Management of comminuted patellar fracture fixation using modified cerclage wiring

Abstract

Background Although there are several different kinds of fixation techniques for displaced comminuted patellar fracture, the treatment remains a challenge for orthopaedic surgeons. The purpose of this study is to evaluate the effectiveness and safety of a fixation technique for comminuted patellar fracture fixation using modified cerclage wiring. Methods From February 2016 to April 2018, 38 cases of simple unilateral closed comminuted patellar fracture were treated by modified cerclage wiring. Among these cases, 16 patients were males and 22 were females, aged 23–68 years (average 40.4 ± 9.1 years). Comminuted patellar fractures were classified according to the AO/OTA classification: 10 cases were type 34-C2 (three fragments), 28 cases were type 34-C3 (more than three fragments). Postoperative complications including loosening of internal fixation, fragment re-displacement, nonunion, infection, breakage of internal fixation and traumatic osteoarthritis were assessed. The clinical results after operation were evaluated by the clinical grading scales of Böstman including range of movement, pain, work, atrophy, assistance in walking, effusion, giving way, and stair-climbing during follow-up. Results A total of 38 patients were followed up for 6–36 months (mean time 16.1 ± 5.8 months). The bone union radiographically occurred at approximately 2.5–3.5 months (mean time 2.92 ± 0.25 months). No postoperative complications, such as infection, dislocation, breakage of the implants, painful hardware, and post-traumatic osteoarthritis, were observed. According to the clinical grading scales of Böstman, satisfactory results were obtained, and the mean score at the final follow-up was 28.7 (range 20–30) points. Thirty-two patients (84.2%) with excellent results had a mean score of 29.5 ± 0.7 (range 28–30) points, and six patients (15.8%) with good results had a mean score of 24.5 ± 2.2 (range 20–27) points. The patients with excellent and good scores had active flexion of 130° (110–140). Conclusions Modified cerclage wiring can effectively treat comminuted patellar fracture and offers a new strategy resulting in satisfactory results without obvious complications.

Comparison of the Therapeutic Effects of Tension Band with Cannulated Screw and Tension Band with Kirschner Wire on Patella Fracture

“…Intraoperative fixation is a common method for the treatment of displaced patella fracture, which can better recover joint function and quadriceps femoris function, and prevent osteoarthritis [ 5 , 6 ]. Traditionally, the Kirschner wire tension band method is widely used, which is superior to other surgical methods in terms of tension resistance and can recover patella function to the maximum extent [ 7 ].…”

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

“…However, our results revealed that the patellar concentrator alone produces poor reduction of the inferior patellar pole fracture. Lateral comminuted fractures were earlier shown to be difficult to fix with patellar concentrator alone [ 20 ], so multiple C-arm fluoroscopies are needed to ensure proper reduction. In addition, repeated reduction may negatively affect blood supply to the fracture site and thereby prolong healing time.…”

“…In a prior report, an author successfully used percutaneous steel wire cerclage fixation technique to reduce and fix an inferior patellar pole fracture [ 16 ]. Moreover, another scholar employed modified cerclage wiring to correct comminuted patellar fracture, with satisfactory results [ 20 ]. Given these evidences, it was likely that the steel wire cerclage method can be used for reducing and fixing 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

“…Hence, the patellar concentrator possesses advantages of both simple operation and early functional exercise, and is suitable for various types of patellar fractures [5,10].However, our results revealed that the patellar concentrator alone produces poor reduction of the inferior patellar pole fracture. Lateral comminuted fractures were earlier shown to be di cult to x with patellar concentrator alone [18], so multiple C-arm uoroscopies are needed to ensure proper reduction. In addition, repeated reduction may negatively affect blood supply to the fracture site and thereby prolong healing time.…”

“…In a prior report, an author successfully used percutaneous steel wire cerclage xation technique to reduce and x an inferior patellar pole fracture [13]. Moreover, another scholar employed modi ed cerclage wiring to correct comminuted patellar fracture, with satisfactory results [18]. Given these evidences, it was likely that the steel wire cerclage method can be used for reducing and xing patellar fractures.…”