Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System

Yang, Xu; Wu, Qinfen; Lai, Chin-Hui; Wang, Xin

doi:10.1016/j.injury.2017.07.013

Cited by 20 publications

(31 citation statements)

References 24 publications

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“…The conventional surgical techniques do not allow sufficient stability for comminuted fracture of the lower pole of the patella. 5,[9][10][11][12][13] The described technique answers different challenges: 1) the possible loss of reduction, 2) the soft tissue irritation due to breakage of wire and migration, and 3) the need for additional surgery for the removal of implants. The advantages and disadvantages of the technique are described in Table 2.…”

Section: Discussionmentioning

confidence: 99%

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Patella Distal Pole Fracture Treated Using Ipsilateral Hamstring Autograft Augmentation and No Additional Hardware

Bulaïd

Fabre

Parratte

et al. 2021

Arthroscopy Techniques

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Patellar lower-pole fractures occur in relatively young patients after eccentric contraction of the quadriceps or direct trauma. Early diagnosis and adequate treatment lead to excellent outcomes and prevent tendon retraction and scarring. The aim of surgical treatment is to restore articular congruence and reestablish the extensor mechanism of the knee. All surgical treatments (sutures and tension band wiring, separate vertical wiring or augmented with Krackow sutures, wiring through screws, basket plate, hook plate) use additional hardware. We propose a hardware-free technique using ipsilateral hamstring augmentation.

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Section: Discussionmentioning

confidence: 99%

“…Almost all surgical treatments (sutures and tension band wiring, separate vertical wiring or augmented with Krackow sutures, wiring through screws, basket plate, hook plate) use additional hardware. 5,6 Because new techniques aim to reduce implant complications, 7 we propose a hardware-free technique using ipsilateral hamstring augmentation (Video).…”

mentioning

confidence: 99%

Patella Distal Pole Fracture Treated Using Ipsilateral Hamstring Autograft Augmentation and No Additional Hardware

Bulaïd

Fabre

Parratte

et al. 2021

Arthroscopy Techniques

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“…3 In such cases, the tension band technique should be combined with an additional cerclage around the fractured patella to reduce the gaps in a circumferential manner. Yang et al 9 modified the AO MATB technique by substituting two stainless steel wires with two titanium cables and demonstrated excellent Rasmussen score (mean 27.9 of 30) at 1 year after surgery. Borrowing from these concepts, our modification aims to improve the compression function of the tension band in both the static and dynamic phases.…”

Section: Discussionmentioning

confidence: 99%

The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures

Wang

Luo

Chen

et al. 2019

J Orthop Surg (Hong Kong)

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Purpose: The purpose of this study was to assess the outcomes in a series of patients, who underwent cerclage and figure-of-eight tension band wiring using a single titanium cable for comminuted patellar fractures. Methods: We describe a modified tension band technique using a single titanium cable to create an ellipsoidal cap structure that combines the circumferential and figure-of-eight wrapping in the fixation of closed Association for the Study of Internal Fixation/Orthopaedic Trauma Association 34C2 and 34C3 patellar fractures. We retrospectively reviewed 25 patients (16 males and 9 females, mean age 54 years) who underwent the described fixation technique between 2015 and 2017. Postoperative function was evaluated using the Böstman score. Results: At the mean follow-up of 25 months (range 17–39 months), the mean Böstman score was 27.3 ± 2.6 points (range 23–30). Eighteen patients (72%) had excellent results (score ≥28); seven patients (28%) had good results (score 20–27); and no patients had an unsatisfactory result (score < 20). All surgical incisions healed without major wound complications. Two patients reported minor complications (soft tissue irritation, cellulitis). No patients demonstrated loss of reduction or implant failure during the follow-up period. Conclusion: The modified anterior ellipsoidal cap tension band using a single titanium cable created an effective tension band structure in the treatment of comminuted patella fractures. It is a simple operative technique that produced a stable fixation construct, which allowed early functional rehabilitation and weight-bearing with a high rate of excellent outcomes at 2 years after surgery.

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“…Surgical treatment is recommended for displaced fractures of the inferior pole of the patella to restore the extensor mechanism of the lower extremity. Various techniques have been proposed for treating such comminuted fractures, including tension band wiring (TBW) [ 4 ], wiring through cannulated screws [ 5 ], separate vertical wiring, augmentation with a rim plate, cerclage wiring or suture [ 6 – 8 ], plate fixation [ 9 – 12 ], partial patellectomy with transosseous reattachment (TOR) [ 13 ], and suture anchoring [ 2 – 14 ]. Although excellent outcomes have been reported, most have been obtained from case series; few studies have compared the clinical results of the aforementioned methods.…”

Section: Introductionmentioning

confidence: 99%

“…TBW is a traditional treatment for transverse patellar fracture. Some surgeons also use TBW in treating inferior pole patellar fractures even when the fragment is small or comminuted, but few results have been reported [ 4 , 5 ]. Conversely, TOR with partial patellectomy is a treatment for inferior pole patellar fracture, especially when the fragment is too small or comminuted to be fixed.…”

Section: Introductionmentioning

confidence: 99%

Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment

Chang

Chuang

et al. 2021

J Orthop Surg Res

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Background The optimal surgical technique for the fixation of inferior pole patellar fracture remains controversial. The aims of this study were (1) to compare clinical and radiological outcomes following fixation of inferior pole patellar fracture by using tension band wire (TBW) and transosseous reattachment (TOR) without excision of the bony fragment and (2) to determine the risk factors for postoperative radiological loss of reduction. Methods For this retrospective cohort study, consecutive patients with inferior pole patellar fracture between January 2010 and December 2017 were recruited. The patients were grouped according to their fixation method (TBW or TOR), and demographic data, clinical outcomes, and postoperative Insall–Salvati (IS) ratio were analyzed. Then, the patients were grouped according to radiological loss of reduction, the possible risk factors for loss of reduction were identified, and odds ratios were calculated. Result This study included 55 patients with inferior pole patellar fracture; 30 patients were treated using TBW and 25 were treated using TOR. Clinical failure occurred in two patients in the TBW group (7%) and three in the TOR group (12%). The rate of radiological loss of reduction was significant higher in the TOR group, whereas removal of implants was significantly more common in the TBW group. Patella baja was noted immediately after surgery in the TOR group, but the IS ratios of the two groups were similar after 3 months. Fracture displacement of more than 30 mm was the only independent risk factor for postoperative radiological loss of reduction. Conclusion For treating inferior pole patellar fracture, both TWB and TOR were effective and had a low clinical failure rate. In 60% of patients undergoing TBW fixation, however, additional surgery was required to remove the implants. Patella baja occurred immediately following TOR, but the patellar height was similar to that in the TBW group after 3 months. Surgeons should be aware of the high risk of postoperative radiological loss of reduction, especially when the fracture displacement is more than 30 mm.

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Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System

Cited by 20 publications

References 24 publications

Patella Distal Pole Fracture Treated Using Ipsilateral Hamstring Autograft Augmentation and No Additional Hardware

Patella Distal Pole Fracture Treated Using Ipsilateral Hamstring Autograft Augmentation and No Additional Hardware

The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures

Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment

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