Uso de placa malla en el manejo de fracturas conminutas de patela: reporte de caso / Use of mesh plate for the treatment of comminuted patellar fractures: case report

OBJETIVOS Describir la técnica quirúrgica para el uso de placa malla en un caso de fractura conminuta de patela y sus resultados en el seguimiento a mediano plazo. MATERIALES Y MÉTODOS Presentamos un caso de fractura conminuta de patela manejada con el uso de una placa malla y un tornillo canulado asociado, evitando de esta forma la patelectomía parcial y sus posibles complicaciones. RESULTADOS El paciente presentó una evolución satisfactoria, con rango de movimiento de rodilla completo y en condiciones de alta laboral a los cuatro meses desde la cirugía, sin complicaciones ni reintervenciones. DISCUSIÓN El uso de placas malla permite el manejo de fracturas conminutas de patela preservando stock óseo y restaurando la indemnidad del aparato extensor, con una osteosíntesis estable y poco prominente. Casos en que antiguamente la única alternativa era la patelectomía parcial y reinserción del tendón patelar ahora tienen etas placas como opción de manejo. CONCLUSIÓN El uso de placas malla en fracturas conminutas de patela es una alternativa atractiva por la estabilidad que brindan, la capacidad de reservar stock óseo, y la baja tasa de reintervenciones

OBJETIVE To describe the surgical technique for the use of a mesh plate in a case of comminuted patellar fracture and the mid-term follow up outcomes. MATERIALS AND METHODS We present a case of comminuted patella fracture managed with the use of a mesh plate and an associated cannulated screw, thus avoiding partial patellectomy and its possible complications. RESULTS Four months postoperatively, the patient presented full knee range of motion and could be discharged to return to work, with no complications or reinterventions. DISCUSSION The use of mesh plates enables the management of comminuted patellar fractures preserving bone stock and restoring the extensor mechanism with a stable and little prominent osteosynthesis. Cases which previously would only have been treated by partial patellectomy and patellar tendon reinsertion can be treated with these plates. CONCLUSION The use of mesh plates for comminuted patellar fractures is an attractive option due to their stability, their ability to preserve bone stock, and the low rates of reintervention.

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.

Tratamiento de la fractura conminuta de patela: ¿existen diferencias entre realizar o no una eversión? / Treatment of comminuted patellar fracture: are there differences between performing or not performing an eversion?

OBJETIVO Comparar los resultados clínicos, funcionales e imagenológicos de dos técnicas quirúrgicas para el manejo de fracturas conminutas de patela: con y sin eversión patelar. MÉTODOS En una serie de casos retrospectivos de fracturas conminutas de patela tratadas en el mismo centro entre 2014 y 2017, con un seguimiento ≥ 3 meses, se hizo una comparación entre el grupo con eversión y el grupo sin eversión. Los criterios de exclusión fueron patelectomía parcial o total, reinserción tendínea, o rehabilitación incompleta. Las variables analizadas fueron edad, sexo, tabaquismo, diabetes mellitus, energía del accidente, tipo de fractura, variables quirúrgicas (banda de tensión, tornillos, alambres, nudos, cerclaje circular), rango de movimiento (RDM) articular postoperatorio, presencia de osteosíntesis sintomática, puntaje de escalas funcionales (de Tegner-Lysholm y de Kujala) al alta definitiva, complicaciones (rigidez articular, infección, trombosis venosa profunda), y variables imagenológicos con tomografías computarizadas pre- y postoperatorias (brecha, desnivel articular > 2 mm, elementos de fijación intraarticular). RESULTADOS En total, 20 de 22 pacientes, 13 con eversión y 7 sin eversión, cumplieron con los criterios de selección. El seguimiento fue de 3 a 12 meses, y no hubo diferencias estadísticamente significativas respecto a las variables demográficas entre ambos grupos, lo cual los hace comparables. Destacaron el tiempo desde el ingreso al alta, con 7 meses para los pacientes con eversión y 5 meses para los sin eversión (p = 0.032), la proporción de pacientes con desnivel articular > 2 mm, con 7.7% para los con eversión y 14.3% para los sin eversión (p = 0.016), y una tendencia a resultados superiores en escalas funcionales para el grupo con eversión. CONCLUSIÓN El tratamiento de fracturas conminutas de patela con eversión parece ser una alternativa viable dados sus resultados imagenológicos y funcionales superiores a los de la técnica habitual.

PURPOSE To compare the clinical, functional and imaging outcomes of two surgical techniques for the treatment of comminuted patellar fractures: with and without eversion. METHODS In a retrospective series of cases of comminuted patellar fractures treated at a single center between 2014 and 2017, with a follow-up 3 months , we performed a comparison between the eversion group and the non-eversion group. The exclusion criteria were partial or total patellectomy, tendon reinsertion, or incomplete rehabilitation. The variables analyzed were age, gender, smoking, diabetes mellitus, the energy of the accident, the fracture type, surgical variables (tension band, screws, wires, knots, circular cerclage), postoperative joint range of motion (ROM), presence of symptomatic osteosynthesis, the scores on the functional scales (of Tegner-Lysholm and of Kujala) at the final discharge, complications (joint stiffness, infection, deep vein thrombosis), and pre- and postoperative computed tomography imaging variables (gap, step-off > 2mm, intra-articular fixation elements). RESULTS In total, 20 out of 22 patients, 13 undegoing eversion and 7 not undergoing eversion, met the selection criteria.. The follow-up ranged from 3 to 12 months, and there were no statistically significant differences regarding the demographic variables between both groups, which makes them comparable. The most remarkable results were the time from admission to final discharge, of 7 months for the patients in the eversion group, and of 5 months for those in the non-eversion group (p » 0.032), the proportion of patients with a step-off > 2 mm, with 7.7% for the eversion group and 14.3% for the non-eversion group (p » 0.016), and a tendency towards higher scores in the functional scales for the eversion group. CONCLUSION The treatment of comminuted patellar fractures with eversion seems to be a viable alternative, given its superior imaging and functional results compared to those of the usual technique.

Reverse-flow anterolateral thigh flap for knee soft-tissue reconstruction: case report

The reconstruction of the injured tissue around the knee is a complex procedure for the plastic and orthopaedic surgeon. The objective is to provide an acceptable function and aesthetic result. Successful wound management includes meticulous debridement, planning and proper execution of the surgical procedure. An 11-year-old male patient with a right patellar fracture using an anterolateral thigh flap with reverse flow to cover the skin defect. For such purposes, the reverse flow anterolateral flap is an effective, trustworthy and well-documented option. The correct obtaining and implantation of the flap reduces the morbidity of the donor site, offers options in size and design, an adequate length of the pedicle and the possible combination with the fascia lata in case it is required. The versatility of the reverse flow anterolateral flap makes it a possible therapeutic alternative in reconstructive surgery since it is aesthetic and functional for the reconstruction of tissue near the knee joint.

Efficacy observative of proprioception training on rehabilitation therapy of knee joint function after minimally invasive surgery of patellar fracture / 中国综合临床

Objective To explore the clinical effect of proprioceptive training on knee joint function rehabilitation after minimally invasive surgery for patellar fracture.Methods Fifty-eight patients with minimally invasive Kirschner wire tension band internal fixation under arthroscopy in department of orthopedics,Peking Union Medical College Hospital of Chinese Academy of Medical Sciences from March 2016 to April 2018 were selected as research objects,and were divided into experimental group and conventional group according to digital lottery,Twenty-nine cases in each group.The conventional group received conventional rehabilitation therapy such as joint range of motion (ROM) training,joint mobilization technique,muscle strength training,weight-bearing standing and ambulation training,The experimental group added proprioception training on the basis of the conventional group.The affected knee active range of motion (AROM),Lysholm knee scoring scale (LKSS),Berg balance scale (BBS) score and modified Barthel index (MBI) score before treatment and after 2 months of treatment between the two groups were observed and compared.According to the LKSS scoring system,the effect of knee function rehabilitation was evaluated.Results After 2 months of treatment,the active range of motion of the knee joint in the experimental group ((120.3± 17.1) °) was better than that in the conventional group ((100.4± 17.5) °),with significant difference (t =4.380,P =0.000);the LYSHOLM knee joint function score in the experimental group ((93.2 ± 5.3) points) was higher than that in the conventional group ((80.6 ± 7.7) points),with significant difference (t=7.259,P=0.000);the score of BERG balance scale ((52.4±1.6) points vs.(43.7±2.8)points),the difference was significant (t =14.528,P =0.000);the score of improved BARTHEL index ((92.5± 3.1) points vs.(85.6± 2.2) points),the difference was significant (t =9.775,P=0.000).The excellent and good rate of knee joint function in the experimental group was 93.10％ (27/29),which was significantly higher than 72.41％ (21/29) in the conventional group.There was significant difference between the two groups (Z =-2.390,P =0.017).Conclusion The proprioceptive training has a remarkable effect on knee joint function rehabilitation after minimally invasive surgery for patellar fracture.It can significantly improve the range of motion,joint stability and motion control ability of the affected knee,and improve the daily living ability of the patients.

Arthroscopic minimally invasive Kirschner wire tension band internal fixation in the treatment of patellar fractures / 中国综合临床

Objective To investigate the clinical effect of minimally invasive Kirschner wire tension band internal fixation under arthroscopy in the treatment of patellar fracture.Methods From March 2016 to April 2018,ninety patients with patellar fracture admitted to the Department of Orthopedics,Lin Xi Hospital of Kailuan General Hospital were divided into minimally invasive group (58 cases) and control group (32 cases) according to different operative methods.The control group received traditional open reduction and Kirschner wire tension band internal fixation.Minimally invasive group received arthroscopic minimally invasive Kirschner wire tension band internal fixation.The operation status,joint function recovery and VAS scores were compared between the two groups.Results The amount of blood loss,hospitalization time and fracture healing time in minimally invasive group were significantly less than those in control group ((48.7 ±13.6) mlvs.(85.5±12.3) ml,t=12.7,P＜0.05;(12.5±2.8) d vs.(14.8±1.4) d,t=4.35,P＜0.05;(11.2± 1.3) weeks vs.(15.4± 2.2) weeks,t =11.40,P＜0.05).After 6 months of follow-up,the VAS score of the two groups decreased with the time (the VAS score of the minimally invasive group decreased from (7.2±1.1) points preoperatively to (0.9±0.2) points at 6 months postoperatively,and that of the control group decreased from (7.3±1.2) points preoperatively to (1.1±0.3) at 6 months postoperatively).There was a significant difference between the two groups (F group =77.87,P＜0.05).The VAS score of both groups decreased with time (Ft ime=263.47,P＜0.05).The decrease of VAS score in the minimally invasive group was significantly larger than that in the control group (F interaction =28.63,P＜0.05).Conclusion Arthroscopic minimally invasive Kirschner wire tension band internal fixation for patellar fracture has better clinical effect and less trauma.

Effectiveness of high strength suture fixation in treatment of patellar transverse fracture / 中国修复重建外科杂志

Objective: To explore the effectiveness of high strength suture fixation in treatment of patellar transverse fracture. Methods: Between June 2014 and June 2016, 38 patients with the patellar transverse fracture were treated with high strength suture internal fixation. There were 24 males and 14 females with the age of 26 to 64 years (mean, 45 years). There were 6 cases of accident injury and 32 cases of crashing injury. The time interval between injury and surgery was 2-8 days (mean, 5 days). The preoperative visual analogue scale (VAS) score, Lysholm score, and range of motion (ROM) of patients were 84.3±8.4, 44.5±7.2, and (62±12)°, respectively. Results: All patients' incisions healed by first intention after operation. There was no neurovascular injury, deep venous thrombosis of lower limbs, or local foreign matter irritation reaction. The X-ray films showed that the reduction of patella and the location of internal fixator were good at 2 days after operation. All the 38 patients were followed up 12-18 months (mean, 16 months). All fractures healed and the healing time was 2-4 months (mean, 3 months). At last follow-up, according to the Böstman criteria, 36 patients were rated as excellent and 2 as good, with an excellent and good rate of 100%. The VAS score, Lysholm score, and ROM of patients were 10.2±6.6, 93.1±6.4, and (124±14)°, respectively, showing significant differences when compared with preoperative ones ( t=42.759, P=0.000; t=31.099, P=0.000; t=20.727, P=0.000). Conclusion: Application of high strength suture fixation in the treatment of patellar transverse fracture has advantages of simple to operate, effective fixation, and less complication. It can avoid reoperation of removing the internal fixators. The satisfied ROM and function of the knee joint can be obtained after operation.

Biomechanics test of fixation of star-shaped six-part patellar fractures with petal-shaped poly-axial locking plate / 中国修复重建外科杂志

Objective: To compare the biomechanical difference between petal-shaped poly-axial locking plate and tension band wire cerclage in fixing star-shaped 6-part patellar fractures in cadaver model, and provide the experimental data for clinical use.

The clinical research of modified split patella for patellar fracture / 中国基层医药

Objective To assess the clinical efficacy of modified split patella in the treatment of patellar fracture.Methods 56 patients with patellar fracture were selected,and they were divided into two groups according to the random number method.The regular group was treated with common split patella,while the improved group was treated with modified split patella.In both two groups,the aspects of split patella slip,model large and knee pain were recorded.Results The incidence rates of model large and knee pain in the improved group were 3.57%,7.14%, which were 25.00%,32.14%in the regular group,the differences were statistically significant(χ2 =5.250,5.543,P=0.022,0.019).The incidence rate of split patella slip in the regular group was 3.57%,that was 0.00% in the improved group,the difference was statistically significant(χ2 =1.018,P=0.313).Conclusion Modified split patella mini-mizes the incidence of split patella model large and patellofemoral osteoarthritis.Thus,it deserves further application.

Clinical study of three-dimensional strapping reduction in treatment of patellar fracture / 中国修复重建外科杂志

Objective: To investigate the effectiveness of three-dimensional strapping reduction in treatment of patellar fracture.

Patellar Fractures Treated by Modified Tension Band Wiring: A Clinical Study in a Teaching Hospitals.

Background: Patellar fractures are more common in country like India due to the activity of daily life and constitute 1% of all skeletal injuries by direct or indirect mechanism. Direct injuries due to the subcutaneous location of patella and indirect injuries because of forceful contraction of quadriceps with knee in flexed position are common. Thus, improper operative procedure can lead to disability in the patient. Therefore, this study was conducted to assess of advantages and complications associated with fixation technique so as to manage the fracture of patella. Methods: The study was conducted on 60 cases of transverse patellar fracture treated by Modified tension band wiring. All patients who had closed and open type I displaced transverse patellar fractures, acute fractures and who were medically fit for operative procedures were included in the study. Results: The most common age group in our study was 41-50 years. Male patients were 46 (76.7%) and female patients were 14(23.3%). Fracture due to direct injury was seen in 12(20%) patients and 48(80%) cases were with indirect trauma. Right side injury was seen in 26(43.3%) patients while 34 (56.7%) patients had injuries on the left side. The outcome of our study was excellent in 90% of cases, 8.3% was good and only 1.7% was poor. Conclusion: According to our study modified tension band wiring showed better outcome for the early mobilization and management of displaced transverse patellar fracture.

Patellar Fractures Treated by Cannulated Cancellous Screw and Tension Band Wiring – A prospective study in a Teaching Hospital, Sangareddy

Background: Country like India patellar fractures is more common due to the activity of daily life. 1% of all skeletal injuries due to patellar fracture by direct or indirect mechanism. Aim: This present study focus on advantages and complications associated with fixation technique for the management of patellar fracture. Material and Methods: 50 patients with patellar fractures treated by cannulated cancellous screw with tension band wiring. Result: The most common age group in our study was 41-50 years. Among 50 patients 37 were male and 13 were female. Fracture due to indirect injury was 64% and direct trauma was 36%. Outcome of our study was 90% as excellent, 8% as good and 2% poor. Conclusion: According to our study management and early mobilization of displaced transverse patellar fracture by cannulated cancellous screw and tension band wiring showed better result.

Designing of a new drilling guide for K-wire in Tension-band wiring of patellar fractures and its experi-mental study / 实用医学杂志

Objective To develop a newly designed guide and evaluate its clinic application prospect in treatment of patella fracture. Methods In our mechanical experiment, we carried out the tensile test of the two generation drilling guides by biomechanics machine and then analyzed the difference in their deformation. In the corpse experiment , we transversed fractures at the equator of the patella obtained from 10 fresh cadaver speci-mens. They were divided into 2 groups randomly: a test group and a control group. The second-generation of the aiming guide was used for the test group but not for the control group during the experiment. Then we evaluated its clinic application in the treatment of patella fracture. Results In the mechanical experiment, the displace-ment of the first generation guide was significantly larger than that of the newly one. The accuracy in the place-ment of k-wires by the second generation guide was significantly higher than by the first generation guide (P <0.05). Conclusions The drilling guide is reasonable in design and convenient in use. Moreover, it can improve the accuracy and quality of insertion of tension-band wiring of patellar fractures. The second-generation one is better and thus it is worth clinically spreading.

Development and clinical application of new designed Kirschner wires guider for patellar fracture / 局解手术学杂志

Objective To develop a new designed Kirschner wires guider for patellar fracture,and to evaluate its clinic outcomes.Methods From October 2010 to November 2015,totally 72 patients with patellar fracture were detected for this study.Divided them into 3 groups, named as the second-generation guider group,the first-generation guider group and the control group.And then evaluated the clinic outcomes in treatment of patellar fracture of the 3 groups.Results The surgery time,accuracy of placement needle position of the second-generation guider group were better than the other two groups with significant statistical differences (P <0.01).And the clinic outcomes of the first-generation guider group were better than the control group,and the differences were statistically significant (P <0.05).Conclusion The second-generation Kirschner wires guider is reasonable in design and convenient for use.Moreover,it can improve the accuracy and quality of surgery,reduce the operation time,and enhance the clinical effects.

Finite element analysis on mechanical properties of anti-shearing force Ni-Ti shape memory alloy patella claw / 医用生物力学

Objective To establish a 3D finite element model of an anti-shearing force Ni-Ti memory shape alloy patella claw for fixing patellar fracture, and analyze its mechanical performance. Methods The internal fixation model of transverse patellar fracture by patella claw was established by Pro/E 5.0, and then imported it into ABAQUS 10.1 for finite element analysis on its mechanical properties. The mechanical performance and deformation of the patella claw under two different patella femoral joint forces FQ at the knee flexion angle of 30°, 60°, 90° were analyzed, respectively. Results Under the same boundary condition, with the respective FQ as 367.5 N and 3 675 N, the maximum displacements of deformation were different at different flexion angles. As compared to fixation by tension band, using patella claw was preferable, with stronger resistance to tension and more stable anti-shearing force. Conclusions Deformation and displacement of the patella claw are in accordance with the biomechanical results needed in clinic, and its stability can satisfy clinical requirements for functional exercise as early as possible.

Heterotopic Ossification around Patellar Tendon Following Treatment of Patellar Fracture: A Case Report

Heterotopic ossification around the patellar tendon is known to be extremely rare. A 42-year-old man had a transverse fracture of the left patella. Open reduction and tension band wiring were performed. At four weeks, plain radiographs showed an extensive ossification around the patellar tendon and the patient presented limitation of flexion and pain in kneeling position. We just encouraged active and passive ranges of motion exercises and performed one manipulation under anesthesia. At the final follow-up (10 months post-operatively), he was able to flex his knee by 140 degrees. We present a case of heterotopic ossification around the patellar tendon with limitation of knee flexion that was successfully treated with nonoperative treatment.

Modified Tension Band Wiring Combined with Anti-Gliding Loop Augmentation Technique for the Treatment of Comminuted Patellar Fracture: Technical Note and Report of Early Results: Technical Note

In order to investigate the feasibility of a modified tension band combined with anti-gliding loop augmentation technique for the treatment of comminuted patellar fracture, 21 patients with comminuted patellar fracture were enrolled in this study. After the modified tension band wiring of patellar fracture, a cerclage wire was passed around the patella. Anti-gliding loops were made on the bending sites of Kirshner-wires. A knot was tied using both ends of the anti-gliding loops, and the cerclage wire was tightened using proximal knots. Bone union was achieved at 4.5+/-1.5 months postoperatively without nonunion. The Lysholm score was 87.1+/-2.8, and the range of motion of the knee was 2.1degrees+/-3.4degrees to 132.2degrees+/-6.5degrees at the last follow-up. The modified tension band combined with anti-gliding loop augmentation technique might be considered an alternative modification of modified tension band wiring for the treatment of comminuted patellar fracture.

A Case of Delayed Recurrent Hemarthrosis after Percutaneous Pin Fixation of the Patellar Fracture

A 24-year-old man underwent percutaneous fixation with pins for an undisplaced patellar fracture. At 7 months follow-up postoperatively, he presented with recurrent, painful swelling of the operated knee following trivial activities of daily life. Aspiration had been performed two times before he presented to us with symptoms. An x-ray showed that one of the pins was suspected to be protruding at the inferior pole of the patella. Magnetic resonance imaging confirmed effusion in the joint. Arthroscopy revealed that the pin was prominent intraarticularly, and the adjacent infrapatellar fat pad with surrounding synovial tissue seemed to be abraded. The pins were removed under arthroscopic guidance and any pain or hemarthrosis disappeared thereafter.

Treating Displaced Patellar Fracture with Longitudinal Incision ＆ Internal Fixation of the Sidelong Anterior Tension-band Wiring / 中国现代医生

Objective To explore the clinic effects of treating the displaced patellar fracture with a small longitudinal midline incision and internal fixation of the sidelong figure-of-eight anterior tension-band wiring. Methods 93 ea.ses of the displaced patellar fractures were internal fixated with the sidelong figure-of-eight anterior tension-band wiring(1.2 mm) simply, which made a longitudinal midline incision,it length can be made equal to the diam of patella approximately,that gives to enough expose the entire anterior surface of the patella and the patellar tendons. Results Follow-up for 6 to 30 months,93 cases were all obtained bony union. By Zhang Chun-cai score,there were 67 cases excellent,23 good and 3 fair,the excellent and good rate was 96.8%. Conclusion Treating patellar fracture with the fixation methods are very stabilization,and can functional exercise in early. It had similar results to reports using modified (with Kirschner wires) tension band techniques. The methods is simple and mini-trauma and invasive device minimally which results in fewer complications,especially as fractures traversed and comminuted with relative larger fragments are concerned.

The Treatment of Patellar Fracture with Cannulated Screws and Modified Tension Band Wiring by Two Mini-incision Technique

PURPOSE: To evaluate that the radiological and clinical results of transverse patellar fractures treated with cannulated screws and modified tension band wiring by two mini-incision technique. MATERIALS AND METHODS: We reviewed 20 cases displaced transverse patellar fractures treated with cannulated screws and modified tension band wiring by two mini-incision technique. The radiological assessment was based on the time to union, maintenance of reduction. Mean duration of follow up was 27 months with mean age of 46 years. The functional outcome was assessed with the range of motion, complications and Lysholm score. RESULTS: All fractures was healed without displacement. The mean time to union was 7.3 weeks and degree of reduction were excellent in 11 cases and good in 9 cases and mean Lysholm score was 89 points(range, 81 to 95 points). We found no complication like limitation of range of motion of the knee, loss of reduction, irritation and migration of the hardware, and infection at last follow up. CONCLUSION: This surgical technique provide stable fixation, allows early motion exercise by minimizing injury to extensor mechanism and reduce cosmetic problem in scar.