Fixation Of Patellar Fractures Research Articles

A retrospective review of revision and re-revision patella osteosynthesis performed for failure of fixation of initial comminuted fracture patterns: very high complication rates.

Literature on revision osteosynthesis for failed patella fracture fixation is extremely limited. This study reviews the treatment options and outcomes for revision and re-revision osteosynthesis at a Level 1 Trauma Center. All patella revision osteosynthesis between January 2021 and March 2024 were identified using Current Procedural Terminology (CPT) codes at a single tertiary care academic centre. Medical records, operative reports and radiographs were reviewed to collect details regarding patient demographics, initial injury and fracture management, indications for revision surgery, revision construct, post-operative weight bearing and range of motion restrictions, and outcomes. The primary outcome was major failure defined as loss of fixation or further surgery for non-union or infection. Ten patients underwent revision osteosynthesis for failed fixation. All fractures were initially comminuted fracture patterns (AO/OTA 34-C3), with nine (90%) initially treated with a 2.7mm patella-specific variable angle (VA) locking plate (Synthes, Paoli, PA). Half (n=5) of the patients were revised with the same patella specific plate and half with an all suture transosseous fibertape tension band (Arthrex, Naples, FL). Additional fixation in the form of bony augmentation was performed in 20% (n=2) of cases and soft tissue augmentation in 70% (n=7). There was a 70% (n=7) major failure rate, mostly due to loss of inferior pole fixation. There were four re-revision procedures performed with surgical fixation. Two of these subsequently developed infection, one united and the other had no radiographic signs of union and was lost to follow-up, but was without complication. Regardless of the chosen fixation construct, revision osteosynthesis for failed fixation of initial comminuted fracture patterns has an extremely high rate of failure. Complications increase with further revision surgery.

Cannulated compression screws with cable technique leads to a dramatic reduction in patella fracture fixation complications compared to tension band wiring.

The aim of this study was to compare the clinical, radiological and functional outcomes between cannulated compression screw with cable construct (CS) and tension band wiring (TBW) in transverse patella fractures. A retrospective study was conducted on patients surgically treated for AO/OTA 34C1 or 34C2 transverse patella fractures with CS or TBW technique between January 2019 and January 2023. Clinical outcomes included complications related to the implant, wound and fracture at 6 months and 1 year, time to achieving full weight bearing status and early perioperative clinical outcomes. Radiological outcomes included the time to fracture heals and delayed union. Functional outcome measures using the Oxford Knee Scale, 36-short form questionnaire and the Bartlett Anterior Knee Score were assessed. 73 patients were treated with CS (n = 33) or TBW (n = 40). TBW had higher complication rates: 25.0% (n = 10) required implant removal, 12.5% (n = 5) had wire breakage, 12.5% (n = 5) experienced fracture displacement while 52.5% (n = 21) experienced implant migration. In contrast, no CS patients had implant removals, wire breakage or fracture displacement and 3.0% (n = 1) experienced implant migration. At 1day post-operatively, 87.9% (n = 29) CS group patients were able to ambulate as compared to the 55.0% (n = 22) of TBW patients. Furthermore, CS patients ambulated further distances at 11.8 ± 10.6m than the TBW group (6.4 ± 7.4m). The CS group (25.9 ± 24.6 days) also achieved full weight bearing status faster than the TBW group (43.6 ± 39.4 days). The time taken for the fracture to heal and functional outcomes were comparable among the two groups. The CS technique demonstrated lower complications, in particular, no CS patient had implant removals, wire migration or fracture displacement. Additionally, CS technique showed a faster return to ambulation and time to achieving full weight bearing status.

Reconstruction of patella fractures with the tension band technique: A review on clinical results and tips and tricks

IntroductionThe goals of surgical treatment of patellar fractures are a biomechanically stable joint and congruent restoration of the retro patellar joint surface. Surgical treatment strategies for patellar fractures have evolved from tension band in combination with wire cerclages to new devices. MethodsThe modified anterior tension band (MATB) technique for fixation of patellar fractures consists of two longitudinal 1.8 mm Kirschner wires (K-wires) and an 18-gauge stainless steel wire looped in a figure-of-8 pattern over the anterior aspect of the patella. The K-wires should be inserted 5 mm from the anterior cortical surface of the patella, parallel in the coronal and sagittal planes. For mechanical reasons, the wire should be the closest to the anterior aspect of the bone. This construct converts the anterior tensile forces generated by the extensor mechanism and knee flexion into compressive forces on the anterior aspect of the fracture site. The MATB is the most widely accepted method of internal fixation for transverse and comminuted patellar fractures.Only a careful implementation of the MATB in all its phases will provide the best mechanical construct and the least aggressive construct for the soft tissues, allowing early re-education without complications. ResultsGood to excellent clinical results (64–100 %) have been reported with MATB for fixation of patellar fractures. Good to excellent range of knee motion and satisfactory results have been reported despite a high percentage (up to 60 %) of secondary procedures, mainly for removal of symptomatic hardware. ConclusionThis article provides an overview of the use and results of the MATB technique for patellar fractures and the means to improve results with this technique.

A new fluoroscopic view to evaluate the medial and lateral articular reduction quality in patella fractures during internal fixation

To introduce a new fluoroscopic method for assessing the quality of medial and lateral joint surface reduction during internal fixation of patellar fractures and to summarize the clinical outcomes of patients treated using this method. A retrospective analysis was conducted on the clinical data of 52 patients with patellar fractures treated between January 2018 and January 2022 who met the inclusion criteria. There were 27 male and 25 female patients, aged 21-75 years, with an average age of 62 years. The types of patellar fractures included 9 transverse fractures, 37 comminuted fractures, and 6 longitudinal fractures. According to the AO/Orthopaedic Trauma Association (AO-OTA)-2018 fracture classification, there were 21 cases of type 34A, 6 cases of type 34B, and 25 cases of type 34C. The time from injury to operation ranged from 1 to 5 days, with an average of 2.3 days. Treatments included internal fixation with hollow screws or hollow screw tension bands, with or without anchor repair. During operation, the medial and lateral joint surfaces of the patella were observed using the tangential fluoroscopic method to assess the smoothness of reduction of the median ridge, lateral joint surface, medial joint surface, and lateral joint edge. Patients were followed up regularly, and X-ray films were taken to observe fracture healing. Knee joint range of motion, Böstman score, and Lysholm score were used to evaluate functional recovery. The tangential fluoroscopic method for the medial and lateral joint surfaces of the patella during operation showed satisfactory reduction of the joint surfaces and good positioning of the implants. All patients were followed up 12-16 months, with an average of 13.4 months. During the follow-up, fracture displacement occurred in 1 case and titanium cable breakage in 1 case. All patella fractures healed successfully, with a healing time of 8-16 weeks (mean, 11.4 weeks). At last follow-up, knee joint range of motion ranged from 120° to 140°, with an average of 136°. The Böstman score ranged from 20 to 30, with an average of 28, yielding excellent results in 45 cases and good results in 7 cases. The Lysholm score ranged from 88 to 100, with an average of 93, yielding excellent results in 40 cases and good results in 12 cases. The intraoperative application of the tangential fluoroscopic method for the medial and lateral joint surfaces of the patella can quickly determine the fluoroscopic plane of the patella, accurately assess the quality of fracture reduction and the position of internal fixator, thereby improving effectiveness.

Distinct risk profiles for short-term surgical complications and venous thromboembolism exist among extensor mechanism repair procedures.

Extensor mechanism injuries, which comprise patella fractures, patella tendon tearsand quadriceps tendon tears, are severely debilitating injuries and a common cause of traumatic knee pathology that requires surgical intervention. Risk factors for short-term surgical complications and venous thromboembolism (VTE) in this population have not been well characterised. The aim of this study was to identify perioperative risk factors associated with these short-term complications. The National Surgical Quality Improvement Program database was used to identify patients who underwent an isolated, primary extensor mechanism repair from 2015 to 2020. Patients were stratified by injury type. Demographic data were collected and compared. A multivariate logistic regression was used to control for demographic and comorbid factors while assessing risk factors for developing short-term complications. A total of 8355 patients were identified for inclusion in this study. Overall, 3% of patients sustained short-term surgical complications and 1% were diagnosed with VTE within 30 days of surgery. Patella fracture fixation had a nearly twofold higher risk for surgical complications compared to quadriceps tendon repair (p = 0.004). Patella tendon repair had a twofold higher risk for VTE (p = 0.045), specifically deep vein thrombosis (p = 0.020), compared to patella fracture fixation. Increasing age, smokingand American Society of Anesthesiologists Classifications 3 and 4 were also found to be risk factors for surgical complications (p = 0.012, p = 0.004, p = 0.011 and p = 0.032, respectively). This study used a nationally representative, widely validated, peer-reviewed database to provide valuable insights into risk factors for short-term postoperative complications associated with extensor mechanism repair procedures, revealing notable differences in risk profiles among distinct surgical procedures. The results of this study will inform surgeons and patients in enhancing risk assessment, guiding procedure-specific decision-making, optimising preoperative care, improving postoperative monitoringand contributing to future research of extensor mechanism injuries. Level III.

Transverse patella fracture fixation: A cadaveric biomechanical comparison of cannulated screws and anterior tension band versus low-profile, multiplanar mesh plating

IntroductionMultiplanar mesh plating of patella fractures has become more popular in recent years. It was the goal of this study to compare the biomechanical stability of cannulated screw with anterior tension band to multiplanar mesh plating for fixation of transverse patella fractures in cadaver specimens. Materials and MethodsEight matched pairs of fresh frozen cadaveric knees were obtained and soft tissues dissected leaving the extensor mechanism, joint capsule, and retinaculum intact. Transverse fractures were created at the mid-portion of the patella. For each pair, one specimen was repaired using cannulated screws with anterior tension band, and the second was repaired using multiplanar mesh plating. Each specimen underwent cyclic extension loading with loads increasing by 1.1 kg after every 50 cycles. Interfragmentary displacement was measured at the end of each interval at both 5° and 45° of knee flexion angle, with fixation failure defined by >2 mm displacement. ResultsThe specimens fixed with multiplanar mesh plating survived more cycles and higher loads than the specimens fixed with cannulated screws with anterior tension band (p = 0.011 comparing survival plots). After 150 cycles of extension loading, 3 of 8 of the specimens fixed with screws/tension band had failed, whereas none of the mesh plated specimens had failed. After 400 cycles, 7 of 8 of the screws/tension band had failed, whereas half of the mesh plated specimens had failed. ConclusionsWhile a more technically challenging and expensive technique, mesh plating for patella fractures appears to offer greater durability than traditional cannulated screw with tension banding.

Migration of patella tension band metal wires to popliteal fossa: Retrieval by posterior knee arthroscopy – A case report and literature review

Breakage of metal wires after fixation of patella fractures are common. However, migration of the broken wires to intraarticular location, popliteal fossa and distant sites can be least expected and a difficult scenario for retrieval. We describe in a 58-year male who presented with recurrent locking and migration of broken wires in popliteal fossa. he had fixation of patella fracture nine years ago. The metal wire was retrieved safely from the posterior lateral aspect of knee popliteal fossa by posterior knee arthroscopy using two posterior lateral portals. Through this case, we review the presentation of migrated wires, methods of retrieval and role of arthroscopy. Retrieval of migrated wires by knee arthroscopy can be successful in intraarticular location and in select cases at popliteal fossa, however with significant challenges. To avoid concerns with migration of wires, patients treated with wires for patella fractures should be adequately followed with radiography and sensitized for removal before breakage or at the time of breakage.

Lateral rim variable angle locked plating versus tension band wiring of simple and complex patella fractures: a biomechanical study.

Treatment of both simple and complex patella fractures is a challenging clinical problem. Although tension band wiring has been the standard of care, it can be associated with high complication rates. The aim of this study was to investigate the biomechanical performance of recently developed lateral rim variable angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures. Sixteen pairs of human anatomical knees were used to simulate either two-part transverse simple AO/OTA 34-C1 or five-part complex AO/OTA 34-C3 patella fractures by means of osteotomies, with each fracture model created in eight pairs. The complex fracture pattern was characterized by a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral, and an inferior (central distal) fragment mimicking comminution around the distal patellar pole. The specimens with simple fractures were pairwise assigned for fixation with either tension band wiring through two parallel cannulated screws or a lateral rim variable angle locking plate. The knees with complex fractures were pairwise treated with either tension band wiring through two parallel cannulated screws plus circumferential cerclage wiring or a lateral rim variable angle locking plate. Each specimen was tested over 5000 cycles by pulling on the quadriceps tendon, simulating active knee extension and passive knee flexion within the range of 90° flexion to full extension. Interfragmentary movements were captured via motion tracking. For both fracture types, the articular displacements measured between the proximal and distal fragments at the central patella aspect between 1000 and 5000 cycles, together with the relative rotations of these fragments around the mediolateral axis were all significantly smaller following the lateral rim variable angle locked plating compared with tension band wiring, p ≤ 0.01. From a biomechanical perspective, lateral rim variable angle locked plating of both simple and complex patella fractures provides superior construct stability versus tension band wiring under dynamic loading.

Patellar Fracture Fixation Using Wide-Awake Local Anesthesia No Tourniquet (WALANT): A Novel Method

Objective: Patellar fractures, which account for approximately 1% of all fractures, frequently require surgical intervention for significant displacement. Traditional anesthesia methods pose various risks and complications, especially for patients with comorbidities. This study aims to evaluate the safety and feasibility of wide-awake local anesthesia no tourniquet (WALANT) for patellar fracture fixation. Methods: A retrospective evaluation was conducted on a total of 8 patients who underwent patellar fracture fixation using the WALANT technique between 2020 and 2022. Patient demographics, clinical findings, and postoperative outcomes were collected. Peroperative pain was assessed using the Numerical Pain Rating Score (NPRS) and Visual Analogue Scale (VAS). Outcomes, including bleeding, complications, and the Lysholm Knee Score at 12 months postoperatively, were evaluated. Results: The median age at surgery for a total of 8 patients, 6 males and 2 females, was 56 years (range: 38-73). The median surgery duration was 52 minutes (range, 38-73) , and postoperative pain onset was 160 minutes (range, 130-220). Minimal intraoperative bleeding was observed in most cases. Patient satisfaction with WALANT was high, with median VAS scores of 1 (range, 0-3) at 2 hours and 3 (range, 1-5) at 24 hours post-surgery. The median hospital stay was 2 (range, 1-7) days. One patient experienced a superficial skin infection. At 12 months postoperatively, the Lysholm Knee Score indicated satisfactory functional outcomes. Conclusion: This study is the first to explore WALANT for patellar fracture fixation. WALANT provides safe, effective anesthesia, high patient satisfaction, effective pain management, and shorter hospital stays. It benefits patients with comorbidities and offers an alternative to traditional anesthesia. Further research is needed to validate these findings and support wider use.

Novel technique for comminuted patellar fixation using suture tape in spiderweb configuration.

Patella fractures account for 1% of skeletal fractures in orthopedic surgery. Simple two-part patella fractures are uncommon; most fractures are comminuted with significant articular involvement. Traditionally, patella fractures have been fixed using a tension band technique with cerclage wire, which has several complications including soft-tissue irritation, implant migration, and breakage, leading to secondary implant removal in up to 37% of patients. Newer fixation methods using cannulated screws, hook plates, mesh plates, and locking plates show promise but are costly and require extensive soft-tissue dissection. There is a need for a better alternative, especially for the elderly with osteoporotic bones. Various authors have described patellar fixation techniques augmented with sutures and suture tape, showing satisfactory outcomes. This paper proposes a novel all-suture tape method for patellar fixation, suitable for common types of patella fractures including AO 34C1.1 (transverse), AO 34C2 (transverse and split), and 34C3 (comminuted). Suture tape is biomechanically superior in both soft tissue and bone. The patient is laid supine with the knee in full extension. A standard anterior midline approach is adopted. After reducing the fracture fragments and securing them with K-wires, non-absorbable suture tapes are used instead of cerclage wire. The tapes are passed multiple times through the soft tissue, creating loops that are then tensioned to compress the fracture fragments. The technique is completed by creating a tension band fixation with additional suture tapes. This technique offers several benefits, including reduced operative time, minimized soft-tissue dissection, and lower risk of implant prominence and irritation. The suture tape's superior tensile strength and low tissue reactivity reduce complications and the need for secondary surgeries. Early results from two cases show union achieved at 3 months without complications, with patients regaining full range of motion. This preliminary technical paper demonstrates the feasibility of using non-metallic implants for patella fracture fixation. The proposed method shows promising results, suggesting a potential shift in the approach to fracture fixation. Further research and larger cohort studies are needed to validate these findings.

Incidence of postoperative complications in patellar fractures related to different methods of osteosynthesis procedures - a retrospective cohort study

BackgroundPatellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management.MethodsIn a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines.ResultsA total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p < 0.043). The incidence of posttraumatic infection was significantly higher following the hybrid fixation technique with cannulated screws and tension wire than following the other analysed techniques (p = 0.024). No postoperative wound infection was observed after screw fixation or locking plate fixation. Symptomatic hardware was most frequently seen after tension-band fixation. Onset of posttraumatic osteoarthritis was most often found after the hybrid fixation technique (55%).ConclusionSurgical management of patellar fractures remains crucial but fracture fixation using plating systems or small fragment screws is least associated with postoperative complications.Trial registrationTrial registration number (DRKS):00027894.

PATELLA FRACTURE FIXATION WITH NOVEL WAGON WHEEL CONSTRUCT VERSUS TENSION-BAND CONSTRUCT: A TECHNICAL TRICK.

Internal fixation of patella fractures remains technically challenging. Cannulated screws with an anterior tension band have been associated with high rates of implant prominence, and fracture comminution can make appropriate application of a tension band impractical. We present the results of a novel technique using a transtendinous/transligamentous mini-fragment plate positioned peripherally around the patella with radially directed screws: termed the wagon-wheel (WW) construct. Compared with a cohort of fractures treated with cannulated screws with an anterior tension band, there was no difference in final range of motion and rate of nonunion. The WW construct had a significantly decreased incidence of symptomatic implants (5% vs. 32%, P = 0.02), rate of reoperation (9% vs. 38%, P = 0.018), dependency on gait aids (10% vs. 38%, P = 0.031), and a faster time to union (HR: 2.2; 95% CI, 1.28-3.95, P = 0.005). In summary, the WW was designed with the goal of obtaining peripheral plate fixation to maximize fragment-specific fixation while minimizing implant prominence. Patients treated with the WW demonstrated reduced rates of implant prominence and reoperation.

Fixation of patella fracture with non-metallic implant

Introduction Patella fracture fixations were traditionally done using metal tension band wiring techniques. However, complications associated with metallic implants causing soft tissue irritation are not infrequent. Since 1998, there have been emerging case reports and series reporting the use of non-metallic implants, such as braided sutures, in the fixation of patella fractures 3. However, there is a limited clinical study on a direct comparison between metal and suture fixation in patella fractures. The aim of this study is to evaluate the outcome of all-suture fixation in patella fractures and to compare all-suture and metal fixation in mid-pole fractures. Materials and method A total number of 50 patients with operated fracture patella were retrospectively reviewed in a 2.5-year period. Primary outcomes included operation time, time for fracture union and postoperative knee function. Secondary outcomes include complications, need for secondary operations due to prominent implants, infection or loss of fixation. Results There was no statistically significant difference concerning time for fracture union, operation time and postoperative functional knee score between the three fixation methods. The rate of secondary operations was higher in the hybrid group (7 out of 11, 63.6%) and metal group (7 out of 13, 53.8%), and was lowest in an all-suture group (0 out of 28, 0%). Metal implant breakage and soft tissue irritation were the main reasons for secondary operations, which was significantly lower in the all-suture group ( p &lt; 0.0003). Subgroup analysis for mid-pole patella fractures showed similar results in which all primary outcomes showed no statistically significant difference, while the need for secondary operations was higher in the metal group ( p &lt; 0.003). Conclusion All-suture fixation for patella fractures is a feasible option not limited to distal pole fractures. In our series, this technique achieved similar outcomes when compared with traditional metal implants, with lower rates of secondary operations, and could be safely employed in mid-pole fractures as well.

Response to “Letter to the editor on “Fixation of patella fractures with metallic implants is associated with a significantly higher risk of complications and re-operations than non-metallic implants: a systematic review and meta-analysis””

Response to “Letter to the editor on “Fixation of patella fractures with metallic implants is associated with a significantly higher risk of complications and re-operations than non-metallic implants: a systematic review and meta-analysis””

Biomechanical evaluation of an anatomical bone plate assembly for thin patella fracture fixation fabricated by titanium alloy 3D printing

This study established and evaluated the feasibility of a three-dimensional (3D)- printed titanium anatomical surface with adjustable thin bone plate assembly (AATBP) for patella fracture fixation. The AATBP was 1.6 mm in thickness and divided into a proximal plate (PP) with locking screw holes and a distal plate (DP) (0.4 mm in thickness) with compressive screw holes for assembly using a ratchet mechanism to adjust the total fixation height according to the patella size. Two pairs of hooks were designed on the proximal/distal edges to allow passage through the tendon to grip the fractured fragments. 3D printing combined with Computer Numerical Control (CNC) drilling was performed to manufacture the AATBP. Four-point bending and surface roughness tests were performed to evaluate the AATBP mechanical behavior. A cyclic (300 times) load test with 15-kg weights was adopted to compare the biomechanical stability between the AATBP and conventional tension band wiring (TBW) fixations. A parallel finite element (FE) analysis was achieved to understand the fracture gap and bone stress in the two different fixations on a transverse patella fracture. The result showed that the maximum AATBP manufacturing error was 3.75%. The average fracture gaps on the medial/lateral sides after cyclic loads were 2.38 &amp;plusmn; 0.57 mm/2.30 &amp;plusmn; 0.30 mm for TBW and 0.03 &amp;plusmn; 0.01 mm/0.06 &amp;plusmn; 0.03 mm for AATBP fixations. The same trend occurred in the FE simulation. This study confirmed that a complicated thin bone plate, including the anatomical surface, hooks, and ratchet with size-adjustable characteristics, can be fabricated using metal 3D printing with acceptable manufacturing error and reasonable anatomical surface/ thin bone plate assembly fitness. Biomechanical cyclic tests and FE simulation showed that the AATBP fixation is superior to the conventional TBW for patella transverse fractures.

A prospective study to estimate the outcome of patellar fracture fixation with suture material of high resistance properties

Background: Patella fractures make from 0.5% to 1.5% of all bone fractures. The most common fracture type, transverse fracture, impairs knee extension mechanics due to fragment displacement. In the years that followed, newer procedures were pursued in order to alleviate the aforementioned difficulties. K-wires were successfully replaced with cannulated screws. Furthermore, cerclage wiring was replaced with alternative implants without jeopardising the figure-of-eight tension band build. Methods: A prospective study was conducted over a period of 18 months to evaluate the outcome of patellar fractures fixation with newer techniques and sutures. The study had 35 participants. Results: This study included patients in the age group of 21-77 years. Among the total of 35 patients in the study, Maximum number of patients in our study were in the age range of 41-60 years which comprised 42.86%. In this study of 35 patients, 20 were male patients and 15 patients were female i.e. 57.14% of our study group comprised of male patients while 42.86% comprised of female patients. Conclusions: The above study clearly demonstrates that the high resistance suture materials can be used as a potential alternative or may even be better to the existing prevalent fixation of patella fractures with stainless steel and wires. Fibertape fixation presents a lot of advantages over the traditional stainless steel and wire fixation. Biomechanically, fibertape has demonstrated tensile strength and stiffness equal to stainless steel and in certain specific parameters proved even more stronger than the stainless steel.

Predictors of postoperative complications of tension band wiring techniques for patella fracture: A retrospective multicenter (TRON group) study

ObjectiveThe relationship between postoperative complications and operative techniques of tension band wiring (TBW) is not well studied. We aimed to evaluate the incidence of implant breakage, implant migration, and loss of reduction in patellar fractures treated with TBW and identify radiographic factors associated with these postoperative complications. MethodsThis multicenter (named, TRON group) retrospective study included 224 patients who underwent open reduction and internal fixation of patella fractures using TBW from January 2016 to December 2020. Radiographic findings were evaluated by experienced orthopedic surgeons, and radiographic outcomes were assessed for K-wire migration, implant breakage, and loss of reduction. Logistic regression analysis was performed to identify radiographic factors associated with postoperative complications. ResultsImplant migration occurred in 44 cases (19.6%), with bending of a single K-wire end identified as a significant risk factor (OR: 12.90; 95% CI: 4.99–33.30; P < 0.001). Implant breakage occurred in 43 cases (19.2%), with a large patella-tension band ratio (OR: 291.0; 95% CI: 19.60–4330; P < 0.001) and a wide distance between K-wires (OR: 1.15; 95% CI: 1.060–1.250; P = 0.001) identified as significant risk factors. Loss of reduction occurred in 5 cases (2.0%), but no significant risk factors were identified. ConclusionThis study highlights the importance of bending both ends of the K-wires and proper placement of the tension band and K-wires in reducing postoperative complications in patellar fractures treated with TBW. Further research is needed to better understand the risk factors associated with loss of reduction.

Adjunct neutralization plating in patella fracture fixation: a technical trick-Erratum.

Adjunct neutralization plating in patella fracture fixation: a technical trick-Erratum.

Biomechanical Evaluation of Transverse Patella Fracture Fixation using Headless Screws: A Comparison of Suture vs. Cable as a Tension Band.

To explore the performance of headless screws with FiberWire Suture as a tension band and headless screws with a mini-cable tension band in patella fixation. A transverse osteotomy was created in six matched pairs of fresh-frozen cadaver knee joints. One knee was randomly assigned to receive fixation with headless screws plus a cable tension band (Synthes 1.3 mm cable with crimp), while the other was fixed with headless screws plus a suture tension band (#5 FiberWire). Using a servo-hydraulic material testing system, the specimens were first tested non-destructively under 20% of the reported mean failure load with standard technique of cannulated screws with tension band wiring. The specimen was then loaded to 1000 N to test the construct's failure strength. All tests were run under displacement-control with loading threshold. A motion analysis system was used to track the interfragmentary motion to assess fixation stability. The correlation between fixation strength and score of bone density was also examined. In the non-destructive loading test, gap displacement under 150N was 0.10 mm or less for 11 of 12 specimens, and the difference between the two groups was not statistically significant. In the destructive test, 3 of 12 specimens maintained reduction (gap<2mm) at the maximum load of 1000 N. Of the failed specimens, the mean strength was 648±185 N for suture and 784±228 N for cable (p=0.24). Regression analysis shows bone density was associated with the failure load of the tendon (R2=0.43, p=0.02). There was no significant difference in fixation strength or sub-failure fragment displacement between the suture and cable tension band techniques when using headless screws, but suture on average was weaker.

A novel patella fracture fixation technique: finite element analysis.

Patella fractures account for approximately 1% of all bone fractures. The tension band wiring technique has been used in surgical treatment. However, there is no clear information about the location of the K-wires in sagittal plane. Thus, a transverse fracture line was created in the patella finite element model and fixed with Kirchner (k) wires and cerclage at different angles and compared with two different standard tension band models. A total of 10 finite element models were created to study AO/OTA 34-C1 patella fractures. Two models used the classical tension band method with either circumferential or 8-shaped cerclage wire. The other 8 models used K-wires placed at 45° or 60°, either alone or combination with cerclage wire. A force of 200N, 400N, and 800N were applied at 45° knee angle and the resulting data fracture line opening, surface pressure and stress in the implants were analyzed through finite element analysis. When all the results are considered, it was determined that the K-wires 60° crossing at the fracture line and with cerclage modeling was superior to the other models. The diagonal placement of the K-wires with cerclage (could be 45° or 60° medium) was superior to the reference models. This study has shown that the new fixation method we propose could come to the fore as an alternative method to be used successfully in transverse patella fractures and lower complications. In transverse patellar fractures, the use of K-wires crossed at 60° may be a good alternative to the standard method.