Clinico-radiological and functional outcome of surgical management of displaced transverse fracture of patella in adults managed by tension band wiring in a tertiary care hospital in North India: a prospective study

Background: Patella is the largest sesamoid bone in the quadriceps tendon in the body. The main function of patella is to improve the efficiency of quadriceps muscle by improving the mechanical leverage of the quadriceps muscle. There are various methods used for fixation of these fractures. Tension band wiring (TBW) works by converting tensile forces into compressive forces when movements occur at the knee joint. The aim of our study was to evaluate the clinico-radiological and functional outcome of surgical management of displaced transverse fracture of patella in adults managed by TBW.Methods: This was the prospective study of 22 patients aged 20 to 60 years (mean age 41.4 years) with displaced transverse fractures of patella managed by TBW.Results: The final outcome was observed at 6 months follow up. The results were comparable with the existing literature. Radiological union was achieved within 10 to 16.2 weeks, with an average of 12.4 weeks. Out of 22, (n=16, 72.7%) had excellent outcome, (n=5, 22.7%) had good functional outcome, (n=1, 4.5%) had fair outcome. Complications were observed in 6 (27.3%) patients.Conclusions: It is concluded that the surgical treatment with TBW is the best treatment in the management of displaced transverse fractures of patella.

Some Physical Processes Involved in Deformation and Fracture

<p>The effects of strain rate, of moisture content, and of tracheid structure on the transverse fracture properties of Pinus Radiata have been studied. Small rectangular blocks were loaded to failure in transverse tension, with the conditions of fracture being varied as follows: (i) strain raite - at 2 x 10 caret-6 sec caret-1, and from 10 caret-5 to 10 caret 2 sec caret-1 in decade steps , (ii) moisture content - airdry (12.7%) and saturated, and (iii) structure - springwood and summerwood. Microscopical examination (both scanning electron and optical) of the surfaces produced by the facture showed that the cellular level, either of two types of failure could occur. These are called transwall and intrawall; transwall is the longitudinal splitting of a tracheid wall, and intrawall is a splitting between adjacent tracheids.</p>

Some Physical Processes Involved in Deformation and Fracture

<p>The effects of strain rate, of moisture content, and of tracheid structure on the transverse fracture properties of Pinus Radiata have been studied. Small rectangular blocks were loaded to failure in transverse tension, with the conditions of fracture being varied as follows: (i) strain raite - at 2 x 10 caret-6 sec caret-1, and from 10 caret-5 to 10 caret 2 sec caret-1 in decade steps , (ii) moisture content - airdry (12.7%) and saturated, and (iii) structure - springwood and summerwood. Microscopical examination (both scanning electron and optical) of the surfaces produced by the facture showed that the cellular level, either of two types of failure could occur. These are called transwall and intrawall; transwall is the longitudinal splitting of a tracheid wall, and intrawall is a splitting between adjacent tracheids.</p>

Palisade Technique — the New Method for Open Reduction of Pelvic Fractures

Background. Restoration of the pelvic bones and acetabulum anatomy after fracture is an important criterion for functional outcome. Often, the reduction of flat pelvic bones is not an easy task. The authors proposed a method of reduction using a special support site of two or three 3.5 mm cortical screws for Matta bone forceps. The aim of the study was to demonstrate a new way of pelvic bones fragments reduction. Method Description. Three clinical situations are presented when a new method was used: 1) reduction of a pointed fragment of the acetabulum posterior column transverse fracture; 2) reduction of the acetabulum quadrilateral plate fragments with medial displacement and 3) reduction the rupture of the pelvic bones in the sacroiliac joint with the vertical displacement. Previously, a support site was created in one of the fragments from two or three not fully twisted 3.5 mm cortical screws. One of the Matta bone forceps branches was placed on the formed site, and the second on another fragment and the displacement was eliminated. Then the final osteosynthesis was performed with pelvic plates and/or cannulated screws according to the surgical plan. Before closing the wound the support site was removed. Conclusion. The proposed method has shown its effectiveness during the reduction of the flat bones fragments, as it allows you to compress the spongy bones of the pelvis with a thin cortical layer stronger, compared with existing methods during which fragments splitting and pulling out anchor screws in the branches of reduction forceps can occur. The developed method of reduction demonstrated convenience and reliability.

An Advanced Proppant Depositional Study with Post-Production Flow Evaluation in a 10' X 20', Transverse Fracture, Slot Flow Configuration

While the shale revolution flourished prior to the pandemic, the increased supply bubble had already taken a toll on the profitability of horizontal wells with multiple transverse fractures. A significant shift previously occurred to reduce proppant costs by utilizing cheaper, smaller grained, lower strength, and broadly diverse grain sized sands. Due to the extremely low matrix permeability in active unconventional plays, the use of regional 40/70 and 100 mesh sands (50/140, 70/140, etc.) has become commonplace with adequate results. What remains is the need for enhanced conductivity near the wellbore to handle the radial flow convergence loss when the well is brought on-line. Research is being conducted to better understand how to efficiently increase near-wellbore conductivity using lead and tail-in stages with higher permeability (ceramic) proppant when frac sand is the majority of the material pumped into the well. A 10’x20’ Large Slot Flow (LSF) apparatus, equipped with multiple injection points, side-panel ports for leak-off and/or post-test injection, with the ability to be disassembled for sample analysis after testing, was utilized for this project. For this data, the inlet was moved to the centerline of the wall to allow for proppant and fluid to transport into an environment similar to a horizontal wellbore connecting with a transverse fracture. Various tests were conducted to study the depositional characteristics of lead and tail-in stages with ceramic proppant (15% BW-Lead, 5% BW-Tail) and a main stage of 100 mesh sand (80%). Three inlet positions were established in the lower, middle, and upper portion of the apparatus. Tests were recorded to visually capture the efficiency of placing the premium proppants near the wellbore for increased conductivity. A key addition to the study was the innovative, post-production analysis through the side-panel ports. Fluid was injected into the proppant pack to observe the effect of increased near-wellbore conductivity. To improve visibility, the fluid was colored with a fluorescent dye and observed under black lights. The injection front geometry was radial initially, but typically elongated toward the exit point after contacting the ceramic proppant. The amount of time and distance for the fluid to travel through the sand pack, as well as that for the fluid to reach the offtake point once the ceramic bed was reached, were monitored and recorded. The ratio of the velocities should represent a valid qualitative indication of the conductivity contrast of the two proppants. This paper will describe the unique experimental configuration, outline the testing program for both deposition and post-production assessments performed on the deposits, along with results that could provide better design practices leading to improved transverse fracture performance.

Evaluation of Functional Outcome of Patients with Transverse Fracture of Patella Treated with Tension Band Wiring - A Prospective Study Conducted at Trichur, Kerala

BACKGROUND Patella is the largest sesamoid bone in the human body, which plays important role in biomechanics of the knee. It is one of the few bones without periosteal surrounding. Fracture of patella constitute almost 1 % of all skeletal injuries with high prevalence in age group of 20 - 50 years. Fracture of patella may be due to direct/indirect force. Direct force often results in displaced or comminuted fractures. Fracture caused by indirect mechanisms result from a violent contraction of quadriceps muscle with knee flexion. Most of the patella fractures are combination of direct and indirect forces. Most significant effects of fracture patella are loss of continuity of the extensor mechanism of the knee and potential incongruity of the patellofemoral articulation. Treatment option includes reconstruction of entire patella or partial patellectomy and tendon repair or total patellectomy with extensor mechanism repair. Advancement in surgical techniques treatment option being shifted from patellectomy to reconstruction, preservation, and restoration of extensor mechanism. The purpose of this study was to evaluate the functional outcome of transverse fracture of patella treated with tension band wiring. METHODS This prospective study was done among 35 patients, who sustained transverse patellar fractures and were admitted in Department of Orthopaedics, Government Medical College, Thrissur from 01 October 2019 to 01 October 2020. Functional and clinical outcome was assessed at 2 weeks, 4 weeks, 3 months, and 6 months using Goodfellow’s scoring system. RESULTS The mean age was found to be 43 years, males were predominant. In 62.86 % of study population, right side was involved. In 63 % of study population, fracture occurred due to road traffic accidents (RTA). Average union was achieved in 11 - 13 weeks. Functional outcome was excellent to good in 85.71 % of study population. CONCLUSIONS Transverse fracture of patella can be treated with modified tension band wiring without much complications and early weight bearing is possible with good functional outcome. KEYWORDS Transverse Fracture Patella, Prospective Study, Tension Band Wiring, Good Fellows Score