Transverse Patellar Fractures Research Articles

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.

Tension band high-strength suture combined with absorbable cannulated screws for treating transverse patellar fractures: finite element analysis and clinical study.

Objective: Few reports exist on the treatment of transverse patellar fractures (TPFs) using absorbable cannulated screws and high-strength sutures, and most screws and sutures lack good biomechanics and clinical trials. Therefore, this study aimed to demonstrate the biomechanical stability and clinical efficacy of tension-band high-strength sutures combined with absorbable cannulated screws (TBSAS) in treating TPFs (AO/OTA 34 C1). Methods: Finite element models of five internal fixation schemes were established: tension-band wire with K-wire (TBW), TBW with cerclage wire (TBWC), TBW with headless pressure screws (TBWHS), TBW with full-thread screws (TBWFS), and TBSAS. We comprehensively compared the biomechanical characteristics of the TBSAS treatment scheme during knee flexion and extension. Forty-one patients with TPFs in our hospital between January 2020 and August 2022 were retrospectively enrolled and divided into the TBSAS (n = 22) and TBWC (n = 19) groups. Clinical and follow-up outcomes, including operative time, visual analog scale (VAS) pain score, postoperative complications, Bostman score, and final knee range of motion, were compared between both groups. Results: Finite element analysis (FEA) showed that TBWHS and TBWFS achieved the minimum mean fracture interface relative displacement during knee flexion (45°, 0-500N bending load) and full extension (0°, 0-500N axial load). There was no significant difference between TBSAS (0.136mm) and TBWC (0.146mm) during knee flexion (500N); however, TBSAS displacement was smaller (0.075mm) during full extension (500N). Furthermore, the stress results for the internal fixation and the patella were generally lower when using TBSAS. Retrospective clinical studies showed that the TBSAS group had a shorter operative time, lower VAS pain score at 1 and 2months postoperatively, better Bostman knee function score at 3 and 9months postoperatively, and better final knee joint motion than the TBWC group (all p < 0.05). There were five cases (26.3%) of internal fixation stimulation complications in the TBWC group. Conclusion: TBSAS demonstrated excellent safety and effectiveness in treating TPFs. It is sufficient to meet the needs of TPF fixation and early functional exercise and effectively reduces metal internal fixation-induced complications and secondary surgery-induced trauma.

Comparative study of locking neutralization plate construct versus tension band wiring with a cannulated screw for patella fractures: experimental and finite element analysis

Transverse patella fractures, accounting for approximately 1% of Orthopedic injuries, pose intricate challenges due to their vital role in knee mechanics. This study aimed to compare the biomechanical performance of a construct, integrating cannulated screws and an anterior locking neutralization plate, with the conventional tension band wiring technique for treating these fractures. Experimental testing and Finite Element Analysis were employed to evaluate the constructs and gain profound insights into their mechanical behavior. Sixteen cadaveric knees were prepared, and transverse patella fractures were induced at the midpoints using a saw. The plate construct and tension band wire fixation were randomly assigned to the specimens. A cyclic test evaluated the implants' durability and stability, simulating knee movement during extension and flexion. Tensile testing assessed the implants' maximum failure force after cyclic testing, while Finite Element Analysis provided detailed insights into stress distribution and deformation patterns. Statistical analysis was exclusively performed for the experimental data. Results showed the plate enhanced stability with significantly lower deformation (0.09 ± 0.12 mm) compared to wire fixation (0.77 ± 0.54 mm) after 500 cycles (p = 0.004). In tensile testing, the construct also demonstrated higher failure resistance (1359 ± 21.53 N) than wire fixation (780.1 ± 22.62N) (p = 0.007). Finite Element Analysis highlighted distinct stress patterns, validating the construct's superiority. This research presents a promising treatment approach for transverse patella fractures with potential clinical impact and future research prospects. This study presents a promising advancement in addressing the intricate challenges of transverse patella fractures, with implications for refining clinical practice. The construct's improved stability and resistance to failure offer potential benefits in postoperative management and patient outcomes.

A novel technique for treating simple transverse patellar fractures using cannulated screws: a cadaveric and clinical study

BackgroundTension band wiring (TBW) has conventionally been used for the open reduction and internal fixation of the patella. However, it suffers from distinct disadvantages such as large incision, implant irritation, and need for subsequent implant removal. Here, we propose a novel technique using closed reduction and percutaneous fixation with three cannulated screws (TCS), which may be an alternative to this established conventional technique. Although some researchers have proposed alternative methods including closed reduction and cannulated screw fixation, with or without additional wires through the screws, and arthroscopic-assisted reduction and fixation, there are few studies that focus on the biomechanical stability of percutaneous fixation using only cannulated screws. Thus, the purpose of this study was to evaluate TCS versus TBW for simple transverse patellar fractures in cadaveric and patients' level, aiming to determine whether TCS show superiority over TBW in terms of biomechanical stability in a cadaveric study with benign clinical feasibility and outcomes in patients.MethodsWe conducted a cadaveric study with 15 knee specimens that had simple transverse patellar fractures. We used two fixation techniques: TBW (group A, n = 6) and TCS (group B, n = 9). We applied sinusoidal forces (25 N–125 N) at 1/5 Hz and 90° knee flexion to simulate knee movement. We compared the displacements at the fracture site between the two groups. We also used the same technique in a total of 23 patients and followed up them for at least 1 year.ResultsTCS demonstrated favourable biomechanical stability in the cadaveric study. The technique also performed excellently in terms of postoperative pain, knee function recovery, and complication rates during the follow-up period.ConclusionsThe technique provides a surgical treatment option with small incisions, minimal soft tissue irritation, and possibly lower removal rate of bothersome material.

A Comparison of the Efficacy of Cannulated Screws against Modified Tension Band Wire in the Management of Slightly Displaced Fractures of the Patella: A Novel Technique.

The study aimed to compare the outcomes of Open Reduction and Cannulated Screw Fixation (ORCF) and Open Reduction and Tension Band Wire Fixation (ORTF) for treating minimally displaced patellar fractures, with the intention to discern the more efficacious surgical method in terms of various clinical and radiographic parameters. The research was a retrospective controlled trial encompassing 63 patients, culminating in a final data set of 52 patients with transverse patellar fractures with less than 8 mm of displacement. Patients were assessed postoperatively at three, six, and twelve months using measures such as the Lysholm score, Visual Analog Scale (VAS) for pain, and goniometry for active knee extensions and flexion. Statistical analyses were performed using SPSS version 22.0. Results indicated superior clinical outcomes for the ORCF group at twelve months post-treatment, with notable higher Lysholm scores and lower VAS scores for pain at three-, six-, and twelve-month intervals. The ORCF group also demonstrated improved flexion and range of motion, with an average fracture healing time of 2.65 months and significantly lower complication rates, compared to the ORTF group. The ORCF method, leveraging headless compression screws and cerclage wire fixation, emerges as a promising approach for managing minimally displaced transverse patellar fractures, potentially offering improved clinical results and patient satisfaction in comparison to the traditional ORTF method. Further expansive and diverse studies are warranted to substantiate these findings.

Novel screw-cable integrated system(SCIS) for minimally invasive treatment of patella transverse fractures: a finite element analysis

BackgroundThe most recommended method for treating transverse patella fractures is modified tension band wiring (MTBW). However, the optimal instrument for use with MTBW is still undetermined. Hence, we aimed to design a novel screw-cable integrated system (SCIS) and compare its biomechanical characteristics with Kirschner-wire, SCIS, and Cable-Pin systems in treating transverse patellar fracture.MethodsA finite-element (FE) model of transverse patella fracture was created. The fracture model was fixed with either K-wire, SCIS, or Cable-pin. Different tension force loading (400 N and 800 N), direction(0° and 45°), and screw or K-wire depth(5 mm and 10 mm) were set. The maximum displacement of the fragment and maximum gap opening were measured by using FE analysis.ResultsCompared with the K-wire and Cable-pin system, SCIS increased the stability of the fractured patella by reducing fragment displacement and gap opening. Under 400 N loading in the direction 45°, SCIS with screw placing at 5-mm depth reduced the maximum fragment displacement (0.43 mm) by 49.62% and 26%, respectively, compared with the K-wire (0.22 mm) and Cable-pin (0. 22 mm) group. Meanwhile, the gap opening in SCIS (0.05 mm) was reduced by 83% and 59.8% (0.05 to 0.18) compared with the K-wire (0.30 mm) and Cable-pin (0.18 mm) group.ConclusionSCIS demonstrated improved biomechanical stability for treating transverse patellar fractures compared to MTBW with Kirschner wire and the Cable-Pin system. Finite element analysis showed SCIS substantially reduced fracture fragment displacement and gap opening under various loading conditions.

Inter-fragmentary compression using cannulated cancellous screws augmented with modified tension band wiring in transverse patella fractures

The classical Kirschner wires and tension band wiring technique, described by the AO foundation, has been the most widely used method for transverse patella fractures. In this study, we have adopted what we perceive to be an improved technique, the cannulated cancellous screws with modified tension band wiring. 20 patients with transverse patella fractures were included in our prospective single-blinded randomized control study with a duration of 3 years. All patients were operated on with modified tension band wiring with a 4 mm cannulated cancellous screw. Functional evaluation was made using the Tegner lysholm knee scoring scale. Roentgenograms were taken in AP and Lateral views to look for signs of radiological union and interfragmentary gap. The post-operative interfragmentary gap between fracture fragments with 65% of patients having a 0 mm gap, 25% of patients having a 1 mm gap, 5% of patients having a 2 mm gap, and 5% of patients having a 3 mm gap. The mean duration for the radiological union was 10 weeks. Mean Tegner lysholm score at 6 months was 88±4.7. We concluded that modified tension band wiring with cannulated cancellous screw is a safe, reliable, and better alternative method of fixation for transverse patella fractures with excellent union rate, range of motion, and functional outcome.

273 Open Split Fracture of the Patella in a 14-Year-Old Child: An Unusual Occurrence

Abstract Background Patella fractures in children are rare, accounting for approximately 1 % of all paediatric fractures. Due to resilience and adequate flexibility, transverse patellar fractures are extremely rare. This case accounts for less than 10 cases of open transverse or split patellar fracture reported in literature among the paediatric population. Case Presentation A 14-year-old boy was brought in as a pediatric trauma call following a fall and collision of his right knee against a concrete wall on a turf ground while playing football. He had Crohn's disease (on Prednisolone). No history of bone or joint pain, fever, rashes, or juvenile idiopathic arthritis was noted. On clinical examination, a 5cm open horizontal wound in the right knee with no visible bony fragments was noted. Imaging showed a split fracture of the right patella with wide separation of the superior and inferior fragments. Adjacent gas locules and haematoma which extended into the joint space were noted. Clinical outcomes Tension band wiring was done and the patient was placed in a full weight-bearing hinge knee brace with initial range of motion(ROM) of 0-30 degrees followed by an increase of 30 degrees at every 2 weeks. Discussion While sleeve fractures of the patella is more common, a transverse or split pattern is rather unusual and an open fracture in the paediatric population is rare. Other anomalies of the knee joint should be always excluded. The treatment protocol for children is the same as for adults. Restoring the extensor mechanism and realigning the articular surface is essential.

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.

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.

INTERNAL FIXATION OF TRANSVERSE PATELLA FRACTURES USING CANNULATED CANCELLOUS SCREWS WITH ANTERIOR TENSION BAND WIRING: A PROSPECTIVE STUDY

Background: Patella fractures accounts for about 1% of all fractures. Modied tension band wiring using two parallel kirschner wires through patella and anterior tension band loop with stainless steel wire as treatment of displaced transverse patella fracture but has been reported with complications, use of cannulated screws cause less irritation to the soft tissues, provides a stable xation with compression at the fracture site. Materials and Method: This is a prospective study of 35 cases of displaced transverse patella fractures treated by internal xation using cannulated cancellous screws with anterior tension band wiring done from July 2020 to June 2022 at our Institution and followed for 1 year. Results: Road trafc accident was main mechanism of injury. Radiological union was achieved in 91.4% by the end of 13 weeks. In our study we observed that 54.3% patients had good outcome, 40.0% patients had excellent outcome and 5.7% patients had unsatisfactory outcome according to Bostman knee scoring system. Cannulated cancellous screws with gure of eight Conclusion: tension band wiring is safe and reliable for management of displaced transverse patella fractures with good functional outcome as union is faster and full range of motion is achieved early. It also has less chance of implant failure and soft tissue irritation

Biomechanical evaluation of three fixation methods in a feline transverse patella fracture model.

This study aimed to compare the biomechanical properties of three stabilisation techniques in feline patella transverse fractures and select the strongest method with potentially minimal complications. Patella fracture was simulated in 27 feline cadaveric pelvic limbs (mean weight of the cadavers 3.78 kg), and the limbs were randomly grouped to be stabilised with one of the three stabilisation methods. The modified tension band wiring technique with a single Kirschner wire (0.9 mm) and figure-of-eight wiring (20 G) was applied to group 1 (n = 9). Group 2 (n = 9) was stabilised with a combination of circumferential and figure-of-eight wiring techniques with orthopaedic wire (20 G). Group 3 (n = 9) was stabilised with the same technique as group 2, but with #2 FiberWire. The knee joints were positioned and fixed in the neutral standing angle (135°) and tested by applying tensile force. The loads at gap formations of 1, 2 and 3 mm were recorded, and the maximum failure load was measured in each group. In all the loads at displacement (1, 2 and 3 mm), group 3 was significantly stronger than groups 1 and 2, respectively (P <0.017). Group 3 (261.0 ± 52.8 N) showed significantly stronger fixation in the maximum load compared with group 1 (172.9 ± 45.6 N) (P <0.017). No significant difference was observed between groups 1 and 2 (204.9 ± 68.4 N) or between groups 2 and 3. This study shows that the combination of circumferential and figure-of-eight techniques with FiberWire is more resistant to displacement than metal wire in this ex vivo feline patella fracture model.

Comparison of a minimally invasive osteosynthesis technique with conventional open surgery for transverse patellar fractures

PurposeThe study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures. MethodsIt was a retrospective study. Adult patients with closed transverse patellar fracture were included, and with open comminuted patellar fracture were excluded. These patients were divided into minimally invasive osteosynthesis technique (MIOT) group and open reduction and internal fixation (ORIF) group. Surgical time, frequency of intraoperative fluoroscopy, visual analogue scale score, flexion, extension, Lysholm knee score, infection, malreduction, implant migration and implant irritation in two groups were recorded and compared. Statistical analysis was performed by the SPSS software package (version 19). A p < 0.05 indicated statistical significance. ResultsA total of 55 patients with transverse patellar fractures enrolled in this study, the minimally invasive technique was performed in 27 cases, and open reduction was performed in 28 cases. The surgical time in the ORIF group was shorter than that in the MIOT group (p = 0.033). The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery (p = 0.015). Flexion was restored faster in the MIOT group than that in the ORIF group at one month (p = 0.001) and three months (p = 0.015). Extension was recovered faster in the MIOT group than that in the ORIF group at one month (p = 0.031) and three months (p = 0.023). The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group. Complications, such as infection, malreduction, implant migration, and implant irritation, occurred more frequently in the ORIF group. ConclusionCompared with the ORIF group, the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation. Although it requires a long operation time, MIOT may be a wise choice for transverse patellar fractures.

Non-metallic fixation of transverse patella fracture using non-absorbable polyester suture

This study aims to evaluate the functional outcomes for the fixation of transverse patella fracture (TPF) using a transosseous suturing method with a non-absorbable polyester suture. A retrospective case series method was conducted on 37 patients who underwent open reduction and internal fixation using a transosseous suturing technique with a non-absorbable polyester suture at Lower Limb Department, Hospital for Traumatology and Orthopaedics, Ho Chi Minh City, from 1/6/2020 to 1/6/2022. Results showed that the surgery time was 37.43±9.76 minutes; average follow-up time was 8.57±5.35 months. The results of facet joint after surgery and bone healing were 100% (very good and good); bone healing time was 14.22±2.78 weeks; rehabilitation time was 13.84±3.3 weeks; knee function according to Lysholm scale achieved very good and good results with the average score of 97.62±3.7 points; no hardware-related complications in the study. One patient fell again and broke the kneecap; 100% of the patients were satisfied after the treatment, especially with the reason that there was no need for a second surgery to get the instruments. In conclusion, the fixation of TPF using a transosseous suturing method with a non-absorbable polyester suture is safe and effective with no hardware-related complications and does not require a second surgery to instrument collection during the mean follow-up period of 8.57±5.35 months.

Technique of tension band wiring in patella fracture management-our experience

: Fractures of the patella account for about 1% of all skeletal injuries. Displaced patella fractures often result in disruption of the extensor mechanism of the knee. Open reduction and internal fixation is the recommended treatment to restore the extensor mechanism Tension band wiring (TBW) technique using K-wires and stainless steel wires is the most commonly used. The purpose of this study is to study surgical outcome of patella fractures treated with, tension band wiring (TBW) technique and functional outcome of patella fractures treated with TBW technique. It is a Retrospective study of 21 patients carried out from July 2019 to February 2021 admitted to orthopedic ward at our institution. All patients underwent same surgical technique and similar postoperative and physiotherapy protocol. Bostman scoring system was used to perform functional assessment.: In our study there were 14 males and 7 females. Fracture union was achieved in all patients. The mean bostman score was 26.54 at the final follow up.we had 4 complications 1 superficial infection of the surgical wound, 1 knee stiffness and 2 cases of symptomatic implant. We had 8 excellent, 9 good and 4 satisfactory result.: Tension band wiring technique for transverse patella fractures can be a very good option with effective fixation method and relatively easy surgical procedure.

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.

The Outcomes of Cannulated Screws Versus Tension Band Wiring in Treatment of Transverse Patellar Fracture: A Comparative Study

BACKGROUND: For the treatment of displaced patella fractures by tension bands with cannulated screws and by K-wire are widely employed. The clinical efficacy of the two therapy regimens, however, remains a point of contention. AIM: The study goal was to assess the relative advantages and drawbacks of open reduction and internal fixation using tension band wiring versus cannulated screws with wiring in patients sustained displaced patellar fracture. PATIENTS AND METHODS: A clinical trial study conducted in the Orthopedics Department at Al-Yarmook Teaching Hospital during a period of 18 months from June 2020 to November 2021. It included 22 adult patients diagnosed with isolated displaced transverse patellar fracture and scheduled for operative fixation. They were divided randomly into two groups: Tension band technique group (TBT) included 11 patients underwent open reduction internal fixation (ORIF) with TBT and cannulated screws (CS) group included 11 patients underwent ORIF by cannulated screws with wiring. A postoperatively follow-up was continued for 6 months. In which patients were assessed clinically and radiographically 4 time, at the end of the 1st, 2nd, 3rd, and 6th months. RESULTS: After 1, 2, and 3 months, means of Lysholm score and range of flexion were significantly higher; while mean of VAS score of pain was significantly lower in CS group than that in TBT group. No statistical significant differences in postoperative complications were found between study groups. CONCLUSION: Tension band wire with cannulated screws is the most effective surgical approach for internally repairing transverse fractures of the patella which allows for an early start to postoperative functional activity and an improved quality of life.

Biomechanical comparison of different screw-included angles in crossing screw fixation for transverse patellar fracture in level walking: a quasi-dynamic finite element study

BackgroundA minimally invasive technique with various screw configurations without open surgery is currently used for the fixation of transverse patellar fractures. Percutaneous crossing screw configuration has been reported to have a good bone union rate in patellar fractures. However, the difference in mechanical stability of the fractured patella between different screw-included angles has not been fully investigated. Hence, this study aims to compare the mechanical stability of parallel and crossing screw fixations with different screw-included angles for the fixation of transverse patellar fractures during level walking.MethodsA finite element knee model containing a patella with a transverse fracture is created. Two headless compression screws with different angles (0°, 30°, 60°, and 90°) are used to fix the fracture. The loading conditions of the knee joint during level walking are used to compare the stability of the fractured patella with different fixation screw configurations.ResultsThe results indicate that the maximum fracture gap opening distance increased with an increase in the included angle. Two parallel screws yield the smallest gap distance among all screw configurations. The maximum gap opening distances at the anterior leading edge of the fractured patella with two parallel screws and two screws having an included angle of 90° are 0.73 mm and 1.31 mm, respectively, at 15% walking cycle.ConclusionsBased on these results, the superior performance of two parallel screws over crossing screw fixations in the fixation of transverse patellar fractures is established. Furthermore, the smaller the angle between the crossing screws, the better is the stability of the fractured patella.

Modified tension band wiring of transverse patella fractures through cannulated cancellous screws: An analysis of functional outcomes and complications

Introduction: The management of transverse patella fractures with modified tension band wiring using Kirschner wires, though routinely used is associated with complications such as implant loosening, wire migration, and infection. We hypothesized that using cannulated cancellous screws with tension band wiring through the screws will overcome these complications. Objective: The objective was to assess the functional and radiological outcomes following patellar fracture fixation with modified tension band wiring through cannulated cancellous screws. Materials and Methods: Twenty-four patients with transverse patella fractures fixed with modified tension band wiring through cannulated cancellous screws were included in this retrospective study. Surgical technique involved a vertical incision over the knee, reduction of the fracture initial fixation with Kirschner wires, replaced with cannulated cancellous screws. A stainless steel wire was passed through the lumen of the screws, and tension band was applied. Follow-up at 3, 6, and 12 months was done to assess the radiological union. Functional outcome was assessed with the Bostman scoring. Results: The study included 13 male and 11 female patients with an average age of 39.6 years, with 8 three-part and 16 two-part fractures. The average follow-up was 14 months, and the average time to union was 8.5 weeks. Twelve patients had an excellent, 11 patients a good, and one patient an unsatisfactory functional outcome as per the Bostman score. No infection or implant loosening was observed. Conclusion: The technique of patella fracture fixation with modified tension band through cannulated cancellous screws offers an enhanced stability, minimizing the complications such as implant migration, prominent implant, and refracture. As such, we recommend this technique in all transverse patella fractures.