Effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in treatment of patellar inferior pole fracture / 中国修复重建外科杂志

OBJECTIVE@#To investigate effectiveness of suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling in the treatment of patellar inferior pole fractures.@*METHODS@#A clinical data of 37 patients with unilateral patellar inferior pole fracture who met the selection criteria between June 2017 and June 2021 was retrospectively analyzed. Among them, 17 cases were treated with the suture anchor fixation combined with Nice knot strapping via longitudinal patellar drilling (group A), and 20 cases were treated with the traditional Kirschner wire tension band technique (group B). There was no significant difference in terms of gender, age, body mass index, fracture side, combined medical disease, and preoperative hemoglobin between the two groups ( P>0.05). Operation time, intraoperative blood loss, postoperative complications, fracture healing time, knee range of motion, and knee function Bostman score (range of motion, pain, daily work, muscle atrophy, walking aids, knee effusion, soft leg, and stair climbing) and grading were recorded in both groups at last follow-up.@*RESULTS@#There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). All incisions healed by first intention. All patients were followed up 1-2 years, with an average of 1.7 years. X-ray films reexamination showed that all fractures in group A healed, while 2 cases in group B did not heal. There was no significant difference in bone healing time between the two groups ( P>0.05). At last follow-up, the knee range of motion, the range of motion score of Bostman score, total score and effectiveness grading in group A were significantly better than those in group B ( P<0.05). There was no significant difference in the other items of Bostman scores between the two groups ( P>0.05). During follow-up, 2 cases of internal fixation failure and 1 case of internal fixator irritation occurred in group B, and no complication related to internal fixation occurred in group A. The occurrence of complications was significantly lower in group A than in group B ( P<0.05).@*CONCLUSION@#Compared with the traditional Kirschner wire tension band technique, the suture anchor combined with Nice knot strapping via longitudinal patellar drilling for the patellar inferior pole fractures has the advantages of simple operation, reliable fixation, early flexion and extension activity, and better functional recovery of knee joint.

Manejo de fracturas conminutas del polo distal de la patela con asas verticales de alambre: reporte de casos / Management of comminuted fractures of the distal pole of the patela with vertical wire loops: case report

INTRODUCCIÓN Las fracturas conminutas del polo distal de la patela representan un desafío para el cirujano de rodilla, pues no existe un tratamiento estándar que permita una rehabilitación acelerada. Recientemente se han descrito la osteosíntesis y la reinserción del polo distal utilizando asas de alambre verticales. MATERIALES Y MÉTODOS Presentamos dos casos de fractura conminuta del polo distal de la patela resueltos con asas de alambre verticales y modificaciones de esta técnica. RESULTADOS Se realizó osteosíntesis del polo distal de la patela, y se logró una reducción radiográfica satisfactoria, lo que permitió una rehabilitación acelerada, con un rango de movilidad progresivo a tolerancia desde el día siguiente tras la cirugía. Los pacientes lograron recuperar el rango de movimiento completo a los dos y tres meses de operados, evolucionaron satisfactoriamente, sin complicaciones relacionadas a esta técnica y sus variaciones, y recibieron el alta médica tras cuatro meses de la reducción y osteosíntesis. DISCUSIÓN Las técnicas tradicionales para el manejo de fracturas del polo distal implican consideraciones especiales en la rehabilitación y complicaciones asociadas. Se utilizó la técnica de asas de alambres verticales en dos pacientes: en uno de ellos, el procedimiento fue complementado con sutura tipo Krackow; y, en el otro, con una placa para minifragmentos, lo que permitió una rehabilitación acelerada y retorno precoz a sus actividades laborales. CONCLUSIÓN El uso de asas de alambre vertical aparece como una técnica segura, que permite una rehabilitación acelerada y un reintegro laboral precoz.

INTRODUCTION Comminuted fractures of the distal pole of the patella represent a challenge for the knee surgeon, as there is no standard treatment that enables accelerated rehabilitation. Osteosynthesis and reattachment of the distal pole using vertical wire loops has recently been described. MATERIALS AND METHODS We herein present two cases of omminuted fracture of the distal pole of the patella resolved with vertical wire loops and modifications of this technique. RESULTS Osteosynthesis of the distal pole of the patella was performed, achieving a satisfactory radiographic reduction and enabling accelerated rehabilitation, with a progressive range of motion the day after the surgery. The patients achieved full range of motion two and three months after surgery. They progressed satisfactorily, without complications related to this technique and its variations, and were discharged four months after the reduction and osteosynthesis. DISCUSSION The traditional techniques for the management of distal pole fractures involve special considerations regarding rehabilitation and associated complications. The vertical wire loop technique was used in two patients: in one of them, it was supplemented with a Krackow suture; and, in the other, with a mini-fragment plate, which enabled accelerated rehabilitation and early return to work. CONCLUSION The use of vertical wire loops appears to be a safe technique, which enables accelerated rehabilitation and early return to work.

Stability Difference Between Ethibond Thread Suture Fixation and Threaded Anchor Fixation for Inferior Pole Fracture of the Patella Using Finite Element Analysis / 医用生物力学

Objective To compare and analyze biomechanical stability of Ethibond thread suture and threaded anchor for fixing inferior pole fracture of the patella using the finite element method. Methods CT images of the knee joint from a healthy adult volunteer were selected and the inferior patella fracture model was established, then the three-dimensional (3D) models of fracture fixation with Ethibond thread suture and threaded anchor were established. Stress and displacement distributions of each fixiation model at different knee flextion angles were analyzed. Results In the range of 0°-90°, as knee flexion angle increased, the maximum stress and maximum displacement also increased. At the same knee flexion angle, threaded anchor fixation had the highest stress level, and Ethibond thread suture had the lowest stress level and the most uniform stress distributions. The displacement deformation of Ethibond thread suture was the largest, and the displacement deformation of threaded anchor fixation was the smallest. Conclusions The maximum displacement of the seam suture around patellar tendon with Ethibond suture is relatively moderate, and its maximum stress is relatively small, which is a reliable method for fixing inferior pole fracture of the patella in clinic.