A comparison of EFECE systems with tension band wiring for patella fracture fixation in cadavers

Abstract

Background: EFECE systems are newly defined internal fixation systems, which are suitable for patella fracture fixation. The aim of this study was to compare the fixation strength of EFECE Systems with tension band wiring for transverse patellar fracture simulation on fresh frozen cadaver models. Methods: Quadriceps tendon-patella-patellar tendon (QT-P-PT) complex was prepared from human cadavers. After simulation of a transverse patella fracture, in group 1, 5 patella were fixed with a pair of 1.2 mm EFECE wires and 4 EFECE devices. In group 2, 5 patella were fixed with a pair of 1.2 mm Kirschner wires (K-wire) and a cerclage wire according to the tension band technique. Using a testing device with custom-made jaws, increasing distraction force was applied to these QT-P-PT complexes. Extension of these complexes with the distraction forces was observed. The maximum distraction force and the elongation during maximum force were evaluated. Results: After 5 experiments with the EFECE systems, there was no EFECE wire breakage or EFECE wire-EFECE device catching failure. The median maximum force was 740 N (720-810 N). During maximum distraction force the median extension was 2.5 mm (1.6-2.5 mm). After 5 experiments with the tension band technique, there was no Kwire breakage. The median maximum force was 330 N (240-510 N). During this maximum distraction force the median extension was 3.4 mm (2.2-3.8 mm). Conclusions: Based on the biomechanical advantages, patella fracture treatment with EFECE systems may constitute a reasonable alternative in the treatment of patella fractures.

Clinical Outcomes of Cannulated Screws versus Ring Pin versus K-Wire with Tension Band Fixation Techniques in the Treatment of Transverse Patellar Fractures: A Case-Control Study with Minimum 2-Year Follow-Up

“…Patellar fractures account for around 1% of all human body fractures, mainly in adults of 20–50 years old. Open reduction and various internal fixations can be applied clinically to reconstruct the anatomical structure and recover the function, such as KTB, CSTB, and RPTB, where the most widely accepted surgical method for the treatment of transverse patellar fracture is KTB [ 11 , 12 , 19 , 29 ].…”

“…Instead, the compression effects on the patella are mainly exerted by tightening the wires or cables [ 33 ]. The failure mechanism with tension band wiring was reported due to slippage of the cerclage wire and then sinking of the K-wire into the patella [ 12 ], while that with CSTB may partly due to the difficulty in appropriate insertion of cannulated screws [ 34 ]. Notably, the incidence of fixation failure in CSTB is more than twice of that in KTB group (5/30 versus 2/30) according to our results.…”

“…The technical advantage of this standard technique is that this method can convert tension at the fracture site, which is produced by tension band fixation into compression forces at the articular surface, helping in accelerating the healing of the fracture [ 9 , 10 ]. This technique has been widely accepted by orthopaedic trauma surgeons because of its reliable fixation, allowance of early joint motion, and mostly achieving the goals that provide a congruent articular surface and maintain rigid fixation [ 11 , 12 ]. However, a number of studies showed a significant incidence of postoperative complications, including pain, infection, wire breakage, migration, and reduction loss, making the best surgical approach remaining controversial when considering fixation using cannulated screws tension band (CSTB) or ring pins with supplementary tension band (RPTB) [ 13 – 20 ].…”