Analysis of Sports Knee Fractures Based on X-Ray and Computed Tomography Imaging

Objective. To analyse the X-ray and computed tomography (CT) findings of 128 patients with sports-related knee fractures and to improve the diagnosis rate based on the existing methods of diagnosis of sports knee fractures on X-ray and CT images. Method. In this study, we retrospectively analyse the medical records of 128 cases of sports-related fractures in the hospital, analyse the results of X-ray examination and CT imaging of patients with sports knee fractures, and compare the results obtained by the two examination methods, while referring to MRI images performed. Results. CT examination of knee fractures, tibial plateau fractures, and knee joint free body results were compared with X-ray results ( P < 0.05 ), while CT examination of patella fractures and X-ray results were compared. The difference was not statistically significant ( P > 0.05 ). Conclusion. For imaging examination of knee fractures, a single ordinary X-ray or CT scan should be selected according to the specific situation of the patient. For patients with suspected unstable fractures, when the patient’s informed consent and the condition are not allowed, ordinary X-ray film combined with CT examination is used to improve the accuracy of diagnosis and avoid the existence of hidden fractures, resulting in medical accidents.

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

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.

Functional Outcome of “Reconstruction Patellar Plate” in the treatment of patella fractures

Background: The patellar fractures treatment has changed by enhancements in both an improved understanding of patellar function and fracture fixation techniques. The goals of operative fixation include repair of extensor mechanism, restoration of articular congruity, secure fixation and early movements. In this Study Reconstruction patellar plate was introduced in the management of patellar fracture. Aim: To determine the Functional outcome of fixation method of patella fractures by Open Reduction and Internal Fixation with Reconstruction Patellar Plate. Methods: This Prospective study was performed at Department of Orthopaedic Surgery at Lahore General Hospital for a period of 12 months after the approval Research Board of University of health Sciences, Lahore. Non probability purposive sampling method was used to induct 30 patients (who met the inclusive Criteria) underwent reconstruction patellar plate for the treatment of patella fracture. The patients were followed in outpatient department at 4 weeks and 16 weeks. Variables mentioned in Modified Hospital for Special Surgery Knee Score were recorded and Knee score was calculated and graded at 16 weeks. Results: In this study, overall mean age was 25.26 ± 5.02 years. There were 19 (63%) male and 11 (37%) female subjects. The mean of Modified Hospital for Special Surgery Knee Score (MHSSKS) was 84.90±8.87. In this study, there were 12(40%) patients with excellent functional outcome, 14 (46.67%) patients with good functional outcome and 4(13.34%) patients with fair functional outcome. There was no patient with poor functional outcome. Conclusion: Reconstruction Patellar Plate fixation method of patella fractures by Open Reduction and Internal Fixation produced good Functional outcome, which can be familiarized as an alternate to tension band method for the treatment of transverse patellar fracture. Keywords: fracture, patellar, reconstruction patellar plate, tension Band wiring

Comparison of minimally invasive percutaneous fixation and open reduction internal fixation for patella fractures: a meta-analysis

Background Open reduction internal fixation (ORIF) has long been the conventional procedure for managing displaced patella fracture. This surgical approach has certain drawbacks, which might affect clinical outcomes and patient prognosis. Minimally invasive percutaneous fixation (MIPF) was proposed to overcome these disadvantages. Few in-depth investigations have been performed to determine the superiority of MIPF over ORIF. The aim of this study was to compare the efficacies of MIPF and ORIF for patella fractures. Methods The PubMed, Cochrane Library, Embase, and Scopus databases were searched for relevant studies from November 26 to December 17, 2020. Non-English publications and pediatric orthopedic articles were excluded. Statistical analysis was performed using Review Manager, version 5.4, with mean differences (MDs), standardized mean differences (SMDs), odds ratios (ORs), and respective 95% confidence intervals (CIs) calculated using a random effects model. The primary outcomes were the pain score, knee range of motion, and joint functionality. The secondary outcomes were the surgical time, complications, and implant removal rate. Results Six articles with a total of 304 patients were included in the meta-analysis. Pooled analysis revealed that patients with MIPF had a significantly reduced pain score (MD = − 1.30, 95% CI = − 1.77 to −0.82; p < 0.00001) and increased knee extension angles (MD = 0.72, 95% CI = 0.18 to 1.25; p = 0.009) at 3-month follow-up. Furthermore, knee flexion angles (MD = 8.96, 95% CI = 5.81 to 12.1; p < 0.00001) and joint functionality (SMD = 0.54, 95% CI = 0.21 to 0.86; p = 0.001) had statistically improved at 2 years. However, no difference was observed between MIPF and ORIF with regard to the surgical time. The risk of complications (OR = 0.10, 95% CI = 0.05 to 0.18; p < 0.00001) and implant removal rate (OR = 0.20, 95% CI = 0.07 to 0.57; p = 0.003) were significantly lower with MIPF than with ORIF. Conclusions MIPF is more favorable than ORIF in terms of the pain score, knee range of motion, joint functionality, complications, and implant removal rate. Thus, it can be adopted as an alternative to ORIF.

Comparison of total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures: a 10–20-year follow-up study

Background The purpose of this study was to evaluate and compare the long-term clinical outcomes between the total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures. Methods Between January 1987 and December 2003, this retrospective study included a total of 35 patients (mean age, 51.4±16.8 years) with a minimum of 10 years follow-up period, comprising 29 males and 6 females, who were divided into the total patellectomy group (17 patients) or the open reduction and internal fixation (ORIF) group (18 patients) in the Third Affiliated Hospital of Hebei Medical University. We retrospectively collected patient demographics and data on the type of trauma, fracture type, and postoperative complications. Clinical outcomes including knee range of motion (ROM), 36-Item Short-Form Health Survey (SF-36) score [including physical component score (PCS) and mental component score (MCS)], Knee Injury and Osteoarthritis Outcome Score (KOOS), and Kujala score were evaluated and compared between the two groups. Biodex System dynamometer was used to quantitatively evaluate quadriceps femoris muscle power following measurement of peak torque. Results The mean follow-up periods of the total patellectomy group and the ORIF group were 17.2±5.6 and 16.8±4.9 years, respectively. There were no significant differences between the two groups of patient demographics in terms of the number of patients, age, sex, injury side, time to surgery, type of trauma, and fracture classification (p>0.05). Total patellectomy was comparable to osteosynthesis with tension band wiring in terms of ROM [injured knee: 120.4±3.1° vs 118.6±3.3°; uninjured knee: 126.5±2.8° vs 127.3±1.7°; both p>0.05], peak torque [Injured knee: 96.2±2.3 vs 97.3±2.6, N· m; Uninjured knee: 107.6±2.1 vs 106.3±1.8, N· m; both p>0.05], SF-36 score [PCS: 64.1±18.0 vs 61.5±17.9; MCS: 55.1±13.8 vs 54.3±12.4; both p>0.05], KOOS score [76.3±12.1 vs 73.4±11.7; p>0.05], and Kujala score [67.6±11.8 vs 70.8±11.9; p>0.05] at the final follow-up, while total patellectomy had significantly shorter operation time than ORIF group (47.5±12.1 vs 68.8±22.3, min, p<0.05). In the total patellectomy group, complications occurred in 6 of 17 cases (35.3%), and all occurred with calcification. In the ORIF group, complications occurred in 12 of 18 cases (66.7%), including 2 cases of infection (11.1%), 1 case of non-union (5.6%), 2 cases of implant failure (11.1%), 2 cases of soft tissue irritation (11.1%), and 5 cases of patellofemoral arthritis (27.8%). Conclusions Total patellectomy technique was a safe and reliable alternative treatment for treating patients with highly comminuted patella fractures when anatomically reduction and rigid fixation were difficult, although it caused relatively higher rates of calcification.