Patella fractures treated with suture tension band fixation

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.

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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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Abstaining from symptomatic implants of modified tension band wiring by nonabsorbable suture fixation for transverse patella fractures

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02494-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Puripun Jirangkul ◽

Arkaphat Kosiyatrakul

Keyword(s):

Steel Wire ◽

Clinical Results ◽

Tension Band ◽

Fixation Technique ◽

Nonabsorbable Suture ◽

Patella Fractures ◽

Sufficient Stability ◽

The Mean ◽

Conventional Stainless Steel

Abstract Background Modified tension band fixation has become commonly used for transverse patella fractures. The conventional stainless steel wire provides sufficient stability but may be associated with complications. Objective The study aimed to evaluate the effectiveness of a new modified tension band fixation technique for transverse patella fractures using a nonabsorbable suture. Material and methods We present the result of a prospective series using a nonabsorbable suture (FiberWire) for transverse patella fractures. The mean follow-up period totaled 12 months. A total of 16 patients were evaluated by radiographic and clinical review. The postoperative clinical evaluation employed Lysholm and Böstman scores. Result All clinical results on follow-up were good to excellent. Minimal intra-articular joint stepping and further fracture displacement were recorded. No patient needed re-operation, and functional outcomes of the knee were satisfactory. No significant differences were found between the injured and contralateral knee range of motion. No symptomatic implants and skin complications were noted, and all fractures were completed heal within 15 weeks. Conclusion FiberWire provided sufficient stability and reduced postoperative complications. The results proved appropriate, and the technique has merit, as it obviates the need for re-operation.

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Comparison of titanium cable tension band and nickel-titanium patella concentrator for patella fractures

Advances in Clinical and Experimental Medicine ◽

10.17219/acem/62692 ◽

2017 ◽

Vol 26 (4) ◽

pp. 615-619 ◽

Cited By ~ 3

Author(s):

quan-ming zhao ◽

Xiao-feng Gu ◽

Li Cheng ◽

De-hong Feng

Keyword(s):

Nickel Titanium ◽

Tension Band ◽

Cable Tension ◽

Patella Fractures

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

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11i4.4723 ◽

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.

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Comparison of outcomes of osteosynthesis in type II accessory navicular by variable fixation methods

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00378 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0037

Author(s):

Hyun-woo Park ◽

Ho-seong Jang ◽

Jae Wan Suh ◽

Sunghyun Kim

Keyword(s):

Visual Analog Scale ◽

Tension Band ◽

Tension Band Wiring ◽

Social Activities ◽

Type Ii ◽

Analog Scale ◽

Fixation Methods ◽

Scale Scores ◽

Accessory Navicular ◽

Screw Group

Category: Midfoot/Forefoot Introduction/Purpose: To compare the outcomes of fixation methods for osteosynthesis of a type II symptomatic accessory navicular between screw and tension band wiring. Methods: Forty-four patients (mean age, 29.2 years; range, 13–54 years; 21 males and 23 females) who had undergone operative treatment after failed conservative treatment were chosen for the study between 2007 and 2014. The patients were divided into two groups by the method of osteosynthesis: group 1 (screw) and group 2 (tension band wiring). Pre and postoperative evaluations were performed, using the midfoot scale from the American Orthopaedic Foot & Ankle Society (AOFAS), a visual analog scale, time to return to social activities, and plain radiography. Results: The AOFAS midfoot and visual analog scale scores of both groups were improved at the last postoperative follow-up. The time to return to social activities was 12.3 weeks in the screw group and 11.9 weeks in the tension band wiring group (p = 0.394). A broken screw was observed in one case in the screw group and a broken k-wire was detected in two cases in the tension band wiring group. Nonunion was observed in two cases in each group. Conclusion: The tension band wiring technique could be another treatment choice of osteosynthesis for fixation of the accessory navicular bone.

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Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: a meta-analysis

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-018-0919-6 ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 5

Author(s):

Yinwang Zhang ◽

Zhen Xu ◽

Wuxue Zhong ◽

Fuhai Liu ◽

Jie Tang

Keyword(s):

Meta Analysis ◽

Tension Band ◽

Wire Tension ◽

Patella Fractures

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The modified anterior ellipsoidal cap titanium cable tension band for comminuted patellar fractures

Journal of Orthopaedic Surgery ◽

10.1177/2309499019874018 ◽

2019 ◽

Vol 27 (3) ◽

pp. 230949901987401

Author(s):

Fasheng Wang ◽

Tianyi David Luo ◽

Chunyong Chen ◽

Yun Xie ◽

Zhangxiong Lin ◽

...

Keyword(s):

Weight Bearing ◽

Tension Band ◽

High Rate ◽

Wound Complications ◽

Functional Rehabilitation ◽

Postoperative Function ◽

Patella Fractures ◽

The Mean ◽

Patellar Fractures

Purpose: The purpose of this study was to assess the outcomes in a series of patients, who underwent cerclage and figure-of-eight tension band wiring using a single titanium cable for comminuted patellar fractures. Methods: We describe a modified tension band technique using a single titanium cable to create an ellipsoidal cap structure that combines the circumferential and figure-of-eight wrapping in the fixation of closed Association for the Study of Internal Fixation/Orthopaedic Trauma Association 34C2 and 34C3 patellar fractures. We retrospectively reviewed 25 patients (16 males and 9 females, mean age 54 years) who underwent the described fixation technique between 2015 and 2017. Postoperative function was evaluated using the Böstman score. Results: At the mean follow-up of 25 months (range 17–39 months), the mean Böstman score was 27.3 ± 2.6 points (range 23–30). Eighteen patients (72%) had excellent results (score ≥28); seven patients (28%) had good results (score 20–27); and no patients had an unsatisfactory result (score < 20). All surgical incisions healed without major wound complications. Two patients reported minor complications (soft tissue irritation, cellulitis). No patients demonstrated loss of reduction or implant failure during the follow-up period. Conclusion: The modified anterior ellipsoidal cap tension band using a single titanium cable created an effective tension band structure in the treatment of comminuted patella fractures. It is a simple operative technique that produced a stable fixation construct, which allowed early functional rehabilitation and weight-bearing with a high rate of excellent outcomes at 2 years after surgery.

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Evaluation of a new suture material (Duramesh™) by measuring suture tension in small and large bites techniques for laparotomy closure in a porcine model

Hernia ◽

10.1007/s10029-020-02140-7 ◽

2020 ◽

Vol 24 (6) ◽

pp. 1317-1324

Author(s):

Y. Yurtkap ◽

F. P. J. den Hartog ◽

W. van Weteringen ◽

J. Jeekel ◽

G. J. Kleinrensink ◽

...

Keyword(s):

Incisional Hernia ◽

Abdominal Wall ◽

Suture Material ◽

Abdominal Pressure ◽

Postoperative Phase ◽

Burst Abdomen ◽

Linea Alba ◽

Custom Made ◽

Suture Tension ◽

Significant Difference

Abstract Purpose After closure of laparotomies, sutures may pull through tissue due to too high intra-abdominal pressure or suture tension, resulting in burst abdomen and incisional hernia. The objective of this study was to measure the suture tension in small and large bites with a new suture material. Methods Closure of the linea alba was performed with small bites (i.e., 5 mm between two consecutive stitches and 5 mm distance from the incision) and large bites (i.e., 10 mm × 10 mm) with Duramesh™ size 0 (2 mm) and PDS II 2-0 in 24 experiments on six porcine abdominal walls. The abdominal wall was fixated on an artificial computer-controlled insufflatable abdomen, known as the ‘AbdoMan’. A custom-made suture tension sensor was placed in the middle of the incision. Results The suture tension was significantly lower with the small bites technique and Duramesh™ when compared with large bites (small bites 0.12 N (IQR 0.07–0.19) vs. large bites 0.57 N (IQR 0.23–0.92), p < 0.025). This significant difference was also found in favour of the small bites with PDS II 2-0 (p < 0.038). No macroscopic tissue failure was seen during or after the experiments. Conclusion Closure of the abdominal wall with the small bites technique and Duramesh™ was more efficient in dividing suture tension across the incision when compared to large bites. However, suture tension compared to a conventional suture material was not significantly different, contradicting an advantage of the new suture material in the prevention of burst abdomen and incisional hernia during the acute, postoperative phase.

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