scholarly journals Comparing 3 Different Techniques of Patella Fracture Fixation and Their Complications

2019 ◽  
Vol 10 ◽  
pp. 215145931982714 ◽  
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.

Fixation of Closed Transverse Patella Fracture with Cannulated Cancellous Screws and Anterior Tension Band Wiring- A Prospective Study

2020 ◽  
Vol 11 (4) ◽  
pp. 7985-7989
Author(s):  
Senthil Loganathan ◽  
Raghavendran B ◽  
Thiyagarajan U ◽  
Pradeep J
Keyword(s):  
Prospective Study ◽  
Steel Wire ◽  
Knee Function ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Patella Fracture ◽  
Cancellous Screw ◽  
Patella Fractures ◽  
Cancellous Screws ◽  
A Prospective Study

Patella fractures accounts for 1% of all skeletal injuries.  Patella fractures usually need to be treated with accurate reduction and fixation to obtain optimal knee function. Improper reduction of the articular fragments leads to complications like arthritis and quadriceps dysfunction. Tension band wiring and pasting are commonly performed fixation methods. Tension band wiring with K-wires is associated with wire prominence and soft tissue irritation. Cannulated cancellous screw fixation of the fracture and tension band wiring through the cannulated screws avoid the complication of wire migration and breakage.   In our study, we fixed these fractures with cannulated cancellous screws and tension band. This is a prospective study done in SRMC from 2012-2017. A total of 17 Patients with transverse patella fracture are taken into a study, 4mm cannulated cancellous screws with 18 mm stainless steel wire is used for anterior tension band wiring. Extensor retinaculum closure is done for all these patients. All patients had excellent knee function, according to KSS. There was no case of implant prominence or soft issue irritation in any of these patients. One patient had extensor lag. Cannulated cancellous screw with anterior tension band wiring is a reliable, effective and reproducible technique in treating transverse patella fractures.

scholarly journals A Comparison of Efece Systems With Tension Band Wiring for Patella Fracture Fixation in Cadavers

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.

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

Injury ◽  
2015 ◽  
Vol 46 (6) ◽  
pp. 1001-1006 ◽  
Author(s):  
Aaron J. Dickens ◽  
Christina Salas ◽  
LeRoy Rise ◽  
Cristina Murray-Krezan ◽  
Mahmoud Reda Taha ◽  
...  
Keyword(s):  
Fracture Fixation ◽  
Biomechanical Study ◽  
Tension Band ◽  
Patella Fracture ◽  
Titanium Mesh ◽  
Low Profile

scholarly journals Patella fractures treated with suture tension band fixation

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
J. Adjal ◽  
I. Ban
Keyword(s):  
Suture Material ◽  
Tension Band ◽  
Bony Union ◽  
Promising Alternative ◽  
Fixation Methods ◽  
Metallic Implants ◽  
Patella Fractures ◽  
Suture Tension

Abstract Background Patella fractures requiring surgery are traditionally treated using metallic implants, which are associated with high re-operation rates, mainly due to implant prominence. To overcome the problem of prominent metallic implants, we present a technique based purely on braided sutures. Methods This technique is described in a step-wise, standardised way based on our findings on six patients treated at our institution. Results This technique can be adapted to all types of patella fractures. The described suture configuration allows maintenance of inter-fragmentary reduction until bony union without symptoms from the suture material. Conclusions We believe that this technique is a safe and promising alternative to traditional metallic fixation methods.

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

Injury ◽  
2017 ◽  
Vol 48 (8) ◽  
pp. 1749-1757 ◽  
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

scholarly journals Multiply Broken Metallic Hardware Removal for United Patella Fracture Applied Twenty Years Before: A Case Report

2020 ◽  
Vol 58 (231) ◽  
Author(s):  
Kapil Mani K.C. ◽  
Parimal Acharya ◽  
Bandhu Ram Pangeni ◽  
Ankit Niroula ◽  
Amuda KC
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Tension Band ◽  
Patella Fracture ◽  
Fracture Union ◽  
Initial Surgery ◽  
Metal Wires ◽  
Neurovascular Structures ◽  
Metallic Hardware ◽  
Fatal Complications

Breakage of tension band wires, used to treat the patella fracture, is not uncommon several years after the fracture fixation. Broken wires may migrate to surrounding neurovascular structures, other vital organs like heart and may cause potentially fatal complications. Once the wires have been broken, it is very difficult to remove the broken pieces of metal wires. We report a 50 years old male patient with broken tension band wires at multiple sites for patella fracture. The broken wires were removed 20 years after the initial surgery without any undue complications, however patient sustained significant soft tissue damage to remove all the pieces of broken wires that would otherwise have been removed without any undue complications immediately after fracture union.

scholarly journals Lower pole of patella fractures treated with non-absorbable trans-osseous sutures: an effective surgical method to avoid implant related complications

2021 ◽  
Author(s):  
Aniruddha Mondal ◽  
Ayon Das
Keyword(s):  
Tertiary Care ◽  
Functional Results ◽  
Absorbable Suture ◽  
Patella Fracture ◽  
Suture Fixation ◽  
Inferior Pole ◽  
Distal Pole ◽  
Absorbable Sutures ◽  
Patella Fractures

<p><strong>Background: </strong>The treatment option for inferior pole of patella fracture is still being debated. Although tension‑band wiring is the most widely used technique to treat patellar fractures, metal implant‑related complications such as implant failure, palpable hardware are very common and additional procedures are often necessary to treat the complications. The aim of the study was to evaluate the functional results in patients with inferior pole of patella fracture treated by trans-osseous non-absorbable suture fixation.</p><p><strong>Methods:</strong> Patients who underwent trans-osseous suture fixation by no. 5 Ethibond for post-traumatic distal pole patella fracture were included in the study. This was a prospective study conducted at a tertiary care Government Hospital in Kolkata, between December 2018 to May 2020. All patients were followed up at an interval of 2 weeks, 6 weeks, 12 weeks, 6 months and 9 months. Bostman score was used to assess the functional outcomes of the patients.</p><p><strong>Results: </strong>Outcome at final follow-up was assessed with Bostman scoring system. In a total of 11 patients, 8 (72.8%) patients showed excellent and 3 (27.2%) patients had good results during the final follow-up. None of the patients demonstrated unsatisfactory result. At the end of 9 months, the average Bostman score for 11 patients was 27.9.</p><p><strong>Conclusions: </strong>The trans-osseous suturing with non-absorbable sutures is a safe and effective fixation technique for the treatment of distal pole patella fractures. It allows for rapid recovery with minimal implant‑related complications. It also reduces the re-surgery rates significantly.</p>

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

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.

Sign in / Sign up

Export Citation Format

Share Document