Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Peizhao ^1,2 , HAN Xu ² , WANG Xiao ² , YU Jinyang ² , YUAN Yanhao ² ,  TAN Honglue ²

1. Henan University of Chinese Traditional Medicine, Zhengzhou Henan, 450046, P.R.China;
2. The 3rd Department of Knee Injury, Henan Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;

Corresponding?author：

TAN Honglue, Email: hnlc.love@163.com

Keywords：

Inferior patella fracture; non-absorbable suture; patella claw; internal fixation

DOI：

10.7507/1002-1892.202003178

Video：

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Objective To investigate the effectiveness of non-absorbable suture cerclage combined with patella claw fixation for the treatment of inferior patella fractures.Methods Between September 2016 and January 2019, 22 patients with inferior patella fractures were treated. There were 12 males and 10 females, with a mean age of 49.1 years (range, 32-67 years). The causes of injury were traffic accident in 8 cases, falling in 12 cases, and other causes in 2 cases. The interval from injury to operation was 3-7 days (mean, 4.4 days). For the operation, 3 or 4 longitudinal tunnels were drilled backward from the surface of the proximal fracture fragment with Kirschner wires; under the guidance of lumbar puncture needles and steel wires, non-absorbable suture passed through the tunnels and encircled the inferior fracture fragment, then tighten to achieve a satisfactory reduction of the fracture; finally, the patella claw was used to strengthen the fixation. During the follow-up, complications were observed, maximum motion range of the knee joint was measured, X-ray examination was performed and fracture healing time was recorded. The knee function was evaluated according to B?stman scores.Results All the 22 patients were followed up 12-36 months (mean, 19.4 months). No infection, joint stiffness, bone nonunion, loss of reduction, or displacement of internal fixation occurred. All fractures were clinically healed, and the bone healing time was 2-3 months (mean, 2.6 months). At last follow-up, the maxium motion range of knee joint was 130°-135°, with an average of 132.6°. The B?stman score of the affected knee was 28-30 (mean, 29.2). All cases were graded as excellent results.Conclusion Non-absorbable suture cerclage combined with patella claw fixation for inferior patella fractures has the advantages of simple operation, reliable fixation, and few complications, and the clinical results are satisfactory.

Citation： WANG Peizhao, HAN Xu, WANG Xiao, YU Jinyang, YUAN Yanhao, TAN Honglue. Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1243-1247. doi: 10.7507/1002-1892.202003178 Copy

1.	Veselko M, Kastelec M. Inferior patellar pole avulsion fractures: Osteosynthesis compared with pole resection. Surgical technique. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 1): 113-121.
2.	何雙建, 趙建寧. 髕骨下極骨折手術治療進展. 實用骨科雜志, 2018, 24(1): 49-51.
3.	Gwinner C, M?rdian S, Schwabe P, et al. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW, 2016, 5: Doc01. doi: 10.3205/iprs000080. eCollection 2016.
4.	Yang KH, Byun YS. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. J Bone Joint Surg (Br), 2003, 85(8): 1155-1160.
5.	B?stman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
6.	耿震, 林永杰, 王國偉, 等. 帶線錨釘結合髕骨爪治療髕骨下極骨折. 中國矯形外科雜志, 2019, 27(14): 1330-1332.
7.	張建, 楊小勇. 經髕骨脛骨結節環形鈦纜治療髕骨下極骨折的效果分析. 中華骨與關節外科雜志, 2018, 11(2): 115-117, 123.
8.	潘明芒, 薛鋒, 唐果, 等. 不同類型髕骨下極骨折的手術治療. 中國矯形外科雜志, 2016, 24(8): 745-747.
9.	張志新, 周君東, 程明加, 等. 髕骨爪與張力帶治療老年髕骨下極骨折療效分析. 中國骨與關節損傷雜志, 2016, 31(6): 92-93.
10.	Matej?i? A, Ivica M, Juri?i? D, et al. Internal fixation of patellar apex fractures with the basket plate: 25 years of experience. Injury, 2015, 46(Suppl 6): S87-90.
11.	Huang HC, Su JY, Cheng YM. Modified basket plate for inferior patellar pole avulsion fractures: A report of three cases. Kaohsiung J Med Sci, 2012, 28(11): 619-623.
12.	蒙德鵬, 歐陽躍平, 陳匯浩, 等. 花瓣狀多軸鎖定內固定板固定星形六部分髕骨骨折的力學研究. 中國修復重建外科雜志, 2018, 32(3): 311-315.
13.	高翔, 劉輝, 鄭吉湘, 等. 鋼絲垂直間斷縫合結合帶線錨釘固定治療髕骨下極粉碎性骨折. 中華創傷骨科雜志, 2017, 19(2): 169-172.
14.	Kadar A, Sherman H, Drexler M, et al. Anchor suture fixation of distal pole fractures of patella: Twenty seven cases and comparison to partial patellectomy. Int Orthop, 2016, 40(1): 149-154.
15.	Song HK, Yoo JH, Byun YS, et al. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. Yonsei Med J, 2014, 55(3): 785-791.
16.	時欣, 趙建宏, 嚴建軍, 等. 聚酯編織線結合帶鎖扣線纜治療嚴重髕骨粉碎性骨折. 中國組織工程研究, 2014, (3): 482-487.
17.	王健, 唐曉波, 董佩龍, 等. 高強度縫線內固定治療髕骨橫形骨折的療效觀察. 中國修復重建外科雜志, 2018, 32(6): 694-697.
18.	Patel VR, Parks BG, Wang Y, et al. Fixation of patella fractures with braided polyester suture: A biomechanical study. Injury, 2000, 31(1): 1-6.
19.	張欽, 田玉景, 丁濤, 等. 鋼絲垂直間斷縫合結合鈦纜環扎固定治療髕骨下極骨折. 實用骨科雜志, 2019, 25(11): 1042-1044.

1. Veselko M, Kastelec M. Inferior patellar pole avulsion fractures: Osteosynthesis compared with pole resection. Surgical technique. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 1): 113-121.
2. 何雙建, 趙建寧. 髕骨下極骨折手術治療進展. 實用骨科雜志, 2018, 24(1): 49-51.
3. Gwinner C, M?rdian S, Schwabe P, et al. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW, 2016, 5: Doc01. doi: 10.3205/iprs000080. eCollection 2016.
4. Yang KH, Byun YS. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. J Bone Joint Surg (Br), 2003, 85(8): 1155-1160.
5. B?stman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
6. 耿震, 林永杰, 王國偉, 等. 帶線錨釘結合髕骨爪治療髕骨下極骨折. 中國矯形外科雜志, 2019, 27(14): 1330-1332.
7. 張建, 楊小勇. 經髕骨脛骨結節環形鈦纜治療髕骨下極骨折的效果分析. 中華骨與關節外科雜志, 2018, 11(2): 115-117, 123.
8. 潘明芒, 薛鋒, 唐果, 等. 不同類型髕骨下極骨折的手術治療. 中國矯形外科雜志, 2016, 24(8): 745-747.
9. 張志新, 周君東, 程明加, 等. 髕骨爪與張力帶治療老年髕骨下極骨折療效分析. 中國骨與關節損傷雜志, 2016, 31(6): 92-93.
10. Matej?i? A, Ivica M, Juri?i? D, et al. Internal fixation of patellar apex fractures with the basket plate: 25 years of experience. Injury, 2015, 46(Suppl 6): S87-90.
11. Huang HC, Su JY, Cheng YM. Modified basket plate for inferior patellar pole avulsion fractures: A report of three cases. Kaohsiung J Med Sci, 2012, 28(11): 619-623.
12. 蒙德鵬, 歐陽躍平, 陳匯浩, 等. 花瓣狀多軸鎖定內固定板固定星形六部分髕骨骨折的力學研究. 中國修復重建外科雜志, 2018, 32(3): 311-315.
13. 高翔, 劉輝, 鄭吉湘, 等. 鋼絲垂直間斷縫合結合帶線錨釘固定治療髕骨下極粉碎性骨折. 中華創傷骨科雜志, 2017, 19(2): 169-172.
14. Kadar A, Sherman H, Drexler M, et al. Anchor suture fixation of distal pole fractures of patella: Twenty seven cases and comparison to partial patellectomy. Int Orthop, 2016, 40(1): 149-154.
15. Song HK, Yoo JH, Byun YS, et al. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. Yonsei Med J, 2014, 55(3): 785-791.
16. 時欣, 趙建宏, 嚴建軍, 等. 聚酯編織線結合帶鎖扣線纜治療嚴重髕骨粉碎性骨折. 中國組織工程研究, 2014, (3): 482-487.
17. 王健, 唐曉波, 董佩龍, 等. 高強度縫線內固定治療髕骨橫形骨折的療效觀察. 中國修復重建外科雜志, 2018, 32(6): 694-697.
18. Patel VR, Parks BG, Wang Y, et al. Fixation of patella fractures with braided polyester suture: A biomechanical study. Injury, 2000, 31(1): 1-6.
19. 張欽, 田玉景, 丁濤, 等. 鋼絲垂直間斷縫合結合鈦纜環扎固定治療髕骨下極骨折. 實用骨科雜志, 2019, 25(11): 1042-1044.

Chinese Journal of Reparative and Reconstructive Surgery

Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures

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