Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella

Abstract

Comminuted and displaced fractures of the inferiorole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. We have evaluated the clinical effectiveness of the separate vertical wiring technique in acute comminuted fractures of the inferior pole of the patella. A biomechanical study was also performed using ten pairs of embalmed cadaver knees. A four-part fracture was made on the inferior pole of the patella and fixed by two separate vertical wires on one side and two pull-out sutures after partial patellectomy on the other. The ultimate load to failure in the first group was significantly higher than in the second (250.1+/- 109.7 N v 69.7 +/- 18.9 N, p < 0.002), as was the stiffness (279.9 +/- 76.4 N/mm v 23.2 +/- 11.4 N/mm, p < 0.001). The separate wire technique was used in 25 patients with comminuted fractures of the inferior pole of the patella who were followed up for a mean period of 22 months (10 to 50). All the fractures healed at a mean of seven weeks (6 to 10). No breakage of a wire or infection occurred. The mean grading at the final follow-up was 29.5 points (27 to 30) using the Böstman method. This technique preserved the length of the patella, fixed the comminuted fragments of the inferior pole and avoided long-term immobilisation of the knee.

Treatment of Comminuted Fracture of Inferior Pole of Patella Using Partial Patellectomy And Patellar Tendon Repair Using Transosseous Sutures.

“…The cable protects the patellar tendon repair by transmitting loads directly from the Quadriceps tendon or proximal pole of the patella to the tibial tubercle 7 . The disadvantage of using cable wire is that they create additional stress risers in the Patella and the Tibial Tubercle.Secondly they usually require removal one to two years after surgery 8 .In our study we did not use any tension band wiring as the suture material we used (ethibond 5) is non-absorbable,high molecular weight ,long chain linear polyester and features a unique braid configuration. As a result, ethibond 5 suture material offers higher knot breaking strength,and superior strength.…”

A novel technique of patella fracture fixation facilitating early mobilization and reducing re-operation rates

“…1 Displaced fractures with disruption of the extensor mechanism of knee require operative treatment. 2 Various techniques have been described for internal fixation of patella fractures, except for severely comminuted fractures that require partial or total patellectomy. Of the various techniques described, cerclage wiring has been used for many years, however when used alone it is not rigid enough to allow early mobilisation.…”

Repair of the comminuted fracture of the lower patellar pole

“…Furthermore, holding power of technique was not strong enough and failed to include small fragments. [4] Song et al suggested augmentation with cerclage wire. [5] However, circumferential wiring has previously mentioned mechanical limitations and biological drawbacks.…”

“…[5] Yang and Byun used brace and allowed partial weight-bearing at postoperative first month. [4] Osteosynthesis using basket plate allows for full weight-bearing at sixth postoperative week. [8] With present technique, full weight-bearing was encouraged immediately after surgery.…”

“…[2] Furthermore, it may strangle blood vessels in their peripatellar course. [3] Separate vertical wiring technique was first introduced by Yang and Byun, and several modifications have been made; [4][5][6] however, complications have been reported. Basket plate was designed for osteosynthesis of the lower patellar 17-73 years).…”