Treatment of inferior pole patella fracture using Krackow suturing combined with the suture bridge technique

Zhou, Ming; Jia, Xueyuan; Cao, Zhihai; Ma, Yunhong; Wang, Yapeng; Wang, Peng; Kang, Yongqiang; Luo, Junhao; Wu, Yongwei; Rui, Yongjun

doi:10.1007/s00402-022-04525-y

Cited by 6 publications

(14 citation statements)

References 24 publications

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“…Similarly, most of the studies allowed early active mobilization to achieve 90 degrees to full flexion at postoperative 4-6 weeks. 3,5,[7][8][9][10][11][15][16][17][18]27,29,31 Owing to these biomechanical advantages, both KT and VW techniques achieved successful bone union with low complications and satisfactory clinical outcomes when supplementary fixations are properly applied, especially in highly comminuted fractures with low bone quality. Despite these informative findings, this study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

“…However, most studies allowed early weight-bearing and ROM exercises to achieve 90-degree flexion at 4-6 weeks postoperatively (Table 2). 3,5,[7][8][9][10][11][15][16][17][18]27,29,31…”

Section: Surgical Techniques and Postoperative Rehabilitation Protocolsmentioning

confidence: 99%

“…[6][7][8] These methods include Krackow transosseous (KT) suturing and separate vertical wiring (VW) techniques. 5,9,10 Although each of these techniques has advantages and disadvantages, evidence comparing them is lacking. Furthermore, the necessity of supplementary fixation, in addition to these techniques, remains questionable.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 However, secure fixation to allow early motion is challenging in traditional surgical options using the anterior tension band technique with Kirschner wire or screw fixations. 4,5 This is because the inferior pole is a weak cancellous bone, and these fractures are usually small and multifragmentary, involving both the coronal and sagittal planes. 4,5 Thus, partial patellectomy has been traditionally performed for these fractures; however, this method has some disadvantages because the change in patellar height after the resection of the inferior pole may disrupt the normal physiology of the patellofemoral joint and may cause critical problems at long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

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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

Kim,

Son

2024

Journal of Orthopaedic Trauma

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Objectives: To compare, in a systematic review, Krakow transosseous (KT) suturing and separate vertical wiring (VW) fixation methods in inferior pole fractures of the patella and to evaluate whether the supplementary fixation affected bone union. Data Sources: The MEDLINE, Embase, and Cochrane databases were searched from inception to January 15, 2023. The keywords were “patella inferior pole fracture”, “patella distal pole fracture”, “transosseous”, “pull-out suture”, “reattachment”, and “vertical wiring”. Study Selection: All clinical studies describing KT or VW techniques for inferior pole fracture of the patella and reporting bone union-related complications were included. Data Extraction: This meta-analysis included 16 studies with 274 patellae. Demographic data, surgical techniques, clinical outcomes, and complication rates were recorded. The Methodological Index for Non-Randomized Studies criteria were used to assess their quality. Data Synthesis: A meta-analysis was performed using random-effects models and meta-regression. The meta-analytic estimate of bone union-related complications was 3.8% (95% CI, 1.6%-6.0%) for either PO or VW techniques in inferior pole fractures of the patella. The bone union-related complication rates did not differ significantly between the two techniques (KT, 5.7%; VW, 3.0%; P=.277). Meanwhile, supplementation fixation was significantly associated with decrease in bone union-related complication rates (p=.013). Conclusion: Fixation of inferior pole fractures of the patella using either KT or VW techniques provided satisfactory and similar clinical results with minimal bone union-related complications. Supplementary fixation has a positive impact on reducing bone union-related complications in inferior pole fractures of the patella following KT and VW techniques.

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Section: Discussionmentioning

confidence: 99%

“…However, most studies allowed early weight-bearing and ROM exercises to achieve 90-degree flexion at 4-6 weeks postoperatively (Table 2). 3,5,[7][8][9][10][11][15][16][17][18]27,29,31…”

Section: Surgical Techniques and Postoperative Rehabilitation Protocolsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Kim,

Son

2024

Journal of Orthopaedic Trauma

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“…1E ) [14, 17, 19, 26], and transosseous reattachment (TOR; Fig. 1F) with or without partial patellectomy [1, 2, 12, 14, 15, 17, 18, 21, 29, 31, 37, 47]. Additional techniques frequently used for augmentation include the use of cerclage wiring ( Fig.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

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Purpose This study aimed to comprehensively review the existing evidence concerning surgical treatment of inferior pole fractures of the patella and to report the outcomes and complications of different fixation techniques. Method This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches of PubMed, Scopus, and Web of Science were conducted in March 2023. Studies were screened against predecided inclusion and exclusion criteria. The extracted data included fracture characteristics, surgical techniques, and radiographic and functional outcomes. The Methodological Index for Non-Randomized Studies (MINORS) quality assessment tool was used to assess the eligible literature. The primary outcome was postoperative range of motion of different surgical methods, and the secondary outcomes were other clinical results and complications. Results A total of 42 studies satisfied all the inclusion criteria and were deemed suitable for review. Fourteen case–control studies and 28 case series were selected, for a total of 1382 patients with a mean age of 51.0 years (range = 11–90). The follow-up period ranged from 6 to 300 months. The surgical techniques were categorized based on the device used as follows: (1) rigid fixation device; (2) tensile fixation device; (3) mixed device; and (4) extra-patella device. Conclusion Regarding the outcomes following surgical treatment of inferior pole fractures of the patella, the postoperative range of motion (ROM) of each technique ranged from 120° to 135°, with the exception of that involving the patellotibial wire which had poorer outcomes. The lowest functional score was also found in those using the patellotibial wire. Complications after surgery are rare, but approximately half of the patients required additional surgery for implant removal, particularly those whose initial surgery involved rigid fixation devices. It's worth noting that bony fragment excision is no longer recommended, and the combined use of multiple surgical devices is now more common.

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Lateral rim variable angle locked plating versus tension band wiring of simple and complex patella fractures: a biomechanical study

Warner,

Sommer,

Zderic

et al. 2024

Arch Orthop Trauma Surg

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Treatment of inferior pole patella fracture using Krackow suturing combined with the suture bridge technique

Cited by 6 publications

References 24 publications

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

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

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

Lateral rim variable angle locked plating versus tension band wiring of simple and complex patella fractures: a biomechanical study

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