Comparison of a minimally invasive osteosynthesis technique with conventional open surgery for transverse patellar fractures / 中华创伤杂志(英文版)

PURPOSE@#The study aims to compare the efficacy and safety of a new minimally invasive osteosynthesis technique with those of conventional open surgery for transverse patellar fractures.@*METHODS@#It was a retrospective study. Adult patients with closed transverse patellar fracture were included, and with open comminuted patellar fracture were excluded. These patients were divided into minimally invasive osteosynthesis technique (MIOT) group and open reduction and internal fixation (ORIF) group. Surgical time, frequency of intraoperative fluoroscopy, visual analogue scale score, flexion, extension, Lysholm knee score, infection, malreduction, implant migration and implant irritation in two groups were recorded and compared. Statistical analysis was performed by the SPSS software package (version 19). A p < 0.05 indicated statistical significance.@*RESULTS@#A total of 55 patients with transverse patellar fractures enrolled in this study, the minimally invasive technique was performed in 27 cases, and open reduction was performed in 28 cases. The surgical time in the ORIF group was shorter than that in the MIOT group (p = 0.033). The visual analogue scale scores in the MIOT group were significantly lower than those in the ORIF group only in the first month after surgery (p = 0.015). Flexion was restored faster in the MIOT group than that in the ORIF group at one month (p = 0.001) and three months (p = 0.015). Extension was recovered faster in the MIOT group than that in the ORIF group at one month (p = 0.031) and three months (p = 0.023). The recorded Lysholm knee scores in the MIOT group were always greater than those in the ORIF group. Complications, such as infection, malreduction, implant migration, and implant irritation, occurred more frequently in the ORIF group.@*CONCLUSION@#Compared with the ORIF group, the MIOT group reduced postoperative pain and had less complications and better exercise rehabilitation. Although it requires a long operation time, MIOT may be a wise choice for transverse patellar fractures.

Comparison of the clinical efficacy of different fixation systems for the treatment of transverse patellar fractures / 中华创伤杂志(英文版)

PURPOSE@#This study was designed to compare the clinical efficacy of "8" and "0" wire fixation systems combined with double-head cannulated compression screws or Kirschner wires for the treatment of transverse patellar fractures.@*METHODS@#From September 2011 to September 2018, patients with closed transverse patellar fractures treated with a double-head compression screw or Kirschner wire were included and analyzed retrospectively. Patients with patellar fractures combined with distal femoral fractures, tibial plateau fracture or preoperative lower limb dysfunction were excluded. The patients treated with the "8" tension band wire fixation system and Kirschner wire were taken as Group A; those treated with the "0" fixation system and Kirschner wire were taken as Group B; those treated with the "8" fixation system and double-head cannulated compression screw were taken as group C; and those treated with the "0" fixation system and double-head cannulated compression screw were taken as group D. Six weeks and one year after the operation and every month from the third month after the operation until the fractures healed, an X-ray examination was performed to identify fracture healing. The time of fracture healing and postoperative complications of the four groups were compared. One year after the operation, knee function was evaluated by Bostman's score.@*RESULTS@#During the study period, 168 patients with patellar fractures were treated by operations, and 88 patients were excluded because the fracture type did not meet the requirements or because there were combined fractures of the distal femur or tibial plateau. As a result, 80 patients were included in this study, 20 in each group. All the patients were followed up for an average period of 12.2 months. Compared with Group A, patients in Group D presented less postoperative discomfort in the prepatellar region, quicker fracture healing, less fixation failure and better postoperative knee function scores (all p 0.05).@*CONCLUSION@#The "0" wire fixation system combined with a double-head cannulated compression screw seems to be more beneficial than the other three fixation systems for the treatment of transverse patellar fractures.

Arthroscopic minimally invasive Kirschner wire tension band internal fixation combined with lower limb feedback training in the treatment of patellar fractures / 中国综合临床

Objective To investigate the clinical effect of arthroscopy minimally invasive Kirschner wire tension band internal fixation combined with lower limb feedback training for patellar fracture.Methods Fifty-eight cases of patellar fracture who received arthroscopy minimally invasive Kirschner tension band internal fixation from March 2016 to April 2018 in Linxi Hospital,Kailuan General Hospital were included in this study.All cases were divided into control group (32 cases) and observation group (26 cases) according to the different rehabilitation methods.Control group received routine rehabilitation,observation group received intelligent feedback system of the lower limbs based on the control group.The recovery of joint function was compared between two groups.Results The clinical efficacy of the observation group was excellent (18 cases),good (6 Cases),and medium (2 cases),the excellent and good rate was 92.30％ (24/ 26).In the control group,the clinical effect was excellent (19 cases),good (9 cases),and medium (4 cases).The excellent and good rate was 87.50％ (28/32).There was no significant difference in clinical efficacy (z =0.80,P＞ 0.05) and excellent and good rate (x2 =0.36,P＞ 0.05) between two groups after 6 months follow-ups.The scores and total scores of B(o)stman patellar fracture function before treatment in observation group were pain (3.3 ± 0.8),Knee range of motion (3.2 ± 0.7),work (1.8 ± 0.3),muscular atrophy (1.8±0.2),auxiliaries (2.9 ± 0.6),effusion (1.2 ± 0.4),giving way (0.3 ± 0.2),climb stairs (0.3 ±0.2) andtotal score (15.0 ±2.2) respectively.The scores and total scores of B(o)stman patellar fracture function after treatment in observation group were pain (5.7 ± 0.4),Knee range of motion (5.8 ± 0.2),work (3.6 ±0.5),muscular atrophy (3.5 ± 0.6),auxiliaries (3.7 ± 0.4),effusion (1.8 ± 0.3),giving way (1.7 ±0.4),climb stairs (1.7 ± 0.5) and total score (28.3 ± 1.6) respectively.The B(o)stman patellar fracture functional score in observation group increased significantly (t =14.62,19.15,16.47,14.78,6.96,7.18,17.26,14.16,26.30,P ＜ 0.05).The scores and total scores of B(o)stman patellar fracture function before treatment in control group werepain (3.4 ± 0.6),Knee range of motion (3.1 ± 0.6),work (1.9 ± 0.4),muscular atrophy(1.7 ±0.3),auxiliaries (2.8 ±0.5),effusion(1.1 ±0.3),giving way(0.4±0.2),climb stairs (0.4 ±0.2) andtotal score (14.8 ±2.3),respectively.The scores and total scores of B(o)stman patellar fracture function after treatment in control group were pain(5.2±0.6),Knee range of motion(4.9 ±0.7),work(3.1 ±0.6),muscular atrophy (2.5 ± 0.5),auxiliaries (3.2 ± 0.4),effusion (1.3 ± 0.4),giving way (1.3±0.3),climb stairs (1.2 ± 0.4) and total score (22.7 ± 2.5),respectively.The functional scores of B(o)stman patellar fracture in control group were significantly increased (t =13.26,12.44,10.16,8.17,3.38,3.22,15.14,11.31,14.13,all P ＜ 0.05).The scores and total scores of B(o)stman patellar fracture in observation group after treatment were significantly higher than those in control group (t =3.64,6.34,3.39,6.93,4.73,5.28,4.35,4.23,9.89,P ＜ 0.05).In observation group,the range of knee joint activity at different time were before operation (30.2 ± 6.1) °,2 weeks after operation (85.6 ± 6.8) °,4 weeks after operation (100.6± 7.5) °,6 weeks after operation (118.5 ± 8.3) °,8 weeks after operation (138.9 ± 8.2) °,respectively.In control group,the range of knee joint activity at different time werebefore operation (29.3 ±7.2) °,2 weeks after operation (74.8 ± 6.9) °,4 weeks after operation (92.8 ± 7.8) °,6 weeks after operation(102.8 ± 9.4) °,8 weeks after operation (121.1 ± 7.3) °,respectively.The range of knee joint activity of two groups were significantly increased with the duration of treatment,Fgroup =124.58,P ＜0.05.The increases of range of knee joint activity in observation group was significantly higher than that in control group,Fintersecrion =11.78,P＜0.05.The overall levels of range of knee joint activity in observation group were significantly higher than that of control group,and Fbetween =36.27,P＜ 0.05.The KSS scores of in observation group werebefore operation (40.5 ± 8.8),2 weeks after operation (66.4 ± 9.0),4 weeks after operation(76.8±9.1),6 weeks after operation (83.4 ±9.5) and 8 weeks after operation (89.4 ± 8.1),respectively.The KSS scores in control group at different time were before operation(38.9 ±9.2),2 weeks after operation (60.1 ± 8.3),4 weeks after operation (70.4± 8.2),6 weeks after operation (77.6± 7.3) and 8 weeks after operation(82.5±8.6) respectively.The KSS score of two groups were significantly increased with the duration of treatment,Fgroup =84.32,P＜0.05.The increases of KSS score in observation group were significantly higher than that in control group,Fintersecrion =8.94,P＜0.05.The overall levels of range of KSS score in observation group were significantly higher than that of control group,and Fbetween =28.52,P ＜0.05.Conclusion The application of lower limb feedback training system after arthroscopic minimally invasive Kirschner wire tension band fixation can promote the recovery of knee joint function in patients with patellar fracture.

A Clinical Study of the Patellar Fractures / 대한정형외과학회잡지

Fractures of the patella are predominantly intra-articular fractures of a sesamoid bone. The options of treatment vary from closed treatment to total patellectomy, in the middle of the spectrum are osteosynthesis and partial patellectomy. In this series, we experienced 59 cases of patellar fractures from October 1974 to October 1983 at the Department of the Orthopedic Surgery, College of Medicine, Kyungpook National University. The results were as follows:1. Most fractures were encountered in man from twenties to forties. 2. The most common cause of fractures was traffic accident(34 cases, 59.7%), followed by slip down or falling down(15 cases, 26.3% ). 3. The most frequent configuration of fractures was the comminuted. 4. 36 cases were treated with osteosynthesis (32 cases), partial excision (1 case) or total excision (3 cases). Of the 32 cases treated with osteosynthesis, most were treated by modified tension band wiring (16 cases). And as compared with other fixation techniques, the best results were obtained by this method. 5. Modified tension band wire fixation has given accepatable results even in severely comminuted, displaced patellar fractures. Excision was sometimes unavoidable.