Comparison of a Novel Tension Band and Patellotibial Tubercle Cerclage in the Treatment of Comminuted Fractures of Inferior Pole of the Patella

Abstract

Objective To assess the therapeutic effect of a novel tension band using 3.0 mm cannulated screw combined with a titanium cable and specific shims comparatively with patellotibial tubercle cerclage in comminuted fractures of the inferior pole of the patella. Methods The retrospective study from March 2012 to July 2017 was conducted in Peking University Third Hospital and comprised 63 patients with comminuted fractures of the inferior pole of the patella: 41 treated with new tension band using 3.0 mm cannulated screw combined with a titanium cable and specific shims (new tension band group) and 22 with patellotibial tubercle cerclage (tubercle cerclage group). Gender, age, AO/OTA fracture type, injury mechanism, inter‐fragmentary gap, and follow‐up time of patients were recorded. Two groups were compared regarding: operation time, blood loss, partial weight‐bearing time, fracture‐healed time, Bostman score and knee mobility at 12‐month follow‐up, and postoperative complications. Continuous and categorical parameters were analyzed by Mann‐Whitney U test and the chi‐squared test, respectively. Fisher's exact test was used for small data subsets. Results Between the two groups, no statistically significant difference was found in mean age, gender, AO/OTA fracture type, injury mechanism, mean inter‐fragmentary gap, or mean follow‐up time (P > 0.05). The mean operation time of new tension band group was significantly longer than that of tubercle cerclage group (76.4 min vs 64.2 min, P = 0.006), while there was no significant difference in blood loss. After surgery, new tension band group had a significantly earlier mean partial weight‐bearing time (5.2 weeks vs 7.4 weeks, P < 0.001) and fracture‐healed time (9.6 weeks vs 11.6 weeks, P < 0.001). At 12‐month follow‐up, patients of new tension band group had a significantly higher mean Bostman score (28.5 vs 25.8, P < 0.001) and knee mobility (126.7 vs 117.3, P < 0.001). Ten complications related with internal fixation were found in tubercle cerclage group including two cases of loose internal fixation, two cases of cerclage breakage, and six cases of low patella position who undertook secondary operation. No complications were found in new tension band group (0 in 41 vs 10 in 22, P < 0.001). Conclusion Patients with comminuted fractures of the inferior pole of the patella treated with a novel tension band experienced a longer operation time, but earlier partial‐weight‐bearing and fracture‐healed time, better clinical outcomes at 12‐month follow‐up, and less complications. It should be considered an alternative therapy for the treatment of distal pole patellar fractures.

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

“…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.…”

“…In a study that treated patellar inferior pole fracture with a mini-plate usage and tension band, the average Bostman score was 28.1 at the 1 year follow up post operation [1]. Additionally, in a study comparing a Novel Tension Band and Patellotibial Tubercle Cerclage,the average Bostman scores were 28.5 and 25.8, respectively [21].In our study, the average Bostman score of the experimental group was 27.44 and 28.75 at the 6-and 12-month follow ups, respectively.…”

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

“…This not only prevented fracture displacement caused by perforating Kirschner wire or screw at the patella fracture, but also significantly reduced stress cutting caused by the direct contact of the patellar concentrator with patella. Good reduction and firm fixation are the premise of early rehabilitation exercise [ 1 , 23 ]. Based on our analysis, the initial range of motion of our experimental group was markedly enhanced, compared to the control group.…”

“…In a study that treated patellar inferior pole fracture with a mini-plate usage and tension band, the average Bostman score was 28.1 at the 1 year follow up post operation [ 1 ]. Additionally, in a study comparing a Novel Tension Band and Patellotibial Tubercle Cerclage, the average Bostman scores were 28.5 and 25.8, respectively [ 23 ]. In our study, the average Bostman score of the experimental group was 27.44 and 28.75 at the 6-and 12-month follow ups, respectively.…”

Anchor and Krackow‐“8” Suture for the Fixation of Distal Pole Fractures of the Patella: Comparison to Kirschner Wire

“…In most fracture classification systems, distal pole avulsion fractures of the patella fall into a separate category 1 , 2 , 3 . Such fractures account for 9.3% to 22.4% of all patellar fractures and are treated surgically if displaced or associated with complete disruption of the extensor mechanism 4 .…”