Open reduction and internal fixation using multiple nonabsorbable suture materials in acute patella fracture: comparison of clinical and radiological outcome with tension band wiring

Abstract Background For treating displaced patella fractures, tension band wiring is the most widely used technique. However, implant removal surgery is often necessary to alleviate discomfort caused by fixation materials. On the contrary, fixation using nonabsorbable suture materials is anticipated to result in comparable outcomes without need for further implant removal surgery. However, there is a lack of clinical studies comparing the two fixation techniques (wire and nonabsorbable suture materials) for acute patella fractures. Methods From 2014 to 2018, we retrospectively reviewed 60 patients who underwent open reduction with internal fixation for acute patella fracture. Thirty patients (group 1) who received surgery using tension band wiring and 30 patients (group 2) who received surgery using nonabsorbable suture materials were enrolled. The average follow-up period was more than 1 year after operation. Operation time, postoperative bone union time, range of motion (ROM) of the knee joint, postoperative clinical results, and complications were compared between the two groups. Result Operation time, clinical bone union, and radiologic bone union were not statistically different between groups 1 and 2. At 3 months postoperatively, flexion was 120.3 ± 9.4° in group 1 and 110.5 ± 7.7° in group 2, showing statistically significant difference (p = 0.037). At 6 and 12 months postoperatively, the ROM was similar in both groups. Hospital for special surgery score at 3 months postoperatively was 78.4 ± 8.2 in group 1 and 83.7 ± 8.7 in group 2, showing statistically significant differences (p = 0.032). However, at 6 and 12 months postoperatively, there were no statistical differences. Lysholm score at 3 months postoperatively was 73.5 ± 8.1 in group 1 and 80.4 ± 8.2 in group 2, showing statistically significant difference (p = 0.016), but at 6 and 12 months postoperatively, there were no statistical differences. Conclusion Fixation using multiple nonabsorbable suture materials can be an alternative surgical method in managing patella fractures, along with tension band wiring.

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Miniplate 1.5 fixation for the repair of mandibular osteotomies in cats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000100007 ◽

2011 ◽

Vol 26 (1) ◽

pp. 31-37 ◽

Cited By ~ 3

Author(s):

Adelina Maria da Silva ◽

Wilson Machado de Souza ◽

Patrícia de Athayde Barnabé ◽

Marion Burkhardt de Koivisto ◽

Nair Trevizan Machado de Souza

Keyword(s):

Radiolucent Line ◽

The Body ◽

Bone Union ◽

Dental Occlusion ◽

Mandibular Fractures ◽

Significant Difference ◽

Osteotomy Line ◽

Group 2 ◽

Adult Cats ◽

Group 1

Purpose: To evaluate the application of the maxillofacial miniplate 1.5 in the repair of unilateral mandibular osteotomies in cats. Methods: Twelve adult cats were divided into two groups. In group 1 (n=6), the osteotomy was performed in the body of the mandible, behind the 1st molar. In group 2 (n=6), the osteotomy was performed between the 4th premolar and 1st molar. The osteotomy was fixed with a titanium miniplate 1.5. Oral alimentation was reinitiated 24 hours after surgery. Cats were euthanized at 12 weeks postoperative. Results: Radiographs taken 1 week after surgery showed a radiolucent line. The osteotomy line was not more visible on the radiographs taken at 12 weeks postoperative. Macroscopic examination confirmed alignment and bone union of operated hemimandibles. Histological examination showed formation of woven bone within the osteotomy line. The percentage of bone tissue at these areas was measured by the histometry. There was no statistically significant difference between the values of group 1(75.07 ± 5.99) and group 2 (74.76 ± 8.54) (Mann-Whitney's test p= 0.469). Conclusion: We concluded that the use of miniplate 1.5 for the fixation of mandibular osteotomy in cats provided the main goals in the treatment of mandibular fractures: bone union, normal dental occlusion and immediate return to oral alimentation.

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Comparison of Inflammatory Reactions Following Two Different Cesarean Section Techniques: The Modified Misgav-Ladach Versus the Pfannenstiel-Kerr; A Prospective Randomized Trial

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.811 ◽

2018 ◽

pp. 1

Author(s):

Baris Buke ◽

Hatice Akkaya ◽

Cigdem Karakukcu

Keyword(s):

Cesarean Section ◽

Inflammatory Reaction ◽

Operation Time ◽

Blood Samples ◽

Inflammatory Reactions ◽

Tnf Α ◽

Significant Difference ◽

The Difference ◽

Group 2 ◽

Group 1

Objectives: There is not yet a consensus on the optimal surgical technique for cesarean section. This is the first study comparing two different (Cesarean Section) with respect to the following inflammatory reaction in means of changes in inflammatory marker levels. To evaluate the differences in inflammatory reactions following two different (Cesarean Section) techniques, the modified Misgav-Ladach versus the Pfannenstiel-Kerr technique.Study Desıgn: The study population included 88 pregnant women who met the inclusion criteria. These women were randomized into two groups according to Consolidated Standards of Reporting Trials guidelines: Group 1 (Misgav-Ladach group) and Group 2 (Pfannenstiel Kerr group). To compare the inflammatory reactions following surgery, Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α) levels were measured in venous blood samples drawn from the patients just before (0 hour) and 24 hours (24th hour) after the surgery. In 5 women from Group 1 and 2 women from Group 2, the 24th hour blood samples could not be obtained or were lost. Thus, a total of 81 women, 39 women from Group 1 and 42 women from Group 2, comprised the population of study. The differences in inflammatory reactions between the 0 and 24th hours were analyzed by calculating the percent change in IL-6 and TNF-α levels, and these percentages were then compared between the groups.Results: There was a statistically significant difference between Group 1 and Group 2 regarding the serum IL-6 level change between 0 and 24th hour (530±653% and 196±168%, respectively, p=0.022. The difference in TNF-α was also higher in Group 2, but the difference was not statistically significant (229±306% vs. 571±824%, p=0.12). The mean operation time was significantly shorter in Group 1 (9.44 min. vs. 16.86 min, p=0.0001).Conclusions: The results of this study indicate that the modified Misgav-Ladach technique has a weaker inflammatory reaction, which indicates fewer short- and long-term surgical complications.

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Miniplate fixation for the repair of segmental mandibular defects filled with autogenous bone in cats

Acta Cirurgica Brasileira ◽

10.1590/s0102-86502011000300004 ◽

2011 ◽

Vol 26 (3) ◽

pp. 174-180 ◽

Cited By ~ 3

Author(s):

Adelina Maria da Silva ◽

Wilson Machado de Souza ◽

Marion Burkhardt de Koivisto ◽

Patrícia de Athayde Barnabé ◽

Nair Trevizan Machado de Souza

Keyword(s):

The Body ◽

Bone Union ◽

Dental Occlusion ◽

Autogenous Bone ◽

Iliac Crest Bone Graft ◽

Mandibular Fractures ◽

Segmental Defect ◽

Significant Difference ◽

Group 2 ◽

Group 1

PURPOSE: To evaluate the use of maxillofacial miniplate 1.5 in the repair of segmental mandibular defects filled with autogenous bone in cats. METHODS: Twelve adult cats were divided into two groups. A segmental defect of 4mm was created in one of the hemimandibles and filled with autogenous iliac crest bone graft. The operated hemimandible was fixed with a 1.5mm titanium miniplate. In group 1 (n=6), the defect was performed in the body of the mandible, behind the 1st molar. In group 2 (n=6), the defect was performed between the 4nd premolar and 1st molar, with extraction of the 1st molar. Oral alimentation was reinitiated 24 hours after surgery. Cats were euthanized at 20 weeks postoperative. RESULTS: Incorporation of the graft was suggested by the radiographs taken 20 weeks after surgery. Macroscopic examination confirmed alignment and bone union of operated hemimandibles. Histological examination showed formation of woven bone in rostral and caudal mandible/graft interfaces. The percentage of bone tissue at these areas was measured by the histometry. There was no statistically significant difference between the values of group 1(64.48 ± 4.51) and group 2 (71.69 ± 14.47) (Mann-Whitney's test p= 0.294). CONCLUSION: The use of miniplate 1.5 for the fixation of mandibular defects filled with autogenous bone in cats provided the main goals in the treatment of mandibular fractures: bone union, normal dental occlusion and immediate return to oral alimentation.

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Antibacterial-Coated Suture in Reducing Surgical Site Infection in Breast Surgery: A Prospective Study

International Journal of Breast Cancer ◽

10.1155/2012/819578 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 11

Author(s):

Enora Laas ◽

Cécile Poilroux ◽

Corinne Bézu ◽

Charles Coutant ◽

Serge Uzan ◽

...

Keyword(s):

High Risk ◽

Breast Surgery ◽

High Risk Group ◽

Microbial Colonization ◽

Suture Materials ◽

Significant Difference ◽

Axillary Lymphadenectomy ◽

Group 2 ◽

A Prospective Study ◽

Group 1

Background. To reduce the incidence of microbial colonization of suture material, Triclosan- (TC-)coated suture materials have been developed. The aim of this study was to assess the incidence of suture-related complications (SRC) in breast surgery with and without the use of TC-coated sutures.Methods. We performed a study on two consecutive periods: 92 patients underwent breast surgery with conventional sutures (Group 1) and 98 with TC-coated sutures (Group 2). We performed subgroups analyses and developed a model to predict SRC in Group 1 and tested its clinical efficacy in Group 2 using a nomogram-based approach.Results. The SRC rates were 13% in Group 1 and 8% in Group 2. We found that some subgroups may benefit from TC-coated sutures. The discrimination obtained from a logistic regression model developed in Group 1 and based on multifocality, age and axillary lymphadenectomy was 0.88 (95% CI 0.77–0.95) (). There was a significant difference in Group 2 between predicted probabilities and observed percentages (). The predicted and observed proportions of complications in the high-risk group were 38% and 13%, respectively.Conclusion. This study used individual predictions of SRC and showed that using TC-coated suture may prevent SRC. This was particularly significant in high-risk patients.

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A precise navigation device for fixation of patella fractures with modified K-wire tension band: design and application

10.21203/rs.3.rs-38296/v1 ◽

2020 ◽

Author(s):

Fuming Wang ◽

Haolan Xiong ◽

Xiaotao Long ◽

Yang Li ◽

Xiaohua Chen ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Procedure ◽

Evaluation Criteria ◽

Operation Time ◽

Tension Band ◽

Standard Position ◽

Patella Fractures ◽

Intraoperative Fluoroscopy ◽

Significant Difference ◽

K Wires

Abstract Background Traditionally, the technique of modified tension band wires (MTBW) has been the most commonly used surgical procedure. The purpose of this study is to design a precise navigation device that can obtain a standard position of K-wires for (MTBW), and to compare the precise MTBW (P-MTBW) by a navigation device with the conventional MTBW (C-MTBW) by hands in a retrospective study.Methods The device is designed by solidworks2012 software (USA), which can provide a precise guidance for obtaining a parallel K-wires. In addition, it can set the distance between two k-wires and the level of k-wires below patellar anterior surface. From June 2014 to August 2018, a total of 112 patients are employed in this retrospective study. The patients are divided into P-MTBW group and C-MTBW group according to the surgical technique with or without the precise navigation device. We need to record and analyze the operation time and the number of fluoroscopy, postoperative internal fixation imaging, knee function and complications.Results There were 54 patients in P-MTBW group and 58 patients in C-MTBW group. There were statistically significant differences(P＜0.001) in the operation time between P-MTBW group (39.5±4.7; range, 32–49 minutes) and C-MTBW group (53.7±6.8; range, 42–71 minutes). The number of intraoperative fluoroscopy was significantly less (P＜0.001) in P-MTBW group(4.2±1.4) versus that of C-MTBW group (8.3±2.7). According to Iowa knee score, there was no significant difference (P=0.268) in function between the two groups. According to our own evaluation criteria for MTBW, anyone in the P-MTBW group was excellent and 26 patients were excellent, 20 patients were good and 2 patients were fair in the C-MTBW group.Conclusion The navigation device can reduce operation time and intraoperative fluoroscopy frequency. P-MTBW fixation is an accurate and effective surgical procedure for patella fractures.

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Management of displaced transverse fractures of the patella using tension band wiring with or without circumferential cerclage wiring: A comparative study

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20191670 ◽

2019 ◽

Vol 7 (5) ◽

pp. 1752

Author(s):

Zubair A. Lone ◽

John Mohd ◽

Imtiyaz A. Beigh ◽

...

Keyword(s):

Tension Band ◽

Tension Band Wiring ◽

P Value ◽

Fixation Failure ◽

Non Union ◽

Recommended Treatment ◽

Cerclage Wiring ◽

Group 2 ◽

Transverse Fractures ◽

Group 1

Background: Transverse fractures of body of the patella are by far the most common fractures of this bone. Surgical fixation is the recommended treatment in displaced fractures with extensor lag. Although, tension band wiring (TBW) technique is the gold standard for these fractures, few surgeons recommend augmentation with circumferential cerclage wiring to improve the strength of the fixation. We compared the results of the internal fixation of displaced transverse fractures of the patella using TBW and circumferential cerclage wiring with those treated with TBW alone. Methods: We treated 54 displaced transverse fractures of the patella at our institution. We segregated the patients into two groups: Group 1 (n=23) included fractures treated with tension band wiring (TBW) along with augmented circumferential cerclage wiring while as Group 2 (n=31) included fractures treated by TBW alone. Outcome was studied, graded and compared on the basis of knee pain, knee stiffness, quadriceps wasting, loss of flexion and loss of extension. Results: 73.90% patients among group 1 and 70.96% among group 2 showed excellent to good results (P value < 0.1). Fixation failure and need for revision surgery among group 1 and group 2 was found to be 8.69% and 9.67%, respectively (P value < 0.6). Infections and non union occurred among 4.34% patients in group 1 whereas in group 2 it was 6.45% of the patients who encountered the same (P value < 0.6). Conclusions: The use of circumferential cerclage wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over fixation with tension band wiring alone.Keywords: Patella fracture, Tension band wiring, cerclage wiring

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Intraoperative mobilisation of knee and its effect on the final functional outcome in patella fractures: a clinical study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20182739 ◽

2018 ◽

Vol 4 (4) ◽

pp. 642

Author(s):

Deepak Aher ◽

Ajay Dandotiya ◽

Dharmendra Raghuvanshi ◽

Abhishek Pathak

Keyword(s):

Range Of Motion ◽

Functional Outcome ◽

Rating Scale ◽

Road Traffic ◽

Weight Bearing ◽

Operation Time ◽

Tension Band ◽

Tension Band Wiring ◽

Early Weight Bearing ◽

Patella Fractures

Background: Treatment of patellar fractures depends on its type, integrity of extensor mechanism and fragments size. Operative measures are tension band wiring and partial or total patellectomy. Early weight bearing and then gradual mobilization and finally quadriceps strengthening remains the crux of physiotherapy. Aim of this study was to see for the effect of intraoperative mobilisation of knee on functional outcome of tension band wiring in patella fractures.Methods: 30 patients were included in this study from January 2016 to February 2018. Tension band wiring was performed in all the patients. Intraoperative mobilisation of knee as allowed was done when patient was under effect of anesthesia. Final functional outcome was assessed as per the modified knee-rating scale of the Hospital for Special Surgery and also range of motion noted. Patients were evaluated at 1 month, 2 month, 6 month and 12 months.Results: Patients aged from 25-65 years with mean age of 40 years. 26 patients were male and 4 female. In 20 cases, Right knee was involved. All had trauma due to road traffic accident. Mean operation time was 1 hour. At the end of 1 year follow up only 2 patients had range of motion <90, 4 patients had range of motion 90-120 degrees and 24 patients had range of motion >120 degrees. After 1 year, functional outcome was, excellent in 24, good in 4, fair in 1 and poor in 1.Conclusions: Intraoperative mobilisation of knee after a stable fixation with tension band wiring of patella can prove to a very effective method for increasing postoperative range of motion and improving functional outcome.

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COMPARISON OF FUNCTIONAL OUTCOME OF MODIFIED TBW VERSUS MODIFIED TBW AUGMENTED WITH CIRCUMFERENTIAL CERCLAGE WIRING IN TRANSVERSE FRACTURE OF PATELLA

10.36106/8013768 ◽

2021 ◽

pp. 47-48

Author(s):

Satendra Kumar Sinha ◽

Angwsa Hazowary

Keyword(s):

Deep Infection ◽

Tension Band ◽

Tension Band Wiring ◽

P Value ◽

Complication Rates ◽

Transverse Fracture ◽

Group 2 ◽

Displaced Fracture ◽

Group 1

Background: The most common fracture of patella is transverse fracture of body. The gold standard treatment for displaced fracture is by tension band wiring (TBW) technique, augmentation with circumferential cerclage ss wiring has been suggested to improve the strength of the xation. Methods: The study was conducted at Nalanda Medical College, Patna during the period 2018-2020, by treating 28 patients. Group 1 (n=15) treated with modied tension band wiring (TBW) alone while as Group 2 (n=13) treated by modied TBW along with augmented circumferential cerclage ss wiring. Outcome was studied, graded and compared using the Modied Bostman Scale, union rates, and complication rates. Results: The results at nal follow up in group 1 were excellent in 10( 66.67%), good in 4(27.67%) and unsatisfactory in 1(6.67%). In group 2 the results were excellent in 8(61.54%), good in 5(38.46%) and no unsatisfactory results. Both groups have similar outcomes based on the scoring system used. The results were tested using t test and found to be different but not statistically signicant( p value- 0.469). In group one, 1(6.67%) developed deep infection and 1(6.67%) developed supercial infection. In group 2 2(15.38%) developed supercial infection, however these results are not statistically signicant (p value-0.432). Hardware irritation was seen in 3(20%) of group 1 and 3(23.07%) of group 2(p value>.05). 2(13.33%) of group 1 had implant removal during the course of follow up where as 2(15.38) in group 2 had hardware removal done. Conclusions: Modied tensioned band wiring for displaced transverse fracture of patella is an inexpensive and excellent method of treatment and the use of circumferential cerclage ss wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over xation with tension band wiring alone.

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A precise navigation device for fixation of patella fractures with modified K-wire tension band: A comparative retrospective study

10.21203/rs.3.rs-38296/v2 ◽

2020 ◽

Author(s):

Fuming Wang ◽

Haolan Xiong ◽

Xiaotao Long ◽

Yang Li ◽

Xiaohua Chen ◽

...

Keyword(s):

Retrospective Study ◽

Surgical Procedure ◽

Evaluation Criteria ◽

Operation Time ◽

Tension Band ◽

Standard Position ◽

Patella Fractures ◽

Intraoperative Fluoroscopy ◽

Significant Difference ◽

K Wires

Abstract Background Traditionally, the technique of modified tension band wires (MTBW) has been the most commonly used surgical procedure. The purpose of this study is to design a precise navigation device that can obtain a standard position of K-wires for (MTBW), and to compare the precise MTBW (P-MTBW) by a navigation device with the conventional MTBW (C-MTBW) by hands in a retrospective study.Methods The device was designed by solidworks2012 software (USA), which could provide a precise guidance for obtaining a parallel K-wires. Besides, it could set the distance between two k-wires and the level of k-wires below patellar anterior surface. From June 2014 to August 2018, a total of 112 patients were employed in this retrospective study. The patients were divided into P-MTBW group and C-MTBW group according to the surgical technique with or without the precise navigation device. We needed to record and analyze the operation time and the number of fluoroscopy, postoperative internal fixation imaging, knee function and complications.Results There were 54 patients in P-MTBW group and 58 patients in C-MTBW group. There were statistically significant differences(P＜0.001) in the operation time between P-MTBW group (39.5±4.7; range, 32–49 minutes) and C-MTBW group (53.7±6.8; range, 42–71 minutes). The number of intraoperative fluoroscopy was significantly less (P＜0.001) in P-MTBW group(4.2±1.4) versus that of C-MTBW group (8.3±2.7). According to Iowa knee score, there was no significant difference (P=0.268 at one year) in function between the two groups. According to our own evaluation criteria for MTBW, anyone in the P-MTBW group was excellent and 26 patients were excellent, 20 patients were good and 2 patients were fair in the C-MTBW group.Conclusion The navigation device can reduce operation time and intraoperative fluoroscopy frequency. P-MTBW fixation is an accurate and effective surgical procedure for patella fractures.

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Ureteral access sheath use in retrograde intrarenal surgery

Archivio Italiano di Urologia e Andrologia ◽

10.4081/aiua.2019.2.112 ◽

2019 ◽

Vol 91 (2) ◽

Cited By ~ 1

Author(s):

Mustafa Karaaslan ◽

Senol Tonyali ◽

Mehmet Yilmaz ◽

Sedat Yahsi ◽

Sedat Tastemur ◽

...

Keyword(s):

Operation Time ◽

Multivariate Regression Analysis ◽

Renal Surgery ◽

Ureteral Access Sheath ◽

Access Sheath ◽

Significant Difference ◽

The Mean ◽

Group 2 ◽

Intrarenal Pressure ◽

Group 1

Objective: To determine if there is a difference between postoperative urinary infection rates after retrograde intra-renal surgery (RIRS) when ureteral access sheath (UAS) was used or not used. Materials and methods: We retrospectively analyzed the medical records of all patients who underwent RIRS at our institution between January 2016 and October 2018. Results: 129 patients were included in the study. The mean age of the patients was 48.8 ± 12.1 years; 94 patients were male and 35 were female. The mean stone size (largest diameter), stone attenuation and stone volume were 15.3 ± 5.8 mm, 1038 ± 368 HU and 1098 ± 1031 mm3, respectively. Out of 129 patients, 81 were treated by using UAS (Group 1) and 48 were treated without use of UAS (Group 2). There was no statistically significant difference between the two groups in terms of post-operative infection (p = 0.608). However, the operative time of patients with post-operative infection was statistically higher than the other patients; 88.35 ± 22.5 min versus 59.37 ± 22.1 min (p = 0.017). In multivariate regression analysis, operation time (p = 0.02, r = 1.07) was found to be the sole predictor of post-operative infection. Conclusions: Using UAS during RIRS might reduce the intrarenal pressure and also has several advantages. However not prolonging the operation time too much could be of higher importance than UAS use in terms of preventing post-operative infection after RIRS.

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