Study of double button plate fixation in treatment of inferior pole of patella fracture

Fan, Meng; Wang, Dong; Sun, Kai; Jiang, Wenxue

doi:10.1016/j.injury.2020.01.031

Cited by 20 publications

(17 citation statements)

References 12 publications

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“…In the late stage, quadriceps atrophy, joint effusion, articular cartilage degeneration and secondary meniscus injury can become aggravated, which will seriously affect the quality of life of patients. Therefore, the current view is that PCL tibial avulsion fractures should be rmly xed to avoid postoperative displacement or poor healing, resulting in the instability of the knee joint [10].…”

Section: Discussionmentioning

confidence: 99%

Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture

Sun

Fan

2022

Preprint

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Background The posterior cruciate ligament plays an important role in maintaining the stability of the knee joint. To date, researchers have not reached agreement on which type of ﬁxation material should be used to treat PCL tibial avulsion fractures. The aim of this study was to investigate the effects of double button plate fixation in the treatment of posterior cruciate ligament avulsion fractures.We retrospectively reviewed our database, which was collected prospectively. From January 2019 to January 2020, 33 patients with posterior cruciate ligament avulsion fractures.Hypothesis To verify the effects of double button plate fixation of PCL avulsion fractures.Methods Patients with posterior cruciate ligament avulsion fractures were treated with double button plate fixation. The primary outcomes of this study were surgical complications (fixation failure/displacement, implant breakage, nonunion, infection), radiological parameters, and knee function. Secondary outcomes included reoperation rates for the fixation methods and the prevalence of symptomatic hardware causing soft tissue irritation.Results The results showed that double button plate fixation have no incidence of complications and can recovery postoperative range of motion (ROM), Knee Society Score (KSS) function and Lysholm scores.Conclusion The use of double button plate fixation technology has the following advantages: less trauma, shorter operation time, convenient use of instruments and fixtures, and it does not need to be taken out again, thus avoiding secondary trauma. Moreover, the strength of the suture is large, and the tension of the posterior cruciate ligament can be fully reduced by tying the suture band. Double button plate fixation under direct vision is safe and reliable without the need for additional equipment. Even comminuted fractures can also be effectively fixed by knotting.Our results suggest that this technique is a reliable and useful alternative treatment for irreparable rotator cuff tears.Level of Evidence: Case-control study, Level III.

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Section: Discussionmentioning

confidence: 99%

Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture

Sun

Fan

2022

Preprint

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“…Fortunately, the comminuted bone block connects to the patellar ligament, so it can be reduced via anchor suture technology [3,7,8].However, the suture is elastic and requires additional protection via external xation after operation. Additionally, there is a great risk in early exercise.…”

Section: Discussionmentioning

confidence: 99%

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

Chen¹,

Cao

Sun

et al. 2021

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Objective: The patellar inferior pole fracture is typically comminuted. Hence, achieving firm fixation and early activity is highly challenging. In this article, we employed the method of wire cerclage through a generated bone hole to reduce the fracture. Our objective was to compare the clinical efficacy of patellar concentrator alone with a combination of cerclage and patellar concentrator in the treatment of patellar inferior pole fracture.Methods: We conducted a retrospective review of patients with patellar inferior pole fractures, who underwent patellar concentrator fixation only (the control group) or cerclage combined with patellar concentrator fixation (the experimental group), performed by a single surgeon, between July 2015 and October 2019. Our analysis included surgical indexes like7 aspects (fracture gap after operation, operation time, intra-operative blood loss,intra-operative number of C-arm fluoroscopies conducted, Insall-Salvati ratio calculated immediately after operation, initial range of motion on the 7th day after operation, and fracture healing time), as well as the Bostman score and complications recorded on 1-, 3-, 6-, and 12-month follow up post operation.Results:A total of 94 patients with patellar inferior pole fracture and a minimum 1-year followup were recruited. Following operation, the control group had 33(71.74%) patients with a fracture gap of 0-2 mm and 13(28.26%)patients with a fracture gapgreater than 2 mm(P=0.002). Conversely,the experimental grouphad46(95.83%)patients with a fracture gap of 0-2 mm and 2(4.17%) patients with a fracture gapgreater than 2 mm(P=0.002). Compared to the control group, the experimental group did not experience enhanced operation time or intra-operative blood loss (P=0.811, P=0.823). The Insall-Salvati ratio and initial range of motion in the experimental group were larger than the control group (P=0.037, P=0.000). Alternately, the number of intra-operative C-arm fluoroscopies conductedand fracture healing time of the experimental group were considerably less than the control group (P=0.003,P=0.000).Moreover, at 1-, 3-, 6-, and 12-month follow ups after operation, the Bostman scores of the experimental group were remarkably higher than the control group (P< 0.05).At 12 months post operation, 23 cases (50%) were classified as excellent, 22 cases (47.83%) were good, and 1 case (2.17%) was poor in the control group(P=0.005). In the meantime, in the experimental group, 38 cases (79.17%) were deemed as excellent and 10 cases (20.83%) were good (P=0.005).Lastly, complications were detected in 3 cases (6.52%;1 case of internal fixation loss,2 cases of hematoma) within the control group, and in 1 case(2.08%; marginal wound necrosis) within the experimental group. There was no wound infection, implant discomfort, or broken fixation in eithergroup.Conclusion: Managingthe patellar inferior pole fracture with wire cerclage through a generated bone hole is both simple and effective. Moreover, an additional step of patellar concentrator fixation facilitates early functional exercise, with satisfactory clinical outcome.

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“…It is virtually impossible to restrict the pole fragments completely from the surface of the patella without interference to the patellar tendon. Among current forms of fixation, the implants either thrust through the patellar tendon or compress on its surface 11,13,14,19,21 . The soft tissue irritation waiting to happen necessitates a second surgery for implant removal.…”

Section: Feasibility Of the Novel Techniquementioning

confidence: 99%

“…The methods of traditional tension band and cerclage wiring are not useful as they do not provide satisfactory stability if the distal pole is comminuted and are often associated with loss of reduction and soft tissue irritation due to breakage and migration of the wiring 4 . Therefore, various new techniques have been described in the literature for osteosynthesis of the inferior pole of the patella, with the primary goal of reliable fixation [12][13][14][15][16] . However, most of the current techniques remain less helpful for comminuted inferior pole fractures and are commonly associated with certain complications.…”

Section: Introductionmentioning

confidence: 99%

“…Some anatomical locking plates are used to manage comminuted patellar fractures, offering high coverage and stable locking fixation 5,17 . In addition, specific plate constructs have been developed to manage inferior pole fractures of the patella, such as the basket plate, the hook plate, and the button plate 8,13,14 . However, to our knowledge, there is no current technique using a rim plate beneath the patellar tendon to fix the inferior pole of the patella.…”

Section: Introductionmentioning

confidence: 99%

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Novel Rim Plating Technique for Treatment of the Inferior Pole Fracture of the Patella

Pan

et al. 2021

Orthopaedic Surgery

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To aim of the present paper was to introduce a novel fixation technique for the treatment of inferior pole fracture of the patella. We performed a prospective observational study of consecutive cases of inferior pole fracture of the patella that were treated at our institution between January 2018 and June 2019. The patients include three men and one woman, with an average age of 47 years (range: 42-59 years). All patients were treated with the novel rim plating fixation technique for preserving the inferior pole of the patella. During the surgery, a 2.4 mm straight locking compression plate was contoured to adapt to the arc of the lower half of the patella as the rim plate. After reduction of the fracture, the rim plate was fixed to the proximal fragment of the patella through multiple locking screws, against the continuous pull of the patellar tendon. The rim plate encircles and constricts the inferior pole fragments, functioning as a compression and blocking construct. If necessary, an additional anterior tension band or mini locking plate can be used to further prevent anterior displacement of the inferior pole fragments. Under this rigid fixation, motion of the knee and full weight-bearing were encouraged postoperatively. The patients were followed up monthly until 12 months after surgery. The time to achieve 90 pain-free, full range of motion of the knee, and fracture healing, were recorded. Related complications were monitored, including infection, loss of reduction, fixation failure, anterior knee pain, and soft-tissue irritation. The modified Cincinnati knee rating system was used for knee function assessment. The average operative time was 58.8 min (range: 52-63 min). The average blood loss was 59.8 mL (range: 45-71 mL). For all patients, pain-free 90 range of motion was restored in 2-4 weeks, and the full range of motion was restored in 8-11 weeks. All patients achieved bone union in 6-9 weeks with no displacement of the fragments or breakage of the implant. No patient complained of anterior knee pain or soft-tissue irritation. The modified Cincinnati score at 12-month follow up demonstrated excellent outcomes in all four patients. The rim plating technique may be a feasible option for the treatment of the inferior pole fracture of the patella.

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Study of double button plate fixation in treatment of inferior pole of patella fracture

Cited by 20 publications

References 12 publications

Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture

Clinical Results of Double Button Plate Fixation for Posterior Cruciate Ligament Avulsion Fracture

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

Novel Rim Plating Technique for Treatment of the Inferior Pole Fracture of the Patella

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