Outcomes for a custom-made anchor-like plate combined with cerclage in the treatment of inferior pole patellar fracture

Abstract

Objective An inferior pole fracture of the patella requires surgical treatment to restore the knee extension mechanism of the knee joint. Different from other types of patellar fractures, inferior pole fractures are usually comminuted, and other traditional fixation methods, such as tension band wiring, may not meet the fixation needs. We propose fixing inferior pole fractures of the patella with a custom-made anchor-like plate combined with cerclage and report the surgical outcomes. Material and methods This is a retrospective clinical study. From June 2018 to August 2020, 21 patients with inferior patella fracture treated at Hong Hui Hospital Affiliated to Xi’an Jiaotong University received a custom-made anchor-like plate combined with cerclage. Complications of the surgical fixation methods and final knee function were used as the main outcome measures. Results All fractures achieved good union, and the union time ranged from 8 to 12 weeks. No patients had serious complications, such as internal fixation failure or infection. The average duration of surgery of patients was 75.05 7.26 min, and the intraoperative blood loss was 60.099.49 ml. At the last follow-up, the range of motion of the knee was 120°-140°, with an average of 131.436.92°, the Bostman score was 27–30, and the Lysholm score ranged from 82 to 95. All patients showed good knee function one year after the operation. Conclusion We used a modified T-shaped plate combined with cerclage technology to fix inferior fractures pole of the patella, providing reliable fixation, allowing early functional exercise of the knee joint, and providing patients with good knee joint function after surgery.

Surgical treatment of inferior pole fractures of the patella: a systematic review

“…Rigid fixation devices included those using plates and screws ( n = 326, 8 studies; Fig. 1A) [6, 9, 18, 23, 27, 30–32] and concentrators ( n = 119, 2 studies; Fig. 1B) [4, 25].…”

“…1A ) or concentrators (Fig. 1B) [4, 6, 9, 18, 23, 25, 27, 30–32], and the use of separated vertical wiring (SVW; Fig. 1C ) [5, 7, 10, 20, 33, 38, 42, 43, 45], tension band wiring (TBW; Fig.…”

“…Additional techniques frequently used for augmentation include the use of cerclage wiring ( Fig. 1G) [4, 10, 22, 23, 29, 38, 42, 44] and patellotibial wiring [21, 22, 37, 46]. Combinations of techniques are also employed to treat inferior pole fractures of the patella.…”

Design and Validation of a Smile‐Necklace Plate for Treating Inferior Patellar Pole Avulsion Fractures: A Review and Hypothesis

“…In recent years, combination techniques have been designed and developed when a single fixation technique cannot meet the challenges presented by inferior patellar pole fractures. Combination techniques have addressed various challenges, including comminuted bone fragments, patellar ligament shear, inferior patellar displacement, and limited early rehabilitation 44 . Combining the WTB technique with cerclage wiring (Fig.…”

“…Combination techniques have addressed various challenges, including comminuted bone fragments, patellar ligament shear, inferior patellar displacement, and limited early rehabilitation. 44 Combining the WTB technique with cerclage wiring (Fig. 1G ) is a widely used fixation approach for treating inferior pole patellar fractures.…”