scholarly journals Treatment of Patellar Fracture With Kirschner Wire Tension Band With Absorbable Sutures

2021 ◽  
Author(s):  
shilong Jin ◽  
Fengwei Qin ◽  
qiyuan Chen ◽  
jinfang Hu ◽  
libin Wei ◽  
...  
Keyword(s):  
Knee Joint ◽  
Range Of Motion ◽  
Rating Scale ◽  
Kirschner Wire ◽  
Absorbable Suture ◽  
Patella Fracture ◽  
Test Form ◽  
Absorbable Sutures ◽  
Patella Fractures

Abstract Study designRetrospective cohort studyObjectiveTension band wiring is considered the standard treatment for patella fractures. However, it is limited for fractures with marginal involvement, comminution, and osteoporotic bone. Our experience indicates that these limitations can be overcome with the technique of Kirschner wire combined with absorbable suture. We evaluated the radiographic and clinical outcomes in patients with patella fracture treated with this new technology.MethodsWe enrolled 32 patients who underwent the new technology for patella fracture at our hospital between 2018 and 2019. Fracture classification and surgical options were reviewed. Numerical Rating Scale (NRS), Levack score system, WOMAC test form of pain, stiffness and function, and knee joint range of motion (ROM) were applied for functional evaluation.Results32 patients were followed up for an average follow-up time of 13 months (11 to 24 months). All fractures were unioned, no wound infection, Kirschner wire exposure and second displacement of fracture fragment was found. None of the patients had knee stiffness, and the range of motion of the knee was 125.6° (110-135). The average NRS for knee pain was 7.5 (6-9) preinjury and 0.5 (0-2) at the last follow-up. Knee joint function recovered well, excellent and good rate was 93.75% (30/32). The average Levack score was 10.0 (6-12), which included twenty evaluations of “excellent” and twelve of “good”. WOMAC averaged 22.5 (14 - 38).ConclusionThe combination of Kirschner wire and absorbable suture for patella fractures is simple and clinically satisfactory, restores knee function well, and is a worthy orthopedic method.

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>

Absorbable suture material in carotid surgery

VASA ◽  
2015 ◽  
Vol 44 (6) ◽  
pp. 451-457 ◽  
Author(s):  
Vincenzo Gasbarro ◽  
Luca Traina ◽  
Francesco Mascoli ◽  
Vincenzo Coscia ◽  
Gianluca Buffone ◽  
...  
Keyword(s):  
Suture Material ◽  
Absorbable Suture ◽  
Paediatric Surgery ◽  
Carotid Surgery ◽  
Suture Materials ◽  
Absorbable Suture Material ◽  
Absorbable Sutures ◽  
Group A ◽  
Group B

Abstract. Background: Absorbable sutures are not generally accepted by most vascular surgeons for the fear of breakage of the suture line and the risk of aneurysmal formation, except in cases of paediatric surgery or in case of infections. Aim of this study is to provide evidence of safety and efficacy of the use of absorbable suture materials in carotid surgery. Patients and methods: In an 11 year period, 1126 patients (659 male [58.5 %], 467 female [41.5 %], median age 72) underwent carotid endarterectomy for carotid stenosis by either conventional with primary closure (cCEA) or eversion (eCEA) techniques. Patients were randomised into two groups according to the type of suture material used. In Group A, absorbable suture material (polyglycolic acid) was used and in Group B non-absorbable suture material (polypropylene) was used. Primary end-point was to compare severe restenosis and aneurysmal formation rates between the two groups of patients. For statistical analysis only cases with a minimum period of follow-up of 12 months were considered. Results: A total of 868 surgical procedures were considered for data analysis. Median follow-up was 6 years (range 1-10 years). The rate of postoperative complications was better for group A for both cCEA and eCEA procedures: 3.5 % and 2.0 % for group A, respectively, and 11.8 % and 12.9 % for group B, respectively. Conclusions: In carotid surgery, the use of absorbable suture material seems to be safe and effective and with a general lower complications rate compared to the use of non-absorbable materials.

Extension-Block Pinning for Unstable Dorsal Proximal Interphalangeal Joint Fracture-Dislocations: A Simple, Percutaneous Technique With Reproducible Outcomes

Hand ◽  
2022 ◽  
pp. 155894472110663
Author(s):  
Christopher A. Worgul ◽  
Andrew B. Stein
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Proximal Phalanx ◽  
Treatment Delay ◽  
Joint Fracture ◽  
Fracture Dislocations ◽  
Pip Joint

Background: Proximal interphalangeal (PIP) joint fracture-dislocations can be technically challenging injuries to treat, and no technique has proven to be superior nor lead to predictably good outcomes. We describe our experience of treating unstable dorsal fracture-dislocations of the PIP joint with extension-block pinning (EBP) at our institution over a 22-year period. Methods: In all, 23 patients with 24 unstable dorsal fracture-dislocations of the PIP joint treated with EBP between January 1998 and October 2020 were identified. All patients underwent closed reduction of the PIP joint and insertion of a Kirschner wire into the proximal phalanx, creating a mechanical block. Range of motion and joint congruity were assessed at final clinic follow-up. Long-term function was assessed via completion of a Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire. Spearman’s correlation coefficient was utilized to assess if any association existed between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Results: Mean range of motion at final follow-up was 83.3° and 22 of 24 PIP joints demonstrated a congruent reduction. In all, 15 of the 23 patients completed the QuickDASH questionnaire at a median long-term follow-up of 57.5 months (range: 3-157 months). Average QuickDASH score was 18.8, indicating minimal long-term disability. No statistically significant associations were found between treatment delay, pin-in-body days, or amount of articular surface involved and QuickDASH score. Conclusions: EBP offers a simple and innovative method to treat a complex injury of the PIP joint. It is technically straightforward and cheap, and produces excellent functional outcomes with minimal long-term disability.

scholarly journals Limited Knee-Joint Range of Motion in Patients With Tophaceous Gout Improved With Medical Treatment: A 18-Months Follow Up

2020 ◽  
Vol 7 ◽  
Author(s):  
Chuan-Chin Lu ◽  
James Cheng-Chung Wei ◽  
Cheng-Ang Chang ◽  
Chih-Ming Chen ◽  
Sen-Wei Tsai ◽  
...  
Keyword(s):  
Knee Joint ◽  
Medical Treatment ◽  
Range Of Motion ◽  
Tophaceous Gout ◽  
Joint Range Of Motion ◽  
Joint Range

scholarly journals Clinical analysis of an anchor nail combined with a titanium cable in the treatment of lower patella fractures

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051987350
Author(s):  
Zhijun Dong ◽  
Fuyao Liu ◽  
Yuan Pan ◽  
Shengzhong Wu ◽  
Chunshan Luo
Keyword(s):  
Postoperative Complications ◽  
Knee Joint ◽  
Maximum Degree ◽  
Main Part ◽  
Clinical Effect ◽  
Clinical Analysis ◽  
Healing Time ◽  
Bone Tunnel ◽  
Patella Fractures

Objective This study was performed to evaluate the clinical effect of an anchor nail and titanium cable for lower patella fractures and identify an effective treatment. Methods Thirty-five patients with lower patella fractures were treated using anchor nail and titanium cable technology. The anchor was fixed to the main part of the patella; the lower patella was then fixed. A bone tunnel was created, and the titanium cable was fixed. The fracture was allowed to heal without tension. Postoperative radiographs were obtained at regular follow-up evaluations. The Böstman function scores were used to assess postoperative complications. Results All patients were followed for an average of 15 months. The fracture healing time ranged from 12 to 24 weeks. The postoperative Böstman function scores were as follows: average, 28.6 points; excellent and good scores in 28 and 7 patients, respectively (100% rate of excellent and good scores). At 6 and 12 months postoperatively, the maximum degree of active extension of the affected knee joint was comparable with that of the healthy contralateral joint. Conclusion The combination of an anchor nail and titanium cable for lower patella fractures is simple and clinically satisfactory, restores knee function well, and is a worthy orthopedic method.

scholarly journals Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Katharina E. Wenning ◽  
Martin F. Hoffmann
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Range Of Motion ◽  
Rating Scale ◽  
Neck Disability Index ◽  
Upper Cervical Spine ◽  
Occipitocervical Fusion ◽  
Atlantoaxial Fusion ◽  
Upper Cervical

Abstract Background The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. Methods Over a 5-year period (2010–2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Results Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities (p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients (p = 0.01). Conclusion Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.

Delayed Single Kirschner Wire Compression Technique for Mallet Fracture

2005 ◽  
Vol 30 (2) ◽  
pp. 180-184 ◽  
Author(s):  
D. FRITZ ◽  
M. LUTZ ◽  
R. ARORA ◽  
M. GABL ◽  
M. WAMBACHER ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Articular Surface ◽  
Kirschner Wire ◽  
Compression Technique ◽  
Active Range Of Motion ◽  
Mallet Fracture ◽  
Strenuous Work ◽  
Distal Interphalangeal ◽  
The Mean

Twenty-four mallet fractures which involved at least one third % of the articular surface of the distal interphalangeal joint were treated by open reduction and internal fixation using a single double-ended Kirschner wire at a mean of 9 days after injury (range 4–15). At a mean follow-up of 43 (range 12–18) months the active range of motion, pain and the Warren and Norris criteria were evaluated. The mean active range of motion was from −2° extension (range 0–10°) to 72° flexion (range 50–90°). Nineteen patients were pain free and five suffered from mild pain during strenuous work. The Warren and Norris results were successful in 22 and improved in two cases. Radiographs showed, that all the fractures united in a near-anatomic position but with joint narrowing in six digits.

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

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

<p class="abstract"><strong>Background:</strong> 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.</p><p class="abstract"><strong>Methods:</strong> 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.<strong></strong></p><p class="abstract"><strong>Results:</strong> 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 &lt;90, 4 patients had range of motion 90-120 degrees and 24 patients had range of motion &gt;120 degrees. After 1 year, functional outcome was, excellent in 24, good in 4, fair in 1 and poor in 1.</p><p class="abstract"><strong>Conclusions:</strong> 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.</p>

Radial Osteotomy for Kienböck Disease: Clinical and Radiological Comparison between Younger and Older Patients

2021 ◽  
Vol 26 (03) ◽  
pp. 410-416
Author(s):  
Michiro Yamamoto ◽  
Masahiro Tatebe ◽  
Yasunobu Nakagawa ◽  
Shigeru Kurimoto ◽  
Katsuyuki Iwatsuki ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Clinical Improvement ◽  
Older Patients ◽  
Rating Scale ◽  
Clinical Results ◽  
Numeric Rating Scale ◽  
Patient Reported ◽  
Kienböck Disease ◽  
Disease Stages

Background: The usefulness of radial osteotomy for older patients remains unclear. The purpose of this study was to compare the clinical and radiological outcomes of radial osteotomy with volar locking plate between younger and older patients with Kienböck disease stages II to IIIB. Methods: This was a retrospective comparative study of 21 consecutive patients treated at our department. Lichtman’s classification was used for staging, and four patients had stage II, six patients had stage IIIA, and 11 patients had stage IIIB disease. We divided them into two groups to compare the radiological and clinical results between younger (younger than 40 years) and older patients. The mean follow-up periods in the younger and older groups were 4 and 3.6 years, respectively. For radiological assessment, we evaluated the carpal height ratio (CHR), Stahl index, and union of the fractured lunate. For clinical assessment, we examined the range of motion of the wrist, grip strength, numeric rating scale (NRS) for pain, and the patient-reported Hand20 score preoperatively and at the final follow-up. Results: There were 12 patients in the younger group with a mean age of 23 years (range, 12–37 years), and 9 in the older group with a mean age of 56 years (range, 40–74 years). There were no intra- and post-operative complications in either group. Radiological improvement, including CHR, Stahl index, and union of the fractured lunate, was more common in the younger group than in the older one, as was the case for clinical improvement. However, even in the older group, significant clinical improvement, including the range of motion of the wrist, NRS for pain, and the Hand20 score, was seen postoperatively. Conclusions: Radial osteotomy appears to be a safe and reliable option in older symptomatic patients with Kienböck disease stages II to IIIB.

scholarly journals The “invisible” wiring technique for displaced fracture patella

2020 ◽  
Vol 27 (2) ◽  
pp. 252-257
Author(s):  
Andrew LY Wong ◽  
Kevin KH Wong ◽  
Kam Kwong Wong ◽  
Wing Cheung Wong
Keyword(s):  
Tensile Strength ◽  
Operation Time ◽  
Wound Complication ◽  
Patella Fracture ◽  
High Tensile Strength ◽  
Steel Wires ◽  
Patella Fractures ◽  
Fracture Patella ◽  
Displaced Fracture

Background: Operative treatment of displaced patella fracture dates back to Lister in 1877. Nowadays, steel wires remain the material of choice in tension band technique despite complications such as wire breakage, suboptimal placement, or skin impingement. We propose using a high-tensile strength braided tape-shaped polyblend suture (FiberTape®, Arthrex, Naples, Florida, USA) as an alternative that could minimize complications related to steel wires. Method: Between February 2014 and April 2018, 15 patients with displaced patella fractures (three distal pole, five transverse, and seven comminuted fractures) underwent our proposed method. Open fracture reduction was performed to optimize anatomy before figure-of-eight fixation with FiberTape®. An Ethibond-2 suture was also added as cerclage for stability. Postoperatively, an extension brace was given for wound resting, before progressing to mobilization exercises with a hinge-knee brace. At follow-ups, the knee’s range-of-motion (ROM), along with bone healing status from radiographs, was assessed. Results: The mean operation time was 84.5 min, and all surgeries were performed or supervised by the same senior surgeon. Eight patients were discharged from follow-up (mean follow-up of 9.9 months) after achieving good ROM and fracture healing. One patient defaulted, and the remaining is still being followed-up. There was no wound complication or knot impingement in all cases. One patient required manipulation under anesthesia due to stiffness, and one experienced malunion due to poor compliance to rehabilitation protocol. Conclusion: Fixation using a high-tensile strength braided suture may be an equally effective method in the management of displaced patella fracture. However, larger sample size is useful to provide a more definitive conclusion.

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