Combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures

Zhu, Wen; Xie, Kai; Li, Xinyuan; Li, Li; Yang, Jiazhao; Xu, Lei; Xu, Wei; Wang, Xujin; Fang, Shiyuan

doi:10.1016/j.injury.2020.01.028

Cited by 24 publications

(28 citation statements)

References 16 publications

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“…Moreover, although plates are often used for reduction and xation of comminuted fractures, plates placed at the starting point of the patellar ligament can cause signi cant discomfort [9].Particularly, in elderly patients with osteoporosis, xation failure may be caused by wire cutting problems [12].Therefore, after wire cerclage reduction, we used patellar concentrator xation to protect the knee joint from early exercise damage. Thisnot only prevented fracture displacement caused by perforating Kirschner wire or screw at the patella fracture, but also signi cantly reduced stress cutting caused by the direct contact of the patellar concentrator with patella.Goodreduction and rm xation are the premise of early rehabilitation exercise [1,21]. Based on our analysis, the initial range of motion of our experimental group was markedly enhanced, compared to the control group.…”

Section: Discussionmentioning

confidence: 69%

The Clinical Outcome of the Reduction of the Patellar Inferior Pole Fracture with Wire Cerclage Through A Generated Bone hole, in Combination with Patellar Concentrator: A Retrospective Comparative Study

Chen¹,

Cao

Sun

et al. 2021

Preprint

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Objective: The patellar inferior pole fracture is typically comminuted. Hence, achieving firm fixation and early activity is highly challenging. In this article, we employed the method of wire cerclage through a generated bone hole to reduce the fracture. Our objective was to compare the clinical efficacy of patellar concentrator alone with a combination of cerclage and patellar concentrator in the treatment of patellar inferior pole fracture.Methods: We conducted a retrospective review of patients with patellar inferior pole fractures, who underwent patellar concentrator fixation only (the control group) or cerclage combined with patellar concentrator fixation (the experimental group), performed by a single surgeon, between July 2015 and October 2019. Our analysis included surgical indexes like7 aspects (fracture gap after operation, operation time, intra-operative blood loss,intra-operative number of C-arm fluoroscopies conducted, Insall-Salvati ratio calculated immediately after operation, initial range of motion on the 7th day after operation, and fracture healing time), as well as the Bostman score and complications recorded on 1-, 3-, 6-, and 12-month follow up post operation.Results:A total of 94 patients with patellar inferior pole fracture and a minimum 1-year followup were recruited. Following operation, the control group had 33(71.74%) patients with a fracture gap of 0-2 mm and 13(28.26%)patients with a fracture gapgreater than 2 mm(P=0.002). Conversely,the experimental grouphad46(95.83%)patients with a fracture gap of 0-2 mm and 2(4.17%) patients with a fracture gapgreater than 2 mm(P=0.002). Compared to the control group, the experimental group did not experience enhanced operation time or intra-operative blood loss (P=0.811, P=0.823). The Insall-Salvati ratio and initial range of motion in the experimental group were larger than the control group (P=0.037, P=0.000). Alternately, the number of intra-operative C-arm fluoroscopies conductedand fracture healing time of the experimental group were considerably less than the control group (P=0.003,P=0.000).Moreover, at 1-, 3-, 6-, and 12-month follow ups after operation, the Bostman scores of the experimental group were remarkably higher than the control group (P< 0.05).At 12 months post operation, 23 cases (50%) were classified as excellent, 22 cases (47.83%) were good, and 1 case (2.17%) was poor in the control group(P=0.005). In the meantime, in the experimental group, 38 cases (79.17%) were deemed as excellent and 10 cases (20.83%) were good (P=0.005).Lastly, complications were detected in 3 cases (6.52%;1 case of internal fixation loss,2 cases of hematoma) within the control group, and in 1 case(2.08%; marginal wound necrosis) within the experimental group. There was no wound infection, implant discomfort, or broken fixation in eithergroup.Conclusion: Managingthe patellar inferior pole fracture with wire cerclage through a generated bone hole is both simple and effective. Moreover, an additional step of patellar concentrator fixation facilitates early functional exercise, with satisfactory clinical outcome.

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Section: Discussionmentioning

confidence: 69%

The Clinical Outcome of the Reduction of the Patellar Inferior Pole Fracture with Wire Cerclage Through A Generated Bone hole, in Combination with Patellar Concentrator: A Retrospective Comparative Study

Chen¹,

Cao

Sun

et al. 2021

Preprint

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“…Lazaro et al reported [12] : circular ligation and suture xe the fracture of the inferior pole of the patella, the wire band cannot effectively close the proximal articular surface of the patella, and the fracture fragments can easily enter the joint cavity. Zhu et al [9] . reported that the microplate and tension band wiring in the treatment of inferior pole fractures of the patella have achieved certain clinical effects.…”

Section: Discussionmentioning

confidence: 99%

“…Although the plate xation of fractures provides a new idea for our treatment [9,13,14] , because the patella is a sesamoid, its surface is not at, and there is no guarantee that the plate can be placed in a suitable position; in addition, the inferior pole of the patella and the gap between the patellar ligaments is very small, and placing a steel plate may increase the damage to the tissue structure. Assaf et al [15] .…”

Section: Discussionmentioning

confidence: 99%

“…Like other types of patella fractures, the purpose of surgery for inferior pole fractures is to rebuild the extensor mechanism while restoring the stability of the articular surface [3] ; the difference is that the fragments of inferior pole fractures are small and comminuted, making it di cult to maintain reduction and xation [4][5][6] . In order to better x the inferior pole fracture, many new xation methods have been developed, including suture xation, steel plate xation, and plate combined with tension band xation [7][8][9] . In addition, A partial patellectomy with repairment of the patella ligament and anchor suturing has been used as a method for comminuted distal pole fractures [9,10] , but its effectiveness has not been widely recognized.…”

Section: Introductionmentioning

confidence: 99%

“…In order to better x the inferior pole fracture, many new xation methods have been developed, including suture xation, steel plate xation, and plate combined with tension band xation [7][8][9] . In addition, A partial patellectomy with repairment of the patella ligament and anchor suturing has been used as a method for comminuted distal pole fractures [9,10] , but its effectiveness has not been widely recognized.…”

Section: Introductionmentioning

confidence: 99%

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"Net cage" technique in the treatment of inferior pole patella fracture: a novel patella internal fixation technique

et al. 2021

Preprint

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Objective Fractures of the inferior pole of the patella can cause the knee joint extensor mechanism disorder. The fracture fragments are usually small and comminuted. Therefore, there are certain difficulties in fixation. The purpose of this study is to observe the effect of the "Net cage" technique in the treatment of the inferior pole of the patella. Methods This is a retrospective study that included 16 cases of inferior patella fractures (AO/OTA 34-A1) who underwent the "Net cage" technique from March 2017 to June 2020. Collecting their medical records and follow-up results, measuring indicators include the surgical complications of the fixation method, knee joint function, the number of fluoroscopies, fracture healing, and the incidence of soft tissue stimulation. Results The fractures of all patients healed smoothly, and there were no complications such as failure of internal fixation and fracture of implants. The average number of intraoperative fluoroscopy was 5.56 times (range: 4-10 times); the average fracture healing time was 10.5 weeks (range: 8-14 weeks) ). No patients reported internal fixation-related soft tissue irritation. At the last follow-up, the knee function showed that the average ROM was 133.75° (range: 120°~140°); The average Bostman score was 27.94 points (range: 24-30 points). Conclusion "Net cage" technology for the treatment of inferior pole fractures of the patella has the advantages of reduced fluoroscopy, fixation and stability, early functional exercise, and better knee joints after surgery.

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Long-term outcomes after partial patellectomy in comminuted fractures — a clinical study

Deng

Zhu

et al. 2021

International Orthopaedics (SICOT)

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Combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures

Cited by 24 publications

References 16 publications

The Clinical Outcome of the Reduction of the Patellar Inferior Pole Fracture with Wire Cerclage Through A Generated Bone hole, in Combination with Patellar Concentrator: A Retrospective Comparative Study

The Clinical Outcome of the Reduction of the Patellar Inferior Pole Fracture with Wire Cerclage Through A Generated Bone hole, in Combination with Patellar Concentrator: A Retrospective Comparative Study

"Net cage" technique in the treatment of inferior pole patella fracture: a novel patella internal fixation technique

Long-term outcomes after partial patellectomy in comminuted fractures — a clinical study

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