Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study

Abstract Background: EFECE Systems are newly-defined internal fixation systems, which are suitable for patella fracture fixation. The aim of this study was to compare the fixation strength of EFECE Systems with tension band wiring for transverse patellar fracture simulation on fresh frozen cadaver models. Methods: Quadriceps tendon-patella-patellar tendon (QT-P-PT) complex was prepared from human cadavers. After simulation of a transverse patella fracture, in Group 1, 5 patella were fixed with a pair of 1.2 mm EFECE wires and 4 EFECE devices. In Group 2, 5 patella were fixed with a pair of 1.2 mm Kirschner wires (K-wire) and a cerclage wire according to the tension band technique.Using a testing device with custom-made jaws, increasing distraction force was applied to these QT-P-PT complexes. Extension of these complexes with the distraction forces was observed. The maximum distraction force and the elongation during maximum force were evaluated. Results: After 5 experiments with the EFECE Systems, there was no EFECE wire breakage or EFECE wire-EFECE device catching failure. The median maximum force was 740 N (720-810N). During maximum distraction force the median extension was 2.5 mm (1.6-2.5 mm).After 5 experiments with the tension band technique, there was no K-wire breakage. The median maximum force was 330 N (240-510N). During this maximum distraction force the median extension was 3.4 mm (2.2-3.8 mm).Conclusions: Based on the biomechanical advantages, patella fracture treatment with EFECE systems may constitute a reasonable alternative in the treatment of patella fractures.

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Comparing 3 Different Techniques of Patella Fracture Fixation and Their Complications

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459319827143 ◽

2019 ◽

Vol 10 ◽

pp. 215145931982714 ◽

Cited By ~ 3

Author(s):

Graham Ka-Hon Shea ◽

Karen Hoi-Ting So ◽

Kin-Wai Tam ◽

Dennis King-Hang Yee ◽

Christian Fang ◽

...

Keyword(s):

Soft Tissue ◽

Fracture Fixation ◽

Reoperation Rate ◽

Tension Band ◽

Implant Removal ◽

Patella Fracture ◽

Suture Fixation ◽

Hybrid Fixation ◽

Fixation Methods ◽

Patella Fractures

Introduction: Patella fractures managed by fixation with metal implants often cause local soft tissue irritation and necessitate implant removal. An alternative is to utilize suture-based fixation methods. We have adopted suture and hybrid fixation in the routine management of patella fractures. Here, we compare the results of 3 fixation techniques. Materials and Methods: Eighty-seven eligible patients underwent patella fracture fixation over a 3-year period. As determined by fracture configuration, patients received (1) suture fixation (transosseous sutures and figure-of-eight tension banding with FiberWire), (2) hybrid fixation (transosseous FiberWire sutures and metal tension banding), or (3) metal fixation. Primary outcome measures included reoperation rate and soft tissue irritation. Secondary outcomes included surgical complications, radiological, and functional parameters. Results: Reoperation rate was highest for metal fixation (25/57, 43.9%) and lowest for suture fixation (2/13, 15.4%). Soft tissue irritation necessitating implant removal was the predominant reason for reoperation and was significantly less prevalent following suture fixation (1/13, 7.7%, P < .01). Hybrid fixation resulted in similar rates of soft tissue irritation (6/17, 35.3%) and implant removal (7/17, 41.2%) as compared to metal fixation. There was a significant increase in patella baja (13/17, 76.5%) and reduction in Insall-Salvati ratio (0.742; 95% confidence interval: 0.682-0.802) following hybrid fixation as compared to the other 2 fixation methods ( P < .05). Discussion: Suture fixation results in the least amount of soft tissue irritation and lowest reoperation rate, but these advantages are negated with the addition of a metal tension band wire. Hybrid fixation also unbalances the extensor mechanism. Conclusion: Patients should be counseled as to the expected sequelae of their fixation method. Suture fixation is the favored means to fix distal pole fractures of the patella. An additional metal tension band loop may confer additional stability but should be applied with caution.

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A comparison of EFECE systems with tension band wiring for patella fracture fixation in cadavers

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01781-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Emre Karadeniz ◽

Elif Nedret Keskinoz

Keyword(s):

Fracture Fixation ◽

Tension Band ◽

Tension Band Wiring ◽

Patella Fracture

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Percutaneous Tension-Band Suture Technique for Distal Patella Fracture Fixation

MOJ Orthopedics & Rheumatology ◽

10.15406/mojor.2017.08.00315 ◽

2017 ◽

Vol 8 (3) ◽

Cited By ~ 2

Author(s):

Peter T Simonian

Keyword(s):

Fracture Fixation ◽

Suture Technique ◽

Tension Band ◽

Patella Fracture

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Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation

Injury ◽

10.1016/j.injury.2017.05.037 ◽

2017 ◽

Vol 48 (8) ◽

pp. 1749-1757 ◽

Cited By ~ 18

Author(s):

Ivan Zderic ◽

Karl Stoffel ◽

Christoph Sommer ◽

Dankward Höntzsch ◽

Boyko Gueorguiev

Keyword(s):

Fracture Fixation ◽

Tension Band ◽

Tension Band Wiring ◽

Patella Fracture ◽

Biomechanical Evaluation

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A Comparison of EFECE Systems With Tension Band Wiring for Patella Fracture Fixation in Cadavers

10.21203/rs.2.20710/v1 ◽

2020 ◽

Author(s):

Emre Karadeniz ◽

Elif Nedret Keskinöz

Keyword(s):

Fracture Fixation ◽

Tension Band ◽

Tension Band Wiring ◽

Maximum Force ◽

Patella Fracture ◽

Wire Breakage ◽

Custom Made ◽

Distraction Force ◽

Median Maximum ◽

Tension Band Technique

Abstract Background EFECE Systems are newly-defined internal fixation systems, which are suitable for patella fracture fixation. The aim of this study was to compare the fixation strength of EFECE Systems with tension band wiring for transverse patellar fracture simulation on fresh frozen cadaver models.Methods Quadriceps tendon-patella-patellar tendon (QT-P-PT) complex was prepared from human cadavers. After simulation of a transverse patella fracture, in Group 1, 5 patella were fixed with a pair of 1.2 mm EFECE wires and 4 EFECE devices. In Group 2, 5 patella were fixed with a pair of 1.2 mm Kirschner wires (K-wire) and a cerclage wire according to the tension band technique. Using a testing device with custom-made jaws, increasing distraction force was applied to these QT-P-PT complexes. Extension of these complexes with the distraction forces was observed. The maximum distraction force and the elongation during maximum force were evaluated.Results After 5 experiments with the EFECE Systems, there was no EFECE wire breakage or EFECE wire-EFECE device catching failure. The median maximum force was 740 N (720-810N). During maximum distraction force the median extension was 2.5 mm (1.6-2.5 mm).After 5 experiments with the tension band technique, there was no K-wire breakage. The median maximum force was 330 N (240-510N). During this maximum distraction force the median extension was 3.4 mm (2.2-3.8 mm).Conclusions Based on the biomechanical advantages, patella fracture treatment with EFECE systems may constitute a reasonable alternative in the treatment of patella fractures.

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A Comparison Of Efece Systems With Tension Band Wiring For Patella Fracture Fixation In Cadavers

10.21203/rs.2.20710/v3 ◽

2020 ◽

Author(s):

Emre Karadeniz ◽

Elif Nedret Keskinöz

Keyword(s):

Fracture Fixation ◽

Tension Band ◽

Tension Band Wiring ◽

Maximum Force ◽

Patella Fracture ◽

Wire Breakage ◽

Pt Complex ◽

Custom Made ◽

Distraction Force ◽

Median Maximum

Abstract Background: EFECE Systems are newly-defined internal fixation systems, which are suitable for patella fracture fixation. The aim of this study was to compare the fixation strength of EFECE Systems with tension band wiring for transverse patellar fracture simulation on fresh frozen cadaver models. Methods: Quadriceps tendon-patella-patellar tendon (QT-P-PT) complex was prepared from human cadavers. After simulation of a transverse patella fracture, in Group 1, 5 patella were fixed with a pair of 1.2 mm EFECE wires and 4 EFECE devices. In Group 2, 5 patella were fixed with a pair of 1.2 mm Kirschner wires (K-wire) and a cerclage wire according to the tension band technique.Using a testing device with custom-made jaws, increasing distraction force was applied to these QT-P-PT complexes. Extension of these complexes with the distraction forces was observed. The maximum distraction force and the elongation during maximum force were evaluated. Results: After 5 experiments with the EFECE Systems, there was no EFECE wire breakage or EFECE wire-EFECE device catching failure. The median maximum force was 740 N (720-810N). During maximum distraction force the median extension was 2.5 mm (1.6-2.5 mm).After 5 experiments with the tension band technique, there was no K-wire breakage. The median maximum force was 330 N (240-510N). During this maximum distraction force the median extension was 3.4 mm (2.2-3.8 mm).Conclusions: Based on the biomechanical advantages, patella fracture treatment with EFECE systems may constitute a reasonable alternative in the treatment of patella fractures.

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