Triangular configuration with headless compression screws in the fixation of transverse patellar fracture

Chen, Yen-Nien; Chang, Chih-Hung; Chang, Hung‐Chih; Yang, Tai-Hua; Chang, Chia-Jung; Li, Chunting; Chen, Chih-Hsien

doi:10.1016/j.injury.2021.11.048

Cited by 4 publications

(6 citation statements)

References 27 publications

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“…The loading conditions of the patella differ during walking, and the direction of the muscle force changes during knee flexion and extension. In most previous studies, a worst-case loading condition of the fractured patella was assumed, and the gap opening distance was demonstrated at specific knee flexion angles [ 12 , 32 , 34 ]. In this simulation, the loading condition was extended to the entire walking cycle.…”

Section: Discussionmentioning

confidence: 99%

“…Some specific systems with minimally invasive techniques, such as the cable-pin system, have been proposed to reduce post-surgery pain compared with conventional approaches [ 18 ]. In addition, many approaches with percutaneous screw fixation without the anterior wire, such as two parallel headless compression screws, two parallel full-thread screws, crossing screws, and triangular screw configurations, have been proposed recently [ 12 , 13 , 20 , 35 ]. All approaches satisfy the criteria of a minimally invasive technique.…”

Section: Discussionmentioning

confidence: 99%

“…According to the literature, more than half of those cases with patellar fracture accepted tension band wiring from 2003 to 2015, while the combined approach has increased recently [ 11 ]. The major advantage of the combined approach, such as cannulated screws along with an anterior wire, is its excellent stability [ 12 , 13 ]. Cannulated screws along with an anterior wire were also reported to be superior to tension band wiring in the literature [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…However, the major disadvantage of cannulated screws with an anterior wire is delayed healing and pain after surgery due to damage to the soft tissue because of open surgery [ 15 – 17 ]. Hence, several studies have focused on minimally invasive surgery without the anterior wire and with a specific cable-pin system, two and three parallel headless compression screws, and full-thread screws to enhance the healing process and reduce pain [ 12 , 13 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical comparison of different screw-included angles in crossing screw fixation for transverse patellar fracture in level walking: a quasi-dynamic finite element study

et al. 2023

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Background A minimally invasive technique with various screw configurations without open surgery is currently used for the fixation of transverse patellar fractures. Percutaneous crossing screw configuration has been reported to have a good bone union rate in patellar fractures. However, the difference in mechanical stability of the fractured patella between different screw-included angles has not been fully investigated. Hence, this study aims to compare the mechanical stability of parallel and crossing screw fixations with different screw-included angles for the fixation of transverse patellar fractures during level walking. Methods A finite element knee model containing a patella with a transverse fracture is created. Two headless compression screws with different angles (0°, 30°, 60°, and 90°) are used to fix the fracture. The loading conditions of the knee joint during level walking are used to compare the stability of the fractured patella with different fixation screw configurations. Results The results indicate that the maximum fracture gap opening distance increased with an increase in the included angle. Two parallel screws yield the smallest gap distance among all screw configurations. The maximum gap opening distances at the anterior leading edge of the fractured patella with two parallel screws and two screws having an included angle of 90° are 0.73 mm and 1.31 mm, respectively, at 15% walking cycle. Conclusions Based on these results, the superior performance of two parallel screws over crossing screw fixations in the fixation of transverse patellar fractures is established. Furthermore, the smaller the angle between the crossing screws, the better is the stability of the fractured patella.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biomechanical comparison of different screw-included angles in crossing screw fixation for transverse patellar fracture in level walking: a quasi-dynamic finite element study

et al. 2023

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“…According to the 45 0 flexion condition of the nonweight bearing knee, the force applied by the quadriceps tendon made with ana angle of 20 0 with the horizontal and a aforce of 200 N, 400 N and 800 N was applied [11][12][13][14]. The patellar tendon, on the other hand, was timulated to make.…”

Section: Mesh Generationmentioning

confidence: 99%

Comparison of The Two Different Patella Fracture Fixation Technique: Finite Element Analysis

Demirtaş¹,

Emet²

2022

IJPTE

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Introduction: Fractures of patella account for 1% of bone fractures and this type of injuries can lead to severe knee funciton restrictions due to its role in extansor mechanism. The most common type of fracture pattern is transverse or comminute. According to the guidelines, the most often used surgical techniques are modified tension band wiring and circumferential cercle wiring. However there is no clear information about the configuration of cerclage wiring in the tension band technique. For this purpose, a transverse fracture line was created in the patella finite element model and biomechanical comparison was made in both figure of eight and zero configurations Material and Method: A transverse fracture line was created in patella and the k-wires were directed proximally at 90 degrees in coronal plane, perpendicular to the fracture line. A cerclage wire was wound on each finite element model in figure of zero (reference 1 model) and figure of eight (reference 2 model) configurations. These models were compared with each other in finite element model, with the knee at a 45 degree flexion angle and applying 200 Nm, 400 Nm and 800 Nm of force. Results: When the opening amounts of reference 1 and 2 models were evaluated under 200 Nm, 400 Nm, and 800 Nm loads, it was found that there were 14%, 8%, 13% less openings in the reference 1 model, respectively. When the amount of pressure in the fracture line was evaluated under the same loads, the average pressure was 10%, 15% and 12% higher in the reference 1 model compared to the reference 2 model, respectively. Conclusion: When the determined parameters were evaluated, although the amount of opening at the fracture line was better in the reference 1 model, there was no significant difference between the parameters in both models. Both fixation types allow early motion in clinical applications and help the prevention of displacement of the fracture.

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A novel patella fracture fixation technique: finite element analysis

Demirtaş

Katı

2023

Arch Orthop Trauma Surg

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Triangular configuration with headless compression screws in the fixation of transverse patellar fracture

Cited by 4 publications

References 27 publications

Biomechanical comparison of different screw-included angles in crossing screw fixation for transverse patellar fracture in level walking: a quasi-dynamic finite element study

Biomechanical comparison of different screw-included angles in crossing screw fixation for transverse patellar fracture in level walking: a quasi-dynamic finite element study

Comparison of The Two Different Patella Fracture Fixation Technique: Finite Element Analysis

A novel patella fracture fixation technique: finite element analysis

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