A COMPARATIVE STUDY ON EVALUATING THE OUTCOME OF DISPLACED ISOLATED MEDIAL MALLEOLUS FRACTURE MANAGED WITH TENSION BAND WIRING (TBW) VERSUS MALLEOLAR SCREWS FIXATION

Objective: The Ankle fractures are becoming more prevalent as a result of increased road traffic accidents and sports injuries. There are various modalities of treatment available for Medial Malleolus fractures. Undisplaced fractures are managed conservatively with slab or cast and displaced fractures are fixed with screws, k wires, anchors, tension wiring and plates. The main objective of the study is to compare the clinical outcomes of Tension band wiring versus Malleolar screws in managing Displaced Isolated Medial Malleolus fractures.Methods: This is a cross-sectional study conducted in the Department of Orthopaedics in Kurnool Medical College with 35 patients from November 2022 to November 2023 over one year with displaced isolated Medial Malleolus fractures. Postoperatively the patients are evaluated based on clinical and radiological examinations at one, three, and six months, respectively.Results: The patients are evaluated with Baird and Jackson scoring system postoperatively, where Excellent score: 8(47%) in group 1 and 7(38.8%) in group 2; Good score: 8(47%) in group 1 and 8(44.4 %) in group 2; Fair score: 1(5.8%) in group 1 and 2(11.1%) in group 2; Poor score: 0 in group 1 and 1(5.5%) in group 2. Hence excellent and good results are obtained in 16(94%) patients in group 1(TBW) and 15(82.2) patients in group 2(Malleolar Screws).Conclusion: Tension band wiring can be a better option than Malleolar screws in fixation of Displaced Isolated Medial Malleolus fractures.

Comparison of the efficacy of three types of Kirschner wire tension bands for ulnar olecranal fracture / 中国骨伤

OBJECTIVE@#To compare the clinical effect of three types of Kirschner wire tension band for olecranon fracture.@*METHODS@#The clinical data of 64 patients with olecranon fracture treated by Kirschner wire tension band fixation from March 2016 to May 2020 were retrospectively analyzed. Among them, 19 patients were treated with intramedullary K-wires fixation(group A) including 8 males and 11 females with an average of (48.2±18.3) years old, 3 patients were typeⅠ, and 16 patients were typeⅡ according to Mayo classification;20 patients were treated with transcortical K-wires fixation (group B) including 13 males and 7 females with an average of (43.5±20.4) years old, 3 patients were typeⅠand 17 patients were typeⅡ according to Mayo classification;25 patients were treated with perforated Kirschner wire(group C) including 15 males and 10 females with an average of (55.2±17.5) years old, 4 patients were typeⅠand 21 patients were typeⅡ according to Mayo classification. The operative time, intraoperative blood loss, times of Intraoperative fluoroscopy, fracture healing time and complications of 3 groups were compared. At the final follow-up, elbow function was assessed using the Mayo Elbow Function Scale.@*RESULTS@#There were differences in operative time, intraoperative fluoroscopy times, postoperative VAS and soft tissue irritation among the three groups(P<0.05). The operative time, intraoperative fluoroscopy times in group A and C was better than that in group B. The postoperative VAS score, skin irritability in group C was better than that of group B. The difference was statistically significant on Mayo elbow function score at the final follow-up among three groups(P<0.05), the scores of group A and C were higher than that of group B.@*CONCLUSION@#Compared with transcortical K-wires screw fixation, both intramedullary K-wires screw fixation and perforated Kirschner wire fixation, which can significantly reduce the occurrence of soft tissue irritation, reduce surgical complications and shorten the operation time.

Novel cross-locking intramedullary nails for olecranon: a finite element analysis and specimen experiments / 中华创伤骨科杂志

Objective:To determine the mechanical properties of our self-designed novel cross-locking intramedullary nails and the impact of number of conical locking nails on the fixation through a finite element analysis and specimen experiments.Methods:Mimics 19.0 and SolidWorks 2014 were used to create transverse fracture models of the olecranon which were subjected to fixation with respectively K-wire tension band (KTB) and our self-designed novel cross-locking intramedullary nails (NIN). The strengths of KTB and NIN fixation were analyzed by Ansys. Fifteen human ulna specimens were used to construct a transverse fracture model of the olecranon; an Instron E10000 mechanical testing machine was used to determine mechanical properties in fixation respectively with KTB, one NIN (NIN-1) and 3 NINs (NIN-3).Results:In the finite element analysis, in simulation of the forearm flexed at 45° under a 100 N load, the deformation of the fracture surface of the olecranon in fixation with KTB, NIN-1 and NIN-3 was respectively 0.131 mm, 0.123 mm and 0.121 mm. In the specimen experiments, in simulation of the forearm flexed at 45°, the maximum failure loads for fixation with KTB, NIN-1 and NIN-3 were (313.38±27.68) N, (528.56±53.58) N and (871.04±94.95) N, respectively, showing significant differences among the 3 groups ( P<0.05). The maximum failure load for NIN-3 fixation was significantly greater than that for KTB or NIN-1 fixation, and the maximum failure load for NIN-1 fixation was significantly greater than that for KTB fixation ( P<0.05). Conclusions:Compared with KTB fixation, NIN fixation is more convenient in operation and has better mechanical properties. NIN-3 fixation has the best mechanical properties.

Comparison of hand plating system versus suture anchor fixation in treatment of patellar inferior pole fractures / 中华创伤骨科杂志

Objective:To compare the clinical efficacy between hand plating system (HPS) and classic suture anchor fixation in the treatment of patellar inferior pole fractures.Methods:The clinical data were analyzed retrospectively of the 56 patients who had been treated for patellar inferior pole fractures at Department of Orthopaedics, General Hospital of Northern Theatre Command from January 2018 to December 2019. They were assigned into 2 groups according to their internal fixation methods. In group A of 30 cases subjected to HPS fixation, there were 18 males and 12 females with an age of (61.7±11.3) years; in group B of 26 cases subjected to suture anchor fixation, there were 16 males and 10 females with an age of (60.0±10.5) years. The incision length, operation time, intraoperative bleeding, fracture union time, pain visual analog scale (VAS)and knee function one year postoperation, and follow-up complications were compared between the 2 groups.Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability( P>0.05). The operation time in group A [(59.4±10.8) min] was significantly shorter than that in group B [(66.5±12.3) min] ( P<0.05). There was no significant difference in the incision length or intraoperative bleeding between the 2 groups ( P>0.05). The bone union time was respectively(11.2±1.8) weeks and (12.1±2.4) weeks and the postoperative VAS respectively 0.85±0.12 and 0.91±0.14 for groups A and B, showing no significant difference between the 2 groups ( P>0.05). The knee flexion angle (124.5°±14.6°) and knee Bostman score (29.3±3.5) in group A were significantly better than those in group B (113.2°±11.1° and 26.2±2.9) one year postoperation( P<0.05). Follow-up revealed no complication in group A but 2 cases of implant failure in group B. Conclusion:Compared with the classical anchor suture fixation, HPS may obtain stronger fixation, shorter operation time and better knee function.

Mechanical Properties of Novel Interlocking Intramedullary Nail for Fixing Transverse Olecranon Fractures / 医用生物力学

Objective To study the effect of interlocking intramedullary nail on fixing transverse olecranon fracture. Methods Nine pairs of fresh ulna specimens were collected and the transverse fracture model of olecranon was established. Kirschner wire tension band and interlocking intramedullary nail were used to repair the fracture. Cyclic dynamic tension loads with amplitude of 25 N, mean value of 45 N and frequency of 05 Hz were applied to the triceps tendon under simulated elbow flexion conditions of 30°, 45° and 60°, respectively. The fracture displacements of specimens within 300 cycles were recorded in three groups. ResultsAt 30° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.831±0.333) mm and (3.723±2.390) mm, respectively. At 45° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.167±0.374) mm and (2.455±0.609) mm, respectively. At 60° flexion angle, the fracture displacement of interlocking intramedullary nail group and Kirschner wire tension band group was (1.407±0.342) mm and (3.112±1.025) mm, respectively. The fracture displacement of interlocking intramedullary nail was smaller. Conclusions The mechanical properties of interlocking intramedullary nail are better than those of Kirschner wire tension band, and the interlocking intramedullary nail is more stable and firmer for fixing transverse olecranon fracture. Moreover, the interlocking intramedullary nail is installed with the operating tool, thus the operation is more accurate and faster, and the operation efficiency is greatly improved.

Wide-Awake Olecranon Tension Band Wiring with Ipsilateral Zone 6 Extensor Tendon Repair: A Case Report

@#Wide-awake local anaesthesia, no tourniquet (WALANT) continues to gain popularity and has been adapted for various fracture fixations proximal to the hand. A case of olecranon tension band wiring with concomitant extensor tendon repair is presented. The procedure was done with the patient awake in a lateral decubitus position 30min after the injection of WALANT solution at the intended surgical sites. Pain and discomfort were felt by the patient towards the end of the procedure mainly on his volar forearm where the bolster was placed. Olecranon fixation under WALANT is a viable alternative for patients who prefer to be awake or those with contraindications to general or regional anaesthesia. Alternative patient positioning may be considered, and perioperative pain control should not be overlooked.

Cannulated screws with sutures for treatment of transverse patellar fractures / 中华创伤骨科杂志

Objective:To evaluate the clinical efficacy of cannulated screws with sutures in the treatment of patellar transverse fractures.Methods:A retrospective analysis was performed of the data of 70 patients with patellar transverse fracture who had been admitted to Senior Department of Orthopedics, The Fourth Medical Center of Chinese PLA General Hospital from January 2017 to March 2021. According to the construction methods for the tension band, the patients were divided into 3 groups. In group A of 21 cases subjected to fixation with cannulated screws with sutures (Fiber-Tape), there were 8 males and 13 females with a median age of 55.0 (48.0, 65.0) years; in group B of 32 cases subjected to fixation with Kirschner wire tension band, there were 15 males and 17 females with a median age of 52.5 (41.5, 63.0) years; in group C of 17 cases subjected to fixation with Cable-Pin system, there were 5 males and 12 females with a median age of 55.0 (37.0, 65.0) years. The 3 groups were compared in terms of complications, secondary surgery (removal of internal fixation), operation time, intraoperative blood loss and knee function rated by the Lysholm and B?stman scores at the last follow-up.Results:There were no significant differences in the preoperative general data between the 3 groups, showing they were comparable ( P > 0.05). There was no significant difference in the operation time, intraoperative blood transfusion or follow-up time among the 3 groups ( P > 0.05). The incidence of soft tissue irritation [4.8% (1/21)] and the secondary operation rate [4.8% (1/21)] in group A were significantly lower than those in group B [43.8% (14/32) and 37.5% (12/32)] and group C [41.2% (7/17) and 35.3% (6/17)] ( P < 0.05), but there was no statistically significant difference between group B and group C ( P > 0.05). In groups A, B and C, respectively, the Lysholm knee score was 84.0 (69.0, 88.0), 89.0 (71.5, 95.0) and 82.0 (63.0, 90.0), and the B?stman knee score 26.0 (23.0, 28.0), 26.5 (24.0, 27.5) and 26.0 (22.0, 28.0), showing no significant difference ( P > 0.05). There was no significant difference either in the incidence of other complications among the 3 groups ( P > 0.05). Conclusion:In the treatment of patellar transverse fractures, compared with the Kirschner wire tension band and Cable-Pin system, cannulated screws with sutures (Fiber-Tape) may lead to a lower incidence of soft tissue irritation and a lower rate of secondary surgery, but no significant differences in operation time, intraoperative blood loss, other complications or postoperative functional scores.

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.

Tension Band Wiring Technique for Distal Radius Fracture with a Volar Articular Marginal Fragment: Technical Note

Most distal radius fractures are currently being treated with anterior plating using anatomical precontoured locking compression plates via the anterior approach. However, it is difficult to fix the volar articular marginal fragment because these anatomical plates should be placed proximally to the watershed line. There were just a few methods of fixation for this fragment on medical literature. Herein, we introduced a tension band wiring technique for fixation of a volar articular marginal fragment in the distal radius.

Treatment of Isolated Lateral Malleolar Fractures Using Locking Compression Plate Fixation and Tension Band Wiring Fixation

PURPOSE: The purpose of this study was to compare the clinical and radiological outcomes of locking compression plate (LCP)-screw fixation and tension band wiring (TBW) fixation in isolated lateral malleolar fractures.MATERIALS AND METHODS: From May 2016 to August 2018, 52 patients with isolated lateral malleolar fracture were retrospectively reviewed. They were divided into 30 cases of the LCP fixation group (Group I) and 22 cases of the TBW fixation group (Group II). The clinical and radiological results of those groups were compared. Pearson chi-square tests and independent t-tests were used in the statistical analysis.RESULTS: The mean length of the surgical incision was 8.3 cm in Group I and 4.9 cm in Group II. Radiological union was obtained at a mean of 8.4 weeks in both groups. The mean American Orthopaedic Foot and Ankle Society score was 90 (range, 85–97) and 92 (range, 85–100) in Groups I and II, respectively, at the last follow up.CONCLUSION: Both the LCP-screw and TBW techniques revealed excellent results in isolated lateral malleolar fractures. The tension band technique may be a fine alternative method of fixation in the treatment of isolated lateral malleolar fracture.

Rabbit growth plate morphology in temporary bilateral blocking / Morfología de la placa de crecimiento de conejos durante bloqueo bilateral temporario

Blocking of the growth plate (GP) using plates with screws (tension band plating) is a modern method used to correct deformities and moderate leg length discrepancy in growing children. Determining the duration of temporary bilateral blocking without the occurrence of irreversible changes of GP is of paramount importance important. Methods: Two-month-old Californian breed male rabbits (n=30) were exposed to bilateral blocking of the distal GP of the right femur locking plates with screws for 3, 5, and 7 weeks. The fixators were removed after 5 and 7 weeks in 18 rabbits and 3 weeks after that, animals were sacri!ced. The contralateral limb was used as a control. Histological, histomorphometric, and X-ray analyses were performed. Results: During GP blocking, its height gradually decreased. This decreased was more pronounced after 7 weeks. Destructive changes progressed with an increase in the blocking duration. Three weeks after discontinuation of the bilateral blocking that lasted 5 weeks, the height of the GP signi!cantly increased 1.2 times on the lateral side and 1.9 times on the medial side (p<0.001) compared to the control. When blocking was discontinued after 7 weeks, the structure of the GP was partially restored after 3 weeks, the height of GP signi!cantly increased 1.2 times on the lateral side, and 1.07 times on the medial side (p<0.01) compared to the control. Conclusion: Restoration of the structuralfunctional features of the GP after the removal of the plates depends on the duration of temporary bilateral blocking, which must be taken into account in the clinical setting. (AU)

El bloqueo de la placa de crecimiento (PC) utilizando placas con tornillos (banda de tensión) es un método moderno utilizado para corregir deformidades y alteraciones moderadas en la longitud de las piernas en niños en crecimiento. Es de suma importancia determinar cuál debe ser la duración del bloqueo bilateral temporal sin que ocurran cambios irreversibles en la PC. Métodos: Conejos machos de raza californiana de dos meses de edad (n = 30) fueron expuestos al bloqueo bilateral de la PC distal colocando placas del fémur derecho con tornillos durante 3, 5 y 7 semanas. Los fijadores fueron retirados después de 5 y 7 semanas en 18 de los conejos, y 3 semanas después los animales fueron sacrificados. La extremidad contralateral se utilizó como control. Se realizaron análisis histológicos, histomorfométricos y de rayos X. Resultados: Durante el bloqueo de la PC, su altura disminuyó gradualmente. Esta disminución fue más pronunciada después de 7 semanas. Los cambios destructivos se incrementaron a medida aumentaba la duración del bloqueo. Tres semanas después de la interrupción del bloqueo bilateral que duró 5 semanas, la altura de la PC aumentó significativamente 1.2 veces en el lado lateral y 1.9 veces en el lado medial (p <0.001) en comparación con el control. Conclusión: La restauración de las características funcionales estructurales de la PC después de la extracción de las placas depende de la duración del bloqueo bilateral temporal, lo que debería tenerse en cuenta en el tratamiento clínico de estas alteraciones. (AU)

Osteosynthesis in Lower Pole of Patella Fracture: A Follow up Study in Churu District of Rajasthan

Introduction: Patella is an important component of extensorapparatus and it has a major role in making the extension ofknee efficient. Patella fracture accounts for 1% of all fractures.Treatment options for fracture of lower pole of patella areTension Band Wiring, Circumferential Wiring or with screw ifthe fragment is large enough. Tension Band Fixation involvesboth static and dynamic forces.Objectives: To assess the functional outcome ofosteosynthesis in fracture of lower pole of patella usingTension band Wiring technique.Materials and Methods: The present study was a follow-upstudy conducted in Churu Multispecialty Hospital and ResearchCenter, Churu during Sept 2017 to April 2019. All the patientswith lower pole of patella fracture and whose age was 16 ormore were included in the study. Tension Band wiring is donein all the 15 patients under spinal anesthesia. Patients werefollowed at 1, 6 and 12 weeks after the date of surgery.Patients were evaluated according to Bostman’s method ofclinical grading of knee scoring system and patients weregraded as excellent, poor or unsatisfactory depending on thescore obtained.Results: In present study maximum patellar fractures were inage group 31 to 50 years. Most of the patients in our studywere males. All the variables like flexion loss, extension loss,pain, quadriceps atrophy, effusion, giving way andstair climbing improved in all the cases at final follow-up. Onepatient was lost to follow-up at 12 weeks. Clinical grading alsoimproved and 12 out of 14 patients had excellent scoring atfinal follow-up. Superficial infection developed in one patientand that was recovered fully after antibiotic coverage. Onepatient developed kneeling discomfort and that was alsorecovered at 12 week of follow-up.Conclusion: Osteosynthesis using tension band wiringtechnique is a viable treatment option lower pole fracture ofpatella with good functional results despite the technicaldifficulty associated with this procedure.

A Comparative Study between Double Tension Band Wiring and Reconstruction Plate and Screws for the Treatment of Displaced Bicondylar Intra-Articular Fractures of the Distal Humerus

Objective: In this study our main goal is to evaluatetheoutcome of double tension band wiring and reconstructionplate and screws for the treatment of displaced bicondylar intraarticular fractures of the distal humerus.Methodology: This perspective and randomized study wasconducted at the National Institute of Traumatology andOrthopaedic Rehabilitation (NITOR), Dhaka from July 2003 to2005. Where out of 24 patients 12 were selected for operativetreatment by reconstruction plate and screws (Group –I), and12 were selected for operative treatment by double tensionband wiring (Group-II) as on random basis.Results: During the study, in group-1 and group-2 most of thepatients belongs to 18-30 age group., 75% patients’ injury inleft limb whereas, 35% had injury in left limb in group-2.33.33% patients with reconstruction Plate and Screw, hadexcellent recovery after treatment where as 25% had excellentrecovery when they had double Tension Band Wiring.Conclusion: From our study we can conclude that, operativetreatment of displaced bicondylar intra-articular fractures of thedistal humerus by reconstruction plate and screws gives amore rigid fixation with better functional outcome than bydouble tension band wiring.

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

Double-Pulley technique combined with 8-shaped tension band for fixation of comminuted fractures of distal patellar pole / 第二军医大学学报

Objective: To explore the feasibility and clinical effects of Double-Pulley technique combined with 8-shaped tension band in teatment of comminuted fractures of distal patellar pole. Methods: From Jan. 2017 to Apr. 2018, 10 patients (6 males and 4 females) were treated with Double-Pulley technique combined with 8-shaped tension band in our hospital. The ages of patients ranged from 28 to 58 years old, with an average of (36.4± 11.4) years old. The average time from injury to surgery was (2.8 ± 1.1) d, ranging from 1 to 5 d. The injury cause was traffic accident in 6 cases, falling iniury in 3 cases, and sport injury in 1 case. Bostman's patellar fracture function evaluation system was used to evaluate the postoperative knee joint function. The clinical evaluation indexes included the excellent and good rate of Bostman's patellar fracture function score, and X-ray examination results and knee mobility during follow-up. Results: All patients were followed up for 16 to 24 months. The incision of all patients healed well, and no anterior knee pain or complications were found. Six months after surgery, X-ray examination showed that the patellar fracture healing of 10 patients were all osteonal union. Six months after surgery, the flexion range of knee joint was 132.0°±12.3°, and Bostman's patellar fracture function score was 28.5±1.8, with the excellent and good rate being 100% (excellent in 9 cases and good in 1 case). Conclusion: Double-Pulley technique combined with 8-shaped tension band is effective and reliable in the treatment of comminuted fractures of distal patellar pole, and the patients can start functional exercise early after surgery.

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.

Modified Tension Band Wiring Using FiberWire for Patellar Fractures

In comminuted patellar fractures, we performed modified tension band wiring using a FiberWire (Arthrex) instead of the conventional methods. From March 2016 to March 2018, 63 patients with patellar fractures who needed surgical treatment were treated with modified tension band wiring using two Kirschner wires (K-wires) and FiberWire. We inserted two 1.6-mm K-wires perpendicular to the fracture line after accurate reduction. With the knee flexed over 90°, we sutured around the patella using a FiberWire. Visual analog scale score and Levack's score were improved postoperatively. The mean bone union time was 5.6 months. None of the patients had breakage of wires, and nonunion with deformity occurred in one patient. We think that our method can be easier to handle and reduce irritation or breakage of the wires than conventional methods. In addition, early rehabilitation can be allowed. Therefore, we suggest that this method could be a useful method for the treatment of patellar fractures.

A Functional And Radiological Outcome Of Surgical Management Of Bimalleolar And Trimalleolar Ankle Fractures

BACKGROUND: Ankle joint is one of the unstable joints in the body due to its anatomic position and is more prone to injury during daily activities. Malleolar fractures are one of the most common fractures in orthopedic traumatology. OBJECTIVES : The aim of this study was to evaluate the clinical and functional results of patients with ankle fractures treated with Open reduction and internal fixation with different modalities. Method and Materials:Aprospective study was conducted from April 2016 to April 2018 over a period of 2 years . Total 50 patients were treated by various techniques of open reduction and internal fixation. Result :According to Baird and Jackson scoring system, 23 (51 %) patients had excellent outcome, 14 (31%) had good outcome,6 (13 %) had fair outcome and 2 ( 4 %) had poor outcome. Supination External Rotation injury is the commonest mechanism of injury. CONCLUSION : We concluded that early treatment , anatomical reduction and fracture fixation, stringent postoperative mobilization and rehabilitation should help improve Functional outcome in ankle fractures.

To Evaluate the Clinical Outcome of Transverse Fractures of Patella Treated with Modified Tension Band Wiring A Prospective Study

Background: Patella is the largest sesamoid bone in the body situated in the quadriceps tendon1. The main function of patella is to improve the efficiency of quadriceps muscle by improving the mechanical leverage of the quadriceps muscle. Patellar fractures are common and it constitutes about 1% of all skeletal injuries resulting from either direct or indirect trauma2.The subcutaneous location of the patella makes it vulnerable to direct trauma.Aims of the study were to evaluate the clinical outcome of Transverse fractures of patella treated with modified tension band wiring. The objectives of the study are to study the advantages of modified tension band wiring fixation in patellar fracture, the complications associated with this method of fixation and to assess the role of early mobilization with this technique. Methods: This prospective study is done in Department of Orthopaedics at R L Jalappa Hospital and Research Center, attached to Sri DevarajUrs Medical College, Kolarduring the period from December 2010 to June 2012. This study consists of 30 cases of displaced transverse fracture patella treated by modified tension band wiring. The cases were selected based on inclusion and exclusion criteria. After pre anaesthetic fitness patient, patient was operated (tension band wiring). Operatedknee was immobilized in extension in an above knee posterior slab, and advised to do straight leg raising test.Weight bearing was started from 3rd post-operative day. Sutures were removed on 12th to 14thpost operative day. The discharged patients were advised to report for follow up every month, during each follow up the patients were examined for both subjective symptoms and objective signs which was recorded. The patients were questioned about subjective complaints like pain, difficulty in walking, squatting, climbing and getting down stairs and ability to perform routine work. The patient’s objective assessment was done for Extensor lag, Range of knee movement, circumference of thigh (wasting) and Efficacy of quadriceps (power).Results: The range of age of fracture of patella in our series was between 19-70 years, the mean age was 42 years and the incidence was high in the age group of 31-40 years. In a total of 30 cases, 24 fractures were in men and 6 fractures were in females.22 fractures were as a result of indirect mechanism and 8 cases were due to direct trauma to the patella as in RTA. 17 patients had fracture on the right side and 13 patients had fracture on the left side.Average duration between injuries to hospital admission was about 1.16 days. The average duration between the days of admission to the day of surgery is about 2.93 days and the average duration of stay in hospital is about 13.2 days (ranging from 11 to 22 days).No intra operative complications like fragmentation at wiring, difficulty in closure were encountered. Results were excellent in 26 cases, good in 3 cases and bad in 1 caseasper west’s criteria. Conclusion: Thus we conclude that anatomical reduction and stable fixation in patellar fracture is necessary for the normal integrity and stability of the joint.Early post-operative physiotherapy plays an important role in final outcome, which helps in reducing complication like stiffness of knee and in providing good functional. Our outcome was not influenced by the associated injuries. Long-term follow up is necessary to assess late complications like osteoarthritis and late functional outcome.

Functional Assessment Following Treatment of Acromioclavicular Joint Dislocation by Screw and Tension Band Wiring

Background: The acromioclavicular (AC) joint is commonly involved in traumatic injuries in male athletic population. Treatment of acute complete AC dislocation is controversial in literature. Both conservative and surgical treatment has been reported with similar results. Methods: We report a prospective study of 17 patients of Acromioclavicular dislocations (Type III) managed with screw and tension band wiring and were followed up for a period of 3 years. Repair of Coracoclavicular Ligament was performed if found completely torn. Results: Patients were assessed on basis of pain relief, tenderness, functional ability, range of motion at shoulder and cosmosis. Conclusion:Fixation with screw and Tension band wiring is a simple, easy, less time consuming surgical technique allowing faster rehabilitation in young and adult active patients to achieve a stable, pain free shoulder with no serious intra-operative or post-operative complications.