Nice Knot Research Articles

Is Nice knot suture comparable to wire for cerclage fixation? A biomechanical performance study

Cerclage fixation is a known orthopedic technique shown to be beneficial for circumferential augmentation when screw fixation cannot be used or is undesirable. However, ongoing advances in suture materials and knot techniques exist, and there is a paucity of evidence existing which evaluates comparisons between the two. The objective of this study was to investigate the strength and durability of cerclage fixation between the Nice knot suture technique and monofilament wire. Static displacement over time and compression load testing were analyzed. Compression testing was conducted with the Jamar Hydraulic Hand Dynamometer. Distraction testing was conducted using the Instron test system with its associated program. The Nice knot was tied using number 2 and number 5 FiberWire (Arthrex) and compared to monofilament wire. Clinical failure (displacement of 10 mm), absolute failure (opening of the knot or material failure), maximum compression achieved, and steady state compression maintained were the outcomes of interest. Double-stranded monofilament wire produces maximum consistent compression of 90 kg, followed by single-stranded monofilament wire (60 kg). Number 5 FiberWire has a higher maximum compression load than number 2 FiberWire (50 kg vs. 22 kg), but it is lower than that of the double-stranded monofilament wire constructs. When compared to the single-stranded monofilament construct, the number 5 FiberWire Nice knot is comparable (P < .05). Average steady state compression achieved after 10 minutes of resting showed double-stranded monofilament wire to be 65 kg compared to single- stranded monofilament wire at 42 kg, which when, compared to suture, number 5 FiberWire measured at 15 kg and number 2 FiberWire at 8 kg. Average tension results from Instron distraction testing showed the double-stranded monofilament wire construct was able to withstand greater forces up to a displacement of 6 mm, after which the number 5 FiberWire Nice knot was stiffer. Number 5 FiberWire shows the most linear tension relationship, revealing it more efficiently withstands elastic forces. Load to failure was higher in the number 5 FiberWire Nice knot construct than that in both the monofilament wire constructs. The modes of failure for the Nice knot were always at the knot suture interface rather than at the knot. We propose this suture technique to be a viable alternative method for cerclaging to fix upper limb long-bone fractures.

Comparison of mechanical properties between Nice knot, Modified Nice knot, and surgeon's knot

BackgroundThe success of surgical repairs rely on the effectiveness and integrity of the surgical knots used to secure the repair. The purpose of this study is to examine and compare the performance of the Nice knot, the modified Nice knot, and a commonly used combination of surgeons' and square knots with respect to cyclic loading and load-to-failure usiflueng a high-strength suture composed of ultra-high molecular weight polyethylene in the hands of experienced surgeons. MethodsTwo experienced surgeons threw 3 different knot types 9 times, consisting of the Nice knot, modified Nice knot, and a surgeon's knot utilizing Ultrabraid #2 sutures. Each knot was subject to cyclic loading and load to failure testing. FindingsBoth surgeons had similar displacement data for the surgeon's knot, while the identity of the surgeon impacted displacement for the Nice knot (p = 0.03) and the modified Nice knot (p = 0.0002). The load to failure for the modified Nice knot (p < 0.001) and the Nice knot (p = 0.001) were significantly impacted by the surgeon tying the knot, while the surgeon's knot was not. Specimens failed where the sutures passed through the loop at the “base” of the knot. InterpretationsThe strength and integrity of complex surgical knots are variable between surgeons. While the proposed Modified Nice Knot has a theoretical advantage because the half hitches reinforce the primary knot, in load to failure testing both the Modified Nice Knot and the Nice Knot failed where the suture passed through the loop in the primary knot.

Comparison of double-strand braided polyester sutures tension band (Nice knot) with cable tension band in transverse patellar fractures

BackgroundThe tension band technique is the most common method for internal fixation of transverse patellar fractures. Titanium cable and high-strength sutures have been successfully applied in this treatment; however, few studies have compared the Nice knot technique using sutures with the standard cable technique. Whether the suture technique (Nice knot) provides preferable results compared with those of the cable technique is unclear. MethodsForty patients with transverse patellar fractures participated in this study. Twenty patients underwent sutures tension band fixation (Nice knot), and the others were managed with cable tension bands. All patients were followed up at 1, 3, 6, and 12 months. Pain was measured by VAS scores, flexion and extension of the knee were measured in degrees by goniometry, and knee function was evaluated using the Böstman clinical grading scale. ResultsThe two groups had equal distributions in age, gender, injured side, and fracture classification. The mean operation time in the suture group was shorter (55.75±9.77 minutes versus 64.25±9.63 minutes). The VAS score was comparable in the two groups at the 1-month, 3-month, and 6-month follow-ups; however, the score was lower at 12 months postoperatively in the suture group (P=0.037). No significant difference was found in flexion, extension, Böstman score, or fracture healing time in either group (P>0.05). Postoperative complications were higher in the cable group (9 versus 2) (P = 0.031) but were mostly related to symptomatic soft tissue irritation. ConclusionThe suture tension band technique using braided polyester nonabsorbable sutures tied with Nice knot was as effective as the cable tension band technique for transverse patellar fracture management. However, more convenient operations, less cost and fewer complications were found in suture fixation (Nice knot).

Indirect reduction technique via Nice knot for transverse fracture of patella

To assess the outcomes in indirect reduction technique via Nice knot for transverse patellar fractures. The clinical data of 25 patients with transverse patellar fractures meeting the inclusion criteria between January 2017 and December 2018 were retrospectively analyzed. The patients were divided into trial group ( n=13) and control group ( n=12) according to different intraoperative reduction methods. No significant difference was found in gender, age, affected side, cause of fracture, classification, or the time from injury to operation between the two groups ( P>0.05). In the trial group, No.2 suture was used to cross the quadriceps tendon and patellar tendon to construct the Nice knot, then the suture was tightened to make the distal and proximal fracture segments contact in an indirect reduction pattern. Depend on Nice knot's sliding compression and self-stabilizing function, the suture mesh created an anterior tension band as a temporary fixation. In the control group, Weber's clamp was used to hold the fracture segments directly and fixed temporarily. After reduction, terminal fixation was conducted using a titanium Kirschner wire with titanium cable in both groups. The operation time, intraoperative blood loss, follow-up time, fracture healing time, and complications were recorded and compared in the two groups. At last follow-up, the knee function was evaluated according to the Böstman scoring criteria for efficacy in patellar fractures. The operation time in the trial group was significantly shorter than that in the control group ( t=-2.165, P=0.041). There was no significant difference of intraoperative blood loss between the two groups ( t=0.514, P=0.612). The incisions of the two groups healed by first intention. All the patients were followed up 12-16 months, with an average of 14.4 months, no significant difference was found in the follow-up time between the two groups ( t=-0.309, P=0.760). One patient in the control group developed soft tissue irritation symptoms at 1 day after operation, and no special treatment was given, the symptoms disappeared at 2 months after operation. The fractures of the two groups healed at the 12-week follow-up. During the follow-up, there was no complication such as loosening and fracture of titanium cables and tendon tissue calcification. At last follow-up, the Böstman score presented no significant difference between the two groups ( t=-0.086, P=0.932). In the trial group, an 80-year-old female patient was evaluated as good (score, 27) due to atrophy of the quadriceps femoris, leg weakness, and affected stair climbing, and the rest 24 patients were all evaluated as excellent. The indirect reduction with Nice knot can shorten the operation time in the treatment of transverse patellar fractures, and obtain good effectiveness.

The comparison of Nice knots and traditional methods as an auxiliary reduction-fixation technique in pre-contoured locking plate fixation for comminuted Robinson type 2B clavicle fracture: A retrospective study.

Open reduction and pre-contoured locking plate fixation is a popular treatment option for displaced midshaft clavicle fracture. Lag screw and cerclage are 2 main intraoperative techniques to reduce and fix fragments. However, both lag screw and metallic cerclage have disadvantages. The doubled-suture Nice knot has been reported in many areas of orthopedic surgery for its effectiveness. This study aims to compare the outcomes of comminuted mid-shaft clavicle fractures reduced by Nice knots vs traditional techniques (lag screw or/and metallic cerclage) when bridged with pre-contoured locking plates.We retrospectively reviewed 101 patients (65 females and 36 males) diagnosed with midshaft clavicle fractures with at least one wedge fragment reduced by either Nice knots or traditional methods and bridged with pre-contoured locking plates between December 2016 and April 2019. Operation time, functional outcomes, pain, patient satisfaction, fracture healing, and complications were assessed at a follow-up of 12 to 40 months.The mean age of all the patients was 50.8 years. There were 52 and 49 patients in the Nice knot group and traditional group respectively, and no differences between 2 groups were found in general patient characteristics, fracture type, follow up and injury-to-surgery duration. The Nice knot group had significant less operation time (P < .01) than the traditional group (mean and standard deviation [SD], 78.6 ± 19.0 compared with 94.4 ± 29.9 minutes, respectively). For healing time, functional score, pain, satisfaction and complications, there were no significant differences between groups, despite the Nice knot group had slightly better results.Both Nice knots and traditional methods treated for comminuted Robinson type 2B clavicle fractures were effective and safe. And the Nice knots seemed to be superior with significant less operation time.

Clinical outcomes of doubled-suture Nice knot augmented plate fixation in the treatment of comminuted midshaft clavicle fracture

BackgroundFree bone fragments were difficult to be fixed in many comminuted midshaft clavicle fractures, and the absence of cortical alignment in comminuted fractures had direct influence on the stability of fixation. This survey was performed to assess the efficacy of doubled-suture Nice knot augmented plate fixation in the treatment of comminuted midshaft clavicle fractures.MethodsBetween 2013 and 2018, all patients with comminuted midshaft clavicle fractures treated with doubled-suture Nice knot augmented plate fixation were retrospectively reviewed and included in this research. Demographic data of the patients, characteristics of the fractures, intraoperative parameters and follow-up data of the patients were evaluated and summarized.Results A total of 56 patients were included in this study. The mean follow-up time was 25.6 months (range, 12–60 months). The number of male patients was 38 (67.9 %) and of the female patients was 18 (32.1 %). The average age of all patients was 47.89 ± 16.5 years. The mean time of surgery was 85.6 ± 24.0 min. The average length of incision was 9.2 ± 1.9 cm. The number of doubled-suture Nice knot applied ranged from 1 to 5 knots. All the patients reached bone union after the treatment. There was no implant failure or neurovascular injury observed. And most of the patients showed good functional outcome.ConclusionsThe doubled-suture Nice knot could provide reliable fixation for small bone fragments in comminuted clavicle fractures. Combination of the doubled-suture Nice knot and plate screws fixation was a safe and effective method in comminuted midshaft clavicle fractures treatment.

Intraoperative Nice knots assistance for reduction in displaced comminuted clavicle fractures

PurposeThe Nice knots have been widely used in orthopedic surgeries to fix torn soft tissue and fracture in recent years. The study aims to investigate the clinical efficacy and prognosis of intraoperative and postoperative Nice Knots-assisted reduction in the treatment of displaced comminuted clavicle fracture.MethodsFrom Jan 2014 to Dec 2019, 75 patients diagnosed with unilateral closed displaced comminuted clavicle fracture were treated with open reduction and internal fixation (ORIF) in this study. Nice knot group (the NK group) included 38 patients and the other 37 patients were in the traditional group (the TK group). The time of operation and the amount of bleeding during operation were recorded. Post-operative clinical outcomes and radiographic results were recorded and compared between these two groups. The Visual Analogue Scale (VAS), Neer score, Rating Scale of the American Shoulder and Elbow Surgeons, Constant-Murley score and complications such as infection, nonunion, implant loosening, fragment displacement and hardware pain were observed in the two groups.ResultsIn the comparison between the two groups, there was no significant difference in age, sex, the cause of displaced clavicle fracture, and other basic information between the two groups. The operation time, intraoperative fluoroscopy time, and intraoperative blood loss were significantly reduced in the NK group (P < 0.01). There were 2 cases of plate fracture in the TK group. The follow-up results showed that there was no significant difference in VAS, Neer score, ASES, and Constant-Murley scores between the two groups.ConclusionThe use of Nice knot, in comminuted and displaced clavicle fractures can reduce intraoperative blood loss, shorten operation time, facilitate intraoperative reduction, and achieve satisfactory postoperative clinical results. This study demonstrates that Nice knot is a simple, safe, practical and effective auxiliary reduction method.

Skin stretch suturing with Nice knots in the treatment of small- or medium-sized wounds

BackgroundTo investigate the clinical efficacy and outcomes of skin stretch suturing with self-locking sliding Nice knots in the treatment of small- or medium-sized wounds.MethodsFrom June 2015 to May 2018, 26 patients with small- or medium-sized wounds were included in the present study. Skin stretch suturing with self-locking slide Nice knots was performed to gradually close the soft-tissue defects in these patients. The time of wound closure and healing was recorded. The color and blood supply of the skin, cutaneous sensation, the stretch of skin, and the hair growth situation of the skin wound were observed and recorded.ResultsThere were 17 males and 9 females with an average age of 30.65 years (range, 15–48 years). The areas of the soft-tissue defects were between 3.2 × 7.1 cm and 8.0 × 15.2 cm. All patients underwent stretch suturing with self-locking slide Nice knots to close the soft-tissue defects. All wounds were successfully closed and healed. The mean time of wound closure was 10.69 days (range, 5–20 days), and the mean time of wound healing was 16.85 days (range, 10–24 days). The cutaneous sensation of skin wound recovered normally, and the color of the skin wounds was the same as that of normal skin at the last follow-up. The hair growth situation of the skin wounds also returned to normal.ConclusionsThis study revealed that Nice knots yielded an accepted clinical result as a new method to close small- or medium-sized wounds that was simple and less minimally invasive, resulted in progressive tension, did not return to previous results, and partially replace flaps or free skin grafts.

Modified Double-Endobutton technique combined with Nice knot in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation

To explore the clinical effect of the modified double Endobutton technique combined with Nice node in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation. From March 2016 to January 2019, 23 patients with Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation were treated with modified double Endobutton technique to reconstruct coracoclavicular ligament and Nice node to repair acromioclavicular ligament, including 18 males and 5 females, aged 31 to 53 (43.2±5.4) years, 9 on the left and 14 on the right, and the time from injury to operation was 1 to 10 days. Before operation, X-ray films and CT three-dimensional reconstruction of bilateral shoulder joint were performed. Postoperative complications were observed. Six months after operation, DASHand Constant-Murley scores were used to evaluate the treatment effect. The incision healed in one stage after operation, and no complications such as vascular and nerve injury and stress fracture occurred. All patients were followed up for 6 to 24 (12.0±4.9) months. At 6 months follow-up, the DASH score was 0.40±0.10 lower than that of 19.80±4.50 before operation, and the Constant-Murley score was 94.20±4.20 higher than that of 38.60±3.90 before operation. The treatment of Rockwood Ⅲ-Ⅴ dislocation of acromioclavicular joint with double Endobutton technique and nice knot is satisfactory in the early stage. The long-term effect and complications need further follow-up.

Clavicular osteotomy in complicated revision of total shoulder arthroplasty: indications, surgical technique, and outcomes.

Adequate exposure in revision of total shoulder arthroplasty (TSA) is important for optimal prosthesis placement and functional results. A clavicular osteotomy in difficult cases of revision TSA is a useful surgical technique that increases the superior exposure area, provides safer dissection, minimizes damage to the anterior deltoid muscle, improves glenoid access, and allows for superior dislocation of the humeral component. There is a paucity of literature analyzing the clavicular osteotomy during challenging cases of revision TSA. The aims of this study were to describe the application, surgical technique, and outcomes of revision TSA with a clavicular osteotomy. This was a retrospective study of consecutive patients who underwent revision TSA with a clavicle osteotomy at a single institution (2004-2016). A curved longitudinal clavicular osteotomy is created parallel to the origin of the anterior deltoid muscle. This allows for lateral reflection of the osteotomy and anterior deltoid muscle to significantly increase superior exposure and reduce damage to remaining deltoid muscle fibres. Osteotomy closure is simple with four or five Nice knot osteosutures. The Constant-Murley score and osteotomy healing were assessed at every follow-up. All complications were reviewed. Forty patients who had a mean age of 63.8years (range 37-87) at time of surgery and mean follow-up duration of 34months (range 12-88) were analyzed. Pre-operative Constant-Murley scores improved significantly from 32 ± 19.0 to 58 ± 15.0 (p < 0.001) at oneyear and 65 ± 13.1 (p < 0.001) at twoyears. Primary osteotomy healing and callus formation were evident in 95% of cases by threemonths. Five patients developed post-operative complications (13%) related to the clavicular osteotomy: three mid-diaphyseal clavicular fractures sustained after trauma (8%), one clavicular stress fracture (3%), and case of one loosening (3%). Three patients (8%) required surgical revision of the osteotomy (two internal fixation and one revision osteosuturing). No neurovascular injuries or scapular fractures were encountered. A curved longitudinal clavicular osteotomy is beneficial in difficult revision TSA and is another tool in the arsenal of experienced shoulder surgeons who manage these challenging cases. This surgical technique increases glenoid exposure, facilitates superior dislocation of the humeral component, minimizes anterior deltoid damage, and reduces the risk of neurovascular injuries. All clavicular complications occurred within fourmonths prior to osteotomy union, with many sustained due to trauma. However, patients who developed a complication had comparable shoulder function as those without.

Évaluation biomécanique d’une nouvelle technique de stabilisation acromio-claviculaire par réparation directe

BackgroundThe most commonly used repair techniques to treat an acromioclavicular dislocation imply a suspension mechanism by substituting the supero-inferior oriented coracoclavicular structures with a tight rope mechanism or allograft. Recently, the importance of restoring the antero-posterior stability by addressing the acromioclavicular structures has also been demonstrated. If an in situ repair at the acromioclavicular joint itself could achieve a reposition and would be strong enough, the suspension of the CC structures might become obsolete. Possible advantages would be minimal dissection, lower risk in damaging neurovascular structures, greater stability, reduction of the surgical time and even the possibility of locoregional anesthesia. HypothesisIn this biomechanical study, the feasibility of different in situ repair techniques is explored, thereby testing both compression and translation characteristics. Our hypothesis is that an in situ repair technique results in an adequate repair for the AC joint. Methods and materialsPolyurethane foam blocks will be used as a model for the acromioclavicular joint and the repair techniques will be done by using a combination of sutures and bone anchors or using a transosseous technique. Compression will be measured by means of a Tekscan pressure sensor and translation will be tested in three orthogonal directions using a tensile testing machine. Four different knot anchor configurations (nice knot, surgical knot in two different configurations, nicky's knot) will be tested for compression. The strongest knot anchor configuration will then be compared side to side with a transosseous configuration for translation. ResultsThe nice knot in combination with bone anchors provides the strongest compression. In the side to side comparison of a nice knot anchor configuration versus a transosseous nice knot configuration, the transosseous technique shows more resistance to translation. DiscussionAn in situ repair by a combination of the nice knot with an anchor or a transosseous nice knot configuration can theoretically be used as a repair technique for an acromioclavicular dislocation. In comparison with existing techniques, this model shows favorable results for translation. Level of evidenceIII, controlled laboratory study.

Biomechanical evaluation of a new technique for acromioclavicular stabilization

BackgroundThe most commonly used repair techniques to treat an acromioclavicular dislocation imply a suspension mechanism by substituting the supero-inferior oriented coracoclavicular structures with a tight rope mechanism or allograft. Recently, the importance of restoring the antero-posterior stability by addressing the acromioclavicular structures has also been demonstrated. If an in situ repair at the acromioclavicular joint itself could achieve a reposition and would be strong enough, the suspension of the CC structures might become obsolete. Possible advantages would be minimal dissection, lower risk in damaging neurovascular structures, greater stability, reduction of the surgical time and even the possibility of locoregional anesthesia. HypothesisIn this biomechanical study, the feasibility of different in situ repair techniques is explored thereby testing both compression and translation characteristics. Our hypothesis is that an in situ repair technique results in an adequate repair for the AC joint. Methods and materialsPolyurethane foam blocks will be used as a model for the acromioclavicular joint and the repair techniques will be done by using a combination of sutures and bone anchors or using a transosseous technique. Compression will be measured by means of a Tekscan pressure sensor and translation will be tested in three orthogonal directions using a tensile testing machine. Four different knot anchor configurations (nice knot, surgical knot in two different configurations, Nicky's knot) will be tested for compression. The strongest knot anchor configuration will then be compared side to side with a transosseous configuration for translation. ResultsThe nice knot in combination with bone anchors provides the strongest compression. In the side to side comparison of a nice knot anchor configuration versus a transosseous nice knot configuration, the transosseous technique shows more resistance to translation. DiscussionAn in situ repair by a combination of the nice knot with an anchor or a transosseous nice knot configuration can theoretically be used as a repair technique for an acromioclavicular dislocation. In comparison with existing techniques, this model shows favorable results for translation. Level of evidenceIII, controlled laboratory study.

Vertical Interfragmentary Doubled Suture for Displaced Patella Fractures: Sequential Compressive Tightening with Nice Knot.

In the treatment of displaced patella fractures, open reduction and internal fixation is essential for patellofemoral congruency and restoration of the knee extension mechanism. Various surgical techniques and materials can be used, and their clinical outcomes are favorable. However, soft-tissue and skin irritation, pain, and limited range of motion due to metallic hardware can occur, and removal of hardware such as screws and K-wire may be required after bony union. We present a vertical interfragmentary suture technique for patella fractures using sequential compressive tightening with the Nice knot. This knot-tying technique is low profile, provides stable fixation enough to hold displaced fractures, and does not require a secondary procedure for hardware removal.

The application of the Nice knots as an auxiliary reduction technique in displaced comminuted patellar fractures

PurposeTo evaluate intraoperative and early postoperative clinical outcomes using the Nice knot as an auxiliary reduction technique in displaced comminuted patellar fractures. MethodsThirty-nine patients with unilateral closed displaced comminuted patellar fractures received open reduction and internal fixation (ORIF), utilizing either Nice knot (the NK group, 24 patients) or traditional reduction (the TR group, 23 patients) techniques, were retrospectively reviewed in this study. Intra-operative surgical time and peri-operative hemoglobin were recorded. Post-operative clinical outcomes were measured using visual analgesic score, range of motion of the knee joint and the Böstman scales, and radiographic outcomes were used to evaluate fracture healing. Complications including infection, bone non-union, implant loosening, fragment displacement and painful hardware were also assessed. ResultsIn-hospital records indicated significantly shorter surgical duration (32.6 min) in the NK group than in the TR group (63.9 min). Intraoperative blood loss was also significantly decreased in the NK group (64.7 ml) compared to the TR group (189.1 ml). Patients in the NK and TR groups were followed for mean of 12.9 months and 12.5 months respectively. The union rate was 100% (24/24) in the NK group and 91.3% (21/23) in the TR group. In the TR group, there were two non-unions, including one infected non-union. There was no difference in the visual analgesic score, the range of motion of the knee joint or the Böstman scale at last follow-up between the two groups. ConclusionThe sliding, self-stabilizing Nice knot was associated with reduced surgical time, decreased intraoperative blood loss, and satisfactory postoperative outcomes in the treatment of displaced patellar fractures. Future studies are needed to ensure the generalizability of these findings to additional patient populations at other institutions.

Effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults

To investigate the effectiveness of Nice knot combined with elastic intramedullary nailing fixation in treatment of Robinson type 2B midshaft clavicular fracture in adults. Between March 2016 and January 2018, 20 patients with Robinson type 2B midshaft clavicular fractures were treated with reduction and internal fixation by Nice knot and elastic intramedullary nailing. There were 13 cases and 7 cases, with an average age of 43 years (range, 18-56 years). The causes of injury included the traffic accident in 6 cases, falling in 12 cases, and falling from height in 2 cases. The interval between injury and admission ranged from 1 hour to 2 days (mean, 3.2 hours). The fractures were classified as Robinson type 2B1 in 16 cases and type 2B2 in 4 cases. The length of incision, the operation time, the visual analogue scale (VAS) score on the 2nd day after operation, the fracture healing time, the postoperative shoulder function and the Disability of Arm Shoulder and Hand (DASH) score, the complications, and the time of second surgical removal of internal fixator and incision length were recorded. The length of incision was 2-6 cm (mean, 4.7cm). The operation time was 45-120 minutes (mean, 77.2 minutes). The VAS score was 1-5 (mean, 3.2) on the 2nd day after operation. All incisions healed by first intention and no infection or nerve injury occurred. All patients were followed up 12-32 months (mean, 18.6 months). All fractures healed with the healing time of 10-15 weeks (mean, 12.1 weeks). The Constant score was 92-98 (mean, 96.3) and DASH score was 0-6.4 (mean, 3.1). The elastic intramedullary nailing bending and hypertrophic nonunion occurred in 1 case and the skin stimulated by elastic nail tail in 1 case after operation. The internal fixators were removed at 12-26 months (mean, 14.6 months) after operation. And the length of incision was 1-2 cm (mean, 1.3 cm) and the operation time was 5-15 minutes (mean, 9.0 minutes). For the midshaft clavicular fracture in adults, the procedure of the Nice knot combined with elastic intramedullary nail has advantages of small incision, light pain, rapid fracture healing, small secondary operation injury, and avoiding the risk of clavicular epithelial nerve injury, and can obtain good effectiveness.

Nice Knot New Applications in Wrist Arthroscopy

The use of cerclage alone or as a supplement to other forms of internal fixation is common in orthopedic practice. The Nice knot is a doubled stranded knot described by Boileau and colleagues. Its original application was proposed for tuberosity osteosynthesis in proximal humerus fractures. The Nice knot has been used vastly in shoulder surgery and is now widely use in others surgeries. This article aims to describe the utilization of the Nice knot in wrist arthroscopy to repair the triangular fibrocartilage complex or the scapholunate ligament. We modified the techniques described by Mathoulin for these repairs. The Nice knot is a simple knot, easy to use under arthroscopy to repare the scapholunate ligament and the triangular fibrocartilage complex tears.

The best knot and suture configurations for high-strength suture material. An in vitro biomechanical study

PurposeSurgical knots are particularly challenged by high-strength suture material. It was hypothesized that sutures in a double-stranded looped configuration present mechanical advantages. MethodsThis in vitro biomechanical study repeatedly tested 12 different knots with a static distraction material testing machine with a constant tensile speed. The cow hitch, its altered version, and conventional half hitches were also tested on bovine tendon. Suture material was braided polyblend non-bioresorbable polyester. Primary outcome was knot security (stiffness) at clinical failure (≥3mm displacement). Secondary outcomes were knot size and loop security. ResultsDouble-stranded looped knots were up to three times stronger than one and a half- and single-stranded knots. The cow hitch was stiffest (mean 185 [95% CI 172–197]Newton per millimeter [N/mm]) (p<0.001), followed by the Nice knot (169 [154–183]N/mm). It was stiffer than half hitches (65 [53–78]N/mm). These findings remained in tendons (82 [77–86] and 40 [32–49]N/mm, p<0.001). The cow hitch (7.6mm3) and Nice knot (6.1mm3) were smaller than half hitches (9.5mm3). Loop security did not differ between the cow hitch and Nice knot, but was higher in the cow hitch than half hitch (158 [120–196]N and 85 [57–113]N, p<0.001). ConclusionsDouble-stranded knot configurations with a loop on one side are mechanically stronger and stiffer, less bulky, and preserve applied tension during tying better than conventional knots. The best performing and technically most simple knots best suited to exploit enormous mechanical capabilities of modern high-strength suture material are the cow hitch and Nice knot. Level of evidenceNot applicable due to the biomechanical nature of the study.

Is suture comparable to wire for cerclage fixation? A biomechanical analysis.

Cerclage wire is the current standard for circumferential bone fixation. Advances in technology have improved modern sutures, allowing for expanded utility and broader application. The present study compared the strength and durability of cerclage fixation between modern suture materials and monofilament wire. The Surgeon's Knot, the Nice Knot and the Modified Nice Knot, were each tied using three separate suture materials: no. 2 FiberWire (Arthrex, Naples, FL, USA), no. 2 Ultrabraid (Smith & Nephew, Andover, MA, USA) and no. 5 Ethibond (Johnson & Johnson, Somerville, NJ, USA). These sutures were compared with monofilament wire. Sutures were secured around a fixed diameter using three additional half hitches, whereas a 1.2-mm (18 gauge) stainless steel monofilament wire was used for comparison. One fellow and one orthopaedic surgery resident each tied five trials with every knot/material combination. Samples were subjected to cyclic loading and quasi-static load testing. Respectively, cyclic displacement over time and load to failure were analyzed. Clinical failure (3 mm of cyclic displacement) and absolute failure (opening of the knot or material failure) were the outcomes of interest. During cyclic loading, Ethibond displaced significantly less over time compared to monofilament wire (p < 0.003), whereas FiberWire showed no significant difference. Ultrabraid also behaved similar to wire, except displacing significantly more than wire only with the Surgeon's Knot (p = 0.02). During load to failure, Ethibond and FiberWire failed at significantly greater loads than monofilament wire (p < 0.001), whereas Ultrabraid performed similar to wire. Knot types did not appear to impact the results. High-performance sutures achieve superior results in biomechanical testing under cyclic and quasi-static load compared to monofilament wire, suggesting that they provide an alternative to wire for cerclage fixation with select clinical application. Biomechanical security of suture cerclage is dependent on suture material, although it is not altered significantly by choice of knot. An ex-vivo study with clinical application would further reinforce whether suture cerclage offers a valid alternative to wire cerclage.

The Doubled-Suture Nice Knot.

The authors describe a novel suture fixation technique that combines a doubled suture with a sliding knot. The knot can be tied in both open and arthroscopic surgery to fix torn tendons/ligaments and fractured/osteotomized bones. The advantages of the doubled-suture Nice knot include strength, adjustability, simplicity, and versatility. This technique, which has proven useful in the authors' practice for the past 10 years, has replaced metallic wires and cables for bone fixation. The doubled-suture Nice knot can also be tied over a double-button and has been used for ankle syndesmosis, acromioclavicular joint separation repair, and coracoid bone block fixation. [Orthopedics. 2017; 40(2):e382-e386.].

The Nice knot as an improvement on current knot options: A mechanical analysis

PurposeThere is currently a wide range of suture knots used in rotator cuff repair. The purpose of this study was to compare a new type of self-locking sliding knot called the Nice knot to the self-locking and sliding Nicky's knot. MethodsNice knots and Nicky's knots were tied and subjected to mechanical testing including a pure traction stress and a series of dynamic stresses. Both knots were tied using standard braided suture and reinforced braided suture. The responses to these stresses were measured in the amount of elongation of the knot, maximum effort needed for failure, stiffness of construct and dynamic stiffness. ResultsWith both knots the standard suture had a lower amount of elongation during the dynamic tests than the reinforced braided suture. The reinforced braided suture showed superior results during maximal effort in the pure traction tests. An increased failure rate occurred due to elongation when a dynamic stress was applied to the reinforced suture in both knot types. During dynamic testing the Nice knot showed a decrease in the amount of elongation (P<0.001). ConclusionsThe Nice knot provides a sliding locking knot option which can decrease the risk of elongation during dynamic stress. Level of evidenceBasic Science Study, Biomechanical Study.