Introduction: Fractures of patella account for 1% of bone fractures and this type of injuries can lead to severe knee funciton restrictions due to its role in extansor mechanism. The most common type of fracture pattern is transverse or comminute. According to the guidelines, the most often used surgical techniques are modified tension band wiring and circumferential cercle wiring. However there is no clear information about the configuration of cerclage wiring in the tension band technique. For this purpose, a transverse fracture line was created in the patella finite element model and biomechanical comparison was made in both figure of eight and zero configurations Material and Method: A transverse fracture line was created in patella and the k-wires were directed proximally at 90 degrees in coronal plane, perpendicular to the fracture line. A cerclage wire was wound on each finite element model in figure of zero (reference 1 model) and figure of eight (reference 2 model) configurations. These models were compared with each other in finite element model, with the knee at a 45 degree flexion angle and applying 200 Nm, 400 Nm and 800 Nm of force. Results: When the opening amounts of reference 1 and 2 models were evaluated under 200 Nm, 400 Nm, and 800 Nm loads, it was found that there were 14%, 8%, 13% less openings in the reference 1 model, respectively. When the amount of pressure in the fracture line was evaluated under the same loads, the average pressure was 10%, 15% and 12% higher in the reference 1 model compared to the reference 2 model, respectively. Conclusion: When the determined parameters were evaluated, although the amount of opening at the fracture line was better in the reference 1 model, there was no significant difference between the parameters in both models. Both fixation types allow early motion in clinical applications and help the prevention of displacement of the fracture.
Background/Aim: Proximal humerus fractures are common in elderly patients. Treatment of three and four-part fractures is especially controversial in these patients. In recent years, surgical options have been widely used, especially among shoulder surgeons. The purpose of this study was to compare clinical results of conservative and arthroplasty methods. Methods: Between 2016 and 2020, 30 patients who were treated for Neer type 3 and type 4 proximal humeral fractures were included in the study. Patient data were evaluated retrospectively and then divided into three groups. Group 1 was treated conservatively, group 2 underwent hemiarthroplasty; and group 3 underwent reverse total shoulder arthroplasty. CONSTANT and visual analog scale (VAS) scores and radiological results at six months were evaluated retrospectively from patient records. At the last control they have been evaluated with CONSTANT, University of California/Los Angeles. (UCLA), and VAS scores. Results: Twenty-three (76.7%) of the patients included in the study were females. The mean age was 73.5 (5.7) years. The mean follow-up period was 33 (2.5) months. The mean follow-up periods in groups 1–3 were 33.3 (2.9), 32.8 (2), and 32.2 (2.9) months, respectively. When the CONSTANT scores of the patients were compared at the sixth month, they were observed to be better in the reverse total shoulder arthroplasty group (P = 0.001). Final control CONSTANT scores in the hemiarthroplasty group were lower than in the other groups (P = 0.001) and similar in the reverse shoulder prosthesis and conservative treatment group (P = 1). When the UCLA scores of all groups were compared, the mean UCLA scores were found to be significantly higher in groups 1 and 3 compared to group 2 (P = 0.001). When the VAS scores of the patients were compared, a significant difference between all groups was detected (P < 0.05). The highest VAS scores were observed in group 2, the second highest in group 1, and the lowest in group 3. Conclusion: For treatment of proximal humerus fractures in the elderly, patients should be evaluated according to activity levels and expectations, and surgical treatment should be suggested rather than ordered.
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