Fixation of Multifragmentary Patella Fractures Using a Bilateral Fixed-angle Plate

Abstract

This biomechanical study is the first to compare 3 fixation methods-bilateral fixed-angle plate, modified anterior tension wiring, and cannulated lag screws with anterior tension wiring-in multifragmentary distal patella fractures. A T-shaped 3-part fracture simulating a multifragmentary articular distal patella fracture (AO/OTA 34-C2.2) was created in 18 human cadaver knee specimens. Three groups were created using homogenous ages and bone mineral densities based on the fixation method received. Repetitive testing over 100 cycles was performed by moving the knee against gravity from 90° flexion to full extension. Failure was defined as fracture displacement greater than 2 mm. In all patellae using fixed-angle plates, an anatomical fracture reduction could be maintained throughout cyclic testing, whereas anterior tension wiring and lag screws with tension wiring showed significant fracture displacement after 100 cycles, with mean fracture gaps of 2.0±1.3 and 1.9±1.6 mm, respectively. The differences in fracture gaps between the fixed-angle plate group and the other 2 groups were statistically significant. In both groups using tension wiring, half of the constructs (3 of 6 in each group) failed due to a fracture displacement greater than 2 mm. The bilateral fixed-angle plate was the only fixation method that sustainably stabilized a multifragmentary articular distal patella fracture during cyclic loading when compared with modified anterior tension wiring and cannulated lag screws with anterior tension wiring.

Laparoscopic Pectopexy: A Biomechanical Analysis

“…The latter being considered as fixation failure in biomechanical evaluations since stability may be lost as dehiscence exceeds 2 mm. [ 11 – 15 ]…”

Application of a Shape-Memory Alloy Concentrator in Displaced Patella Fractures: Technique and Long-Term Results

“…No evidence of posttraumatic arthritis or progression of preexisting degenerative patellofemoral joint osteoarthritis was observed. At the final follow-up, Böstman knee scores were excellent in 88 cases (28)(29)(30), good in 55 (20)(21)(22)(23)(24)(25)(26)(27), and unsatisfactory in 13 (<20). According to SF-36 evaluation, the average score was 84.5 (range, 62-91).…”

“…Fixed-angle plate osteosynthesis had been described since 2010, as an alternative to tension wiring. 28 Although biomechanical test showed favorable results, [28][29][30] further clinical evaluation is required. According to the study described, fixed-angle plate is certainly not suitable for comminuted fractures of the patella, and is suitable just for simple transverse patellar fracture.…”

Frakturversorgung der Patella

“…Wild et al haben als Erste den Einsatz einer winkelstabilen Plattenosteosynthese an der Patella beschrieben [41][42][43][44][45]. Diese polyaxiale Platte wird bilateral an der medialen und lateralen Patellakante angelegt.…”