Pipkin described femoral head fractures in the 1950s, but controversy still exists regarding indications for surgery and approaches for operative treatment of femoral head fractures. Clear indications for operative intervention include inability to reduce the hip with closed methods, a nonconcentric reduction, fracture fragments within the articulating surface of the hip, and associated injuries (acetabulum and femoral neck fractures) with their own indications for surgery. The anterior approach described by Smith-Petersen has been modified (using only the distal portion) and used to visualize, clean, reduce, and fix these fractures with and without anterior dislocation of the hip.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Background Transverse patella fractures are often treated with cannulated screws and a figure-of-eight anterior tension band. A common teaching regarding this construct is to recess the screws so that their distal ends do not protrude beyond the patella because doing so may improve biomechanical performance. However, there is a lack of biomechanical or clinical data to support this recommendation. Question In the treatment of transverse patella fractures, is there a difference between prominent and recessed cannulated screw constructs, supplemented by tension banding, in terms of gap formation from cyclic loading and ultimate load to failure? Methods Ten pairs of fresh-frozen cadaver legs (mean donor age, 72 years; range, 64-89 years) were randomized in a pairwise fashion to prominent or standard-length screws. In the prominent screw group, screw length was 15% longer than the measured trajectory, resulting in 4 to 6 mm of additional length. Each patella was transversely osteotomized at its midportion and fixed with screws and an anterior tension band. Gap formation was measured over 40 loaded flexion-extension cycles (90°to 5°). Ultimate The institution of one of the authors (MCA) has received, during the study period, funding from the AOTrauma North America (Paoli, Pennsylvania, USA). One of the authors certifies that he (CM), or a member of his or her immediate family, has received or may receive grants, during the study period, in an amount of less than USD 10,000 from Zimmer Biomet (Warsaw, IN, USA), grants, during the study period, in an amount of less than USD 10,000 from DePuy Synthes (Raynham, MA, USA). One of the authors certifies that he (WMR), or a member of his or her immediate family, has received or may receive personal fees, during the study period, in an amount of USD 10,000 to USD 100,000 from Smith & Nephew (London, United Kingdom), personal fees, during the study period, in an amount of USD 10,000 to USD 100,000 from Synthes (Raynham, MA, USA), personal fees, during the study period, in an amount of USD 10,000 to USD 100,000 from COTA (Washington DC, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research® editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research® neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDA approval status, of any drug or device before clinical use. Each author certifies that his or her institution approved the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.
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