.MethodsFrom January 2016 to June 2019, 16 adult patients (13 males and 3 females) with Rockwood type III or V acromioclavicular joint dislocation were treated with a modified single-endobutton technique combined with the nice knot in our department. The age ranged from 18 to 64 years old with an average of 32.8 years old. Operative time, intraoperative blood loss, post-operative clinical outcomes and radiographic results were recorded and analyzed. Preoperative and last follow-up scores in the Constant-Murley Scale, Neer score, Rating Scale of the American Shoulder and Elbow Surgeons and VAS scale and complications such as infection, re-dislocation, implant loosening, medical origin fracture and hardware pain were recorded and evaluated.ResultsSixteen patients were followed up for 6 to 18 months with an average of 10.3 months. The operative time was 50–90 min with an average of (62.5 ± 3.10) min. The intraoperative blood loss was 30–100 ml, with an average of (55.0 ± 4.28) ml. The complications, such as wound infection, internal fixation failure and fractures, were not found in these cases. According to Karlsson criteria, there were excellent in 14 cases, good in 2 cases at the final follow-up. The mean VAS score of the patients was 5.88 ± 0.26 preoperatively, compared with 0.19 ± 0.14 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). The mean Constant score was 45.5 ± 2.0 preoperatively, compared to 94.0 ± 0.73 at the final follow-up evaluation. The difference was statistically significant (P < 0.05). Patients had statistically significant preoperative and postoperative AC (acromioclavicular distance) and CC (coracoclavicular distance) distances (P < 0.05); 6 months postoperatively the AC(P = 0.412) and CC(P = 0.324) distances were not statistically significant compared to the healthy side.ConclusionNice knot provides a reliable fixation for the single-endobutton technique in the treatment of acromioclavicular dislocations. The modified single-endobutton technique combined with the nice knot can achieve good clinical outcomes in the treatment of Rockwood type III or V acromioclavicular joint dislocation.