Open reduction and internal fixation using multiple nonabsorbable suture materials in acute patella fracture: comparison of clinical and radiological outcome with tension band wiring

Abstract

Background For treating displaced patella fractures, tension band wiring is the most widely used technique. However, implant removal surgery is often necessary to alleviate discomfort caused by fixation materials. On the contrary, fixation using nonabsorbable suture materials is anticipated to result in comparable outcomes without need for further implant removal surgery. However, there is a lack of clinical studies comparing the two fixation techniques (wire and nonabsorbable suture materials) for acute patella fractures. Methods From 2014 to 2018, we retrospectively reviewed 60 patients who underwent open reduction with internal fixation for acute patella fracture. Thirty patients (group 1) who received surgery using tension band wiring and 30 patients (group 2) who received surgery using nonabsorbable suture materials were enrolled. The average follow-up period was more than 1 year after operation. Operation time, postoperative bone union time, range of motion (ROM) of the knee joint, postoperative clinical results, and complications were compared between the two groups. Result Operation time, clinical bone union, and radiologic bone union were not statistically different between groups 1 and 2. At 3 months postoperatively, flexion was 120.3 ± 9.4° in group 1 and 110.5 ± 7.7° in group 2, showing statistically significant difference (p = 0.037). At 6 and 12 months postoperatively, the ROM was similar in both groups. Hospital for special surgery score at 3 months postoperatively was 78.4 ± 8.2 in group 1 and 83.7 ± 8.7 in group 2, showing statistically significant differences (p = 0.032). However, at 6 and 12 months postoperatively, there were no statistical differences. Lysholm score at 3 months postoperatively was 73.5 ± 8.1 in group 1 and 80.4 ± 8.2 in group 2, showing statistically significant difference (p = 0.016), but at 6 and 12 months postoperatively, there were no statistical differences. Conclusion Fixation using multiple nonabsorbable suture materials can be an alternative surgical method in managing patella fractures, along with tension band wiring.

Incidence of Implant Removal in Surgically Treated Patella Fractures

“…Greenberg et al suggested that removal gives significant pain relief but doesn’t significantly improve the functional limitations [ 19 ]. We observed an overall rate of removal to be 20.5% (one in five cases) which is lower when compared to other published literature reporting removal rates at 17% to 70% [ 3 , 8 , 12 , 17 , 19 - 21 ]. The left or right side had no relation to removal rates (equivocal).…”

“…Patella plays a pivotal role in maintaining the integrity of the knee extensor mechanism acting as a fulcrum of the lever of the quadriceps. Thus, any disruption needs intervention to help the patient regain knee extension and independent mobilization [ 11 , 12 ]. A conservative approach is often followed only if there is no articular step, the fracture is undisplaced or the patient is not fit for surgery.…”

“…This can be explained by the increased chances of early cut-through due to osteoporosed bone, loosening, and migration and since the skin is fragile, implants become easily prominent. Literature suggests conflicting observations and advocates fewer chances of removal in the elderly due to low functional demand and attributed high functional activity and increased forces acting on extensor mechanism leading to increased chances of removal in the young [ 3 , 12 , 15 , 20 ]. The comminuted pattern had significantly higher rates of removal (29.4%) relative to other fracture configurations (12.7%).…”

Comparison of Fixation Methods between Transosseous Pull-Out Suture and Separate Vertical Wiring for Inferior Pole Fracture of Patella: A Systematic Review and Meta-Analysis

“…4 Owing to these multifragmentary fracture patterns and inherent weak small bone in distal fragments, the tension band wiring technique is not feasible because it requires an intact cortical buttress to withstand compression and firm fixation to withstand the tensile forces. 32–35 Therefore, alternative fixation modalities are needed for secure fixation. Two main available options are partial patellectomy or reattachment of the distal fragment using various methods.…”

Tension band wiring versus suture anchor technique in patellar inferior pole fracture: Novel double row suture anchor technique

“…TBW is the traditional surgical method for treating patellar fractures. In particular, transverse fractures with large fragments can be easily reduced to obtain and maintain fracture fixation using TBW [ 7 ]. However, TBW is often insufficient to achieve rigid fixation due to comminuted and small fracture fragments in comminuted inferior pole fractures [ 8 ].…”