Double-pulley combined with suture bridge technique for fixation of comminuted fractures of distal patella pole / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of double pulley combined with suture bridge in the treatment of comminuted fracture of the lower pole of the patella.@*METHODS@#From January 2018 to June 2020, 15 patients with comminuted fracture of the lower pole of the patella were treated with double pulley and suture bridge technology, including 9 males and 6 females, aged 28 to 68 years old with an average of (42.4±9.6) years old. All patients had obvious knee joint pain and limited movement after injury. All knee joints were examined by X-ray and CT, which confirmed that they were all comminuted fractures at the lower level of the patella. After operation, X-ray films of the knee joint were taken regularly to understand the fracture healing, the Insall Salvati index was measure, the range of motion of the joint was recorded, and the function of the knee joint was evaluateed by the Bostman scoring system.@*RESULTS@#All the 15 patients were followed up for 7 to 24 months with an average of (11.4±4.2) months, and there was no obvious anterior knee pain. At the last follow-up, the knee joint range of motion of the affected limb was 105° to 140° with an average of (128.5±12.8) °, and the Insall Salvati index was 0.79 to 1.12 with an average of (0.92±0.18). The X-ray film showed that the patella was bone healing, and no anchor fell off, broken, or displaced fracture block was found. Bostman patellar fracture function score was 27.85±2.06, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Double pulley technique combined with suture bridge technique is reliable for reduction and fixation of comminuted fracture of the lower pole of patella, and patients can start functional exercise early after operation.

Luxación femorotibial abierta con fractura de rótula y tibia

RESUMEN Introducción: Las luxaciones de rodilla son poco frecuentes, lo que hace que su combinación abierta, con fracturas de rótula y del tercio superior de la tibia, sea rara y grave. Constituye una entidad causada por traumas de alta energía y se asocia a otras lesiones. Objetivo: Presentar un caso raro y complejo de luxación femorotibial posterior abierta con fractura del polo inferior de la rótula y tercio superior de la tibia. Caso clínico: Paciente masculino de 37 años de edad, que ingresó en el servicio de ortopedia y traumatología, quien como consecuencia de un accidente de tránsito, presentó luxación femorotibial posterior con fractura abierta del polo inferior de la rótula y tercio superior de la tibia, grados III-B, en el inferior derecho. Fue intervenido quirúrgicamente de urgencia; se realizó amplio desbridamiento quirúrgico, reducción de la luxación, reparación primaria de las lesiones ligamentosas, patelectomía parcial, reparación del tendón rotuliano y fijación externa para la fractura del tercio superior de la tibia. El paciente evolucionó bien, sin infección de la herida quirúrgica y recuperación total a los 4 meses. Conclusiones: La combinación de luxación femorotibial posterior abierta, con fractura del polo inferior de la rótula y tercio superior de la tibia es rara y obedece a altas energías traumáticas, como los accidentes automovilísticos. La cirugía de urgencia y la profilaxis antimicrobiana, es el método eficaz para el tratamiento definitivo de esta lesión.

ABSTRACT Introduction: Knee dislocations are infrequent, which makes the combination with open fractures of the patella and the upper third of the tibia, rare and serious. It is an entity caused by high-energy trauma and is associated with other injuries. Objective: To present a rare and complex case of open posterior femorotibial dislocation with fracture of the lower pole of the patella and the upper third of the tibia. Clinical case: A 37-year-old male patient, who was admitted to the orthopedic and trauma service, who, as a consequence of a traffic accident, presented posterior femorotibial dislocation with an open fracture of the lower pole of the patella and upper third of the tibia. grades III-B, in the lower right. He underwent emergency surgery; extensive surgical debridement, dislocation reduction, primary repair of ligamentous injuries, partial patellectomy, patellar tendon repair, and external fixation were performed for the fracture of the upper third of the tibia. The patient evolved well, without infection of the surgical wound and full recovery at 4 months. Conclusions: The combination of open posterior femorotibial dislocation, with fracture of the lower pole of the patella and upper third of the tibia is rare and is due to high traumatic energies, such as motor vehicle accidents. Emergency surgery and antimicrobial prophylaxis is the effective method for the definitive treatment of this lesion.

Management of displaced transverse fractures of the patella using tension band wiring with or without circumferential cerclage wiring: A comparative study

Background: Transverse fractures of body of the patella are by far the most common fractures of this bone. Surgical fixation is the recommended treatment in displaced fractures with extensor lag. Although, tension band wiring (TBW) technique is the gold standard for these fractures, few surgeons recommend augmentation with circumferential cerclage wiring to improve the strength of the fixation. We compared the results of the internal fixation of displaced transverse fractures of the patella using TBW and circumferential cerclage wiring with those treated with TBW alone. Methods: We treated 54 displaced transverse fractures of the patella at our institution. We segregated the patients into two groups: Group 1 (n=23) included fractures treated with tension band wiring (TBW) along with augmented circumferential cerclage wiring while as Group 2 (n=31) included fractures treated by TBW alone. Outcome was studied, graded and compared on the basis of knee pain, knee stiffness, quadriceps wasting, loss of flexion and loss of extension. Results: 73.90% patients among group 1 and 70.96% among group 2 showed excellent to good results (P value < 0.1). Fixation failure and need for revision surgery among group 1 and group 2 was found to be 8.69% and 9.67%, respectively (P value < 0.6). Infections and non union occurred among 4.34% patients in group 1 whereas in group 2 it was 6.45% of the patients who encountered the same (P value < 0.6). Conclusions: The use of circumferential cerclage wiring along with tension band wiring for displaced transverse fractures of patella seems to have no added advantage over fixation with tension band wiring alone. Keywords: Patella fracture, Tension band wiring, cerclage wiring

Two Staged Surgery for Gap Non-Union of Patella Fracture: A Good Alternative.

Gap Nonunion of patella fractures are rare conditions whose treatment is challenging for surgeons. Strict protocol for such fracture gap nonunion of patella is not well documented in the literature. The decision in treatment of these conditions is based on many factors such as functional demands of the patient, factors leading to nonunion, and presence of an intact extensor mechanism of the knee. We present a case of neglected gap nonunion of a transverse fracture of patella treated at 5 months after injury with a two stage reconstruction procedure.

THE CLINICAL ANALYSIS OF ATLAS TITANIUM CABLE IN THE TREATMENT OF 40 cases of COMMINUTED PATELLAR FRACTURES / 现代医院

Objective To investigate the application value of Atlas titanium cable in the treatment of comminuted patellar fractures (CPF).Methods 80 patients with CPF in our hospital from January, 2010 to January, 2013 were randomly selected and divided into observation group (n=40) and control group (n=40) by digital random method.Observation group adopted Atlas tita-nium cable internal fixation treatment while control group adopted the improved tension band steel wire in the hollow compression screws fixation treatment.Preoperative (t0), postoperative 1 month (t1), 6 months (t2) and 1 year (t3) Bostman patellar injury curative effect score (BPICES), operation time, intraoperative blood loss, postoperative knee joint exercise time for the first time, length of hospital stay, treatment costs and complications of two groups were compared.Results Preoperative BPICES of two groups had no statistical significant difference (p>0.05).Compared with t0, t2 and t3 BPICES and the rate of optimal curative effects, two groups increased; Compared with the control group, t2 and t3 BPICES and the rate of optimal curative effects of observation group also increased, and the difference was statistically significant (p<0.05).Operation time, intraoperative blood loss, postoperative knee joint exercise time for the first time, length of hospital stay of observation group were (52.26 ±10.29) min, (70.48 ±10.49) ml, (4.78 ±1.48) d and (5.98 ±1.06) d respectively, which were lower than the (79.95 ±8.42) min, (123.36 ±21.18) ml, (9.14 ±4.48) d and (11.18 ±2.68) d of the control group;Therapy cost of observation group was (16 284.47 ±2 145.78) Yuan, which was higher than the (9 892.48 ±1 456.42) Yuan of the control group (p <0.05).Compared with control group, peptide wire/wire Piercing the skin, pain, infection, skin irritation, slippery bursa phlogistic, internal fixation of fracture parted, fracture end separation and other complications total incidence of observation group were lower (p<0.05).Conclusion Atlas titanium wire trea-ting of patients with CPF had shorter operation time and hospitalization time , less postoperative complications.It can promote the rapid recovery of knee joint function, but its cost is higher.Thus it is suitable for CPF patients with better economic conditions .

A modified mini-invasive approach for treatment of transverse patella fracture / 第二军医大学学报

183 Background More clinical Sdoctors tend to choose minimally invasive treatments for patella fracture. Because patients have lower complications, better function and perfect incision, which makes them early continue working and influences a little on their careers and life. Objective To explore the efficacy of minimally invasive treatment of patella transverse of young people, we choose percutaneous cannulated screw and titanium cable that we design to operate surgery.we observe the surgical incision, hemorrhage and function Methods From February 2009 to June 2012, we applied the minimally invasive technique of percutaneous cannulated screw and titanium cable to treat 30 cases of patella transverse, 16 males and 14 females. Aged 24-45 years, mean 35.4 years.injury mechanism:10 cases in the traffic accident, 6 cases in the fall s injury, 14 cases in the kneeling injury. fracture type:6 cases proximal pole fracture, 11 cases middle pole fracture and 13 cases distal pole fracture. Result All patients healed incision. 30 cases were followed up for mean 18 months. Fracture healed in mean 6.8 weeks. According to Lysholom function score, excellent in 27 cases, good in 2 cases, good rate of 100%. Conclusion Minimally invasive technique of percutaneous cannulated screw and titanium cable to treat the patella transverse fracture is the better choice. It fixes reliable, follow the biomechanical and have low surgical damage. Patients have less complication and get a good clinical efficacy. It is a better choice to treat patella transverse fracture of young fracture.

The choice of the methods of Patella fracture fixation / 中国基层医药

Objective To investigate clinical efficacy of the Kirschner wire and nickel-titanium tension band fixation of patellar different types of patellar fracture.Methods 22 cases of patellar fractures were followed up,analyzed.Two methods of clinical treatment were compared.Results There was no significant difference between two methods of treatment.Transverse patella fractures with Kirschner wire tension band fixation was satisfied,but comminuted fracture of patella should adopt the nickel-titanium poly patella fixation.Conclusion Different types of patella fractures should be based on surgical indication to select different method of internal fixation.

Transverse Fracture through Screw Site after Cannulated Screw Fixation in Vertical Patella Fracture: A Case Report

Many complications after operative treatment of patella including redisplacement of fracture, refracture, weakness of extensor muscles, patellofemoral joint arthritis, metal failure, malunion, infection, avascular necrosis were reported. We report a case of transverse fracture of patella through the cannulated screw fixation site used to fix previous vertical patella fracture with a review of the literatures.

Migration of a Broken Wire to the Popliteal Fossa After the Osteosynthesis of Patella Fracture: A Case Report

In the fixation of patellar fractures, wiring techniques including tension band and cerclage wiring have been widely used. Some patients do not want to operation for removal of wire unless mechanical irritation is present. Authors report a case of a patient with migration of a broken wire to the popliteal fossa after the osteosynthesis of patellar fracture.

Treatment of patella fracture under arthroscope / 中国微创外科杂志

Objective To study the efficacy of arthroscopy in the management of patella fracture.Methods Arthroscopic techniques were employed for treating 42 patients with fresh simple patella fracture.After blood clots and fragments were cleaned up,the fracture was reduced by manipulation.Two Kirschner's pins were parallelly inserted percutaneously for internal fixation of the fracture.Then a modified tension band fixation with percutaneous wire interposition was made.Results The operation time was(1.2~3) hours(mean,2.2 hours).The time to bone union was 7~10 weeks(mean,7.5 weeks).The postoperative hospital stay was 7~14 days(mean,8.5 days).Follow-up checkups in 37 patients for 6 months ~ 4 years(mean,19.2 months) revealed bone union in all the patients and no joint instability or traumatic arthritis.The curative results were classified as excellent in 34 patients,good in 2 patients,and fair in 1,the rate of excellent or good results being 97.3%(36/37).Conclusions Arthroscopic management of patella fracture has advantages of accurate reduction and fixation,little invasion,early postoperative functional training,and quick recovery.

Arthroscopically assisted percutaneous screw fixation for 14 cases of patellar fractures / 中国微创外科杂志

Objective To evaluate the effectiveness of arthroscopically assisted percutaneous screw fixation for treating patella fractures.Methods A total of 14 cases of patella fractures were treated by percutaneous reduction and internal fixation with screws under arthroscope from November 2001 to June 2004 in this hospital.The fracture was reduced by closed manipulation or percutaneous leverage force using the Kirschner wire.Then the patella was temporarily fixed by using a large-sized towel clamp or Kirschner wires.Under the guidance of knee arthroscopy or C-arm fluoroscopy,a micro-incision was made at the site of screw placement,the pilot holes were drilled at a proper depth,and the thread was configured.Two titanium screws or absorbable screws were inserted parallelly.Results Follow-up checkups for 6~18 months(mean,10 months) in 13 cases showed a satisfactory recovery of knee functions.According to the Xu Shaoding's standard,excellent effects were obtained in 11 cases(84.6%) and good effects,2 cases(15.4%).Conclusions Treatment of patellar fractures by percutaneous screw fixation under arthroscope offers advantages of minimal invasion,accurate reduction,reliable fixation,and excellent recovery of joint functions.

Diagnosis and treatment of 7 cases of lacerated fractures of the inferior patella in children / 中华创伤骨科杂志

Objective To analyze the diagnosis and treatment of lacerated fractures of the inferior patella in children. Methods Totally 7 children with lacerated fractures of the inferior patella have been treated by surgery since 1989. Their ages ranged from 8 to 15 years old, and symptom duration from 1 hour to 6 days. 3 of them were fixed by Kirschner wire and tension belt, and 4 sutured with absorbable suture line in the shape of “8”. The evaluation of treatment effects was done according to the relevant knee joint scoring system. Results Postoperative follow ups ranged from 1 to 4 years. The radiograms after operation showed that the fractures united completely. The joint functions of all patients were excellent. Conclusion In the absence of MR (magnetic resonance), the lacerated fractures of the inferior patella can be diagnosed by analyzing the case history, symptoms, physical signs and the results of patella position measurements, before definite confirmation by surgical check-up.

A comparison between percutaneous and open reduction with tension band wiring for the treatment of transverse patella fractures / 中国微创外科杂志

Objective To compare clinical effects between percutaneous and open reduction by using tension band wiring for the treatment of transverse patella fractures. Methods A prospective study was carried out. A series of 62 cases of transverse patella fracture from 1997 to 2003 were divided into two groups: the Percutaneous Group (n=27) and the Open Group (n=35). The Percutaneous Group received percutaneous reduction with tension band fixation, including 23 cases of internal fixation by Kirschner-wire techniques and 4 cases of fixation through cannulated cancellous bone screws. The Open Group received open reduction with Kirschner wiring tension band fixation. The time to bone union, the reduction condition, the movement range and the function of the knee were compared between the two groups. Results All the cases were followed for 6~48 months. The bone union was achieved in both of groups. The rate of “good” or “excellent” knee functions was 88.9% in the Percutaneous Group (24/27) and 88.6% in the Open Group (31/35), respectively, without significant difference (?2=0.000,P=1.000). The time to bone union was earlier in the Percutaneous Group than in the Open Group (?2=6.581,P=0.037). Conclusions Percutaneous reduction with tension band fixation can offer good anatomic reduction and enough fixation strength to meet the requirements for bone union and function recovery in the treatment of transverse patella fractures, with minimal invasion, quick union and excellent clinical outcomes.

Patellar Fracture in ACL Reconstruction with Bone-Patellar Tendon-Bone Autograft: Case Report

Autogenous bone-patellar tendon-bone is popular ligament substitute used in anterior cruciate liga- ment(ACL) reconstructions. Fracture of the patella is a rare but serious complication unique to this type of reconstruction. We report 4 cases of patellar fracture after autogenous bone-patellar tendon-bone ACL reconstruction.

The Operative Treatment of Patellar Fracture Using Indirect Reduction

The goal of treatment of fracture of the patella is to gain accurate fracture reduction, secure fracture fixation, and early range of motion. In severely comminuted fractures of patella, open reduction requires extensive soft tissue dissection and high risk of infection. Furthermore, it is very difficult to get rigid fixation enough to allow early joint motion. An alternative in the management of severely comminuted patellar fractures is the technique of indirect reduction, in which the soft-tissue attachments of the individual fragments are preserved and used to reduce the fracture. Thirteen patients with fracture of the patella were treated by indirect method. Clinical analysis was done by using anterior knee pain score by Shelboume, Lysholm score, and radiological finding. The average Lysholm score was 88.3 and average anterior knee pain score 87.3. Nearly anatomic reduction was obtained in all cases. Indirect reduction seemed to be useful for the treatment of comminuted patella fracture due to minimal soft tissue damage, moderate rigid fixation to allow early joint motion.

50 Examples of DR Image Post-processing in Knee Joint Anterior-posterior Position with Patella Fracture / 医疗卫生装备

Objective To study the applied value of unified image enhancement(IE) and tissue equalization(TE) that the two kinds post-processing functions in the diagnosis of patella fracture. Methods The images of knee joint anterior-posterior position of fifty patella fracture patients were taken. The acquired images were processed with IE and TE, and then the im- ages were divided into pre-treatment group and post-treatment group. Results The post-treatment group of patella imaging have markedly improved, and the statistics analysis have significance difference(P

THE USE OF A MINIATURE EXTERNAL FIXATOR FOR THE COMPRESSION TREATMENT OF PATELLAR FRACTURE:A REPORT OF 60 CASES / 解放军医学杂志

Sixty cases of different types of patellar fractures were treated from December 1986 to October 1990 by a self-designed miniature external fixator. The patients were followed-up for 6 months to 4 years, and there was not a single case of infection, prepatellar bursitis or early degeneration of the knee joint. The structure of the fixator is simple and the operation is easy. It is a versatile tool, because it can be used either for extension or for compression.since the pins are inserted without operation, it gives rise to little pain. Under the present treatment bone healing is rapid and the function of the knee joint is well preserved. The rate of excellent result reaches 98.2 per cent

A Clinical Study of the Patella Fractures / 대한정형외과학회잡지

Fractures of the pateila Is one of the most important subjects considering the increasing number of such patients Much has been written concerning these fractures during last thirty years or more. In this series, we reviewed 78 fractures of the patella, we could follow up from January 1964 to December 1978. Most of the fractures occurred in man, and occurred In third to forth decades. Traffic accident was the most common cause. Twelve cases were open fractures and most of the fractures were comminuted or transverse type. we treated these 78 cases as followings: 1. Total excision, 8 2. Partial excision, 19 3. Open raduction and Internal flxation, 21 (of these, Circumferential wire loop flxation, 13; Magnuson wire loop fixation, 3; Tension band wiring, 5) 4. Conservative treatment, 30. Average follow-up period was 26.6 weeks and average flexion range of knee at the end of the period was 118.2. The end results of Tension band wiring was much better than those of other methods. It Is considered that the range of motion of the knee jolnt after treatment was Influenced by immobilization period. The shorter the period, the better the result.