Treatment of inferior pole patellar fractures with suture anchors and headless compression screws_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Junsong ^1,2 , ZHANG Wei ² , TIAN Zhuan ¹ , JIANG Yu ² ,  YAO Qi ¹

1. Department of Joint Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, P. R. China;
2. Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P. R. China;

Corresponding?author：

YAO Qi, Email: yqjh2010@163.com

Keywords：

Inferior pole patellar fracture; headless compression screw; anchor; internal fixation; knee function

DOI：

10.7507/1002-1892.202506038

Video：

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Objective To evaluate the effectiveness of anchor suture combined with headless compression screw fixation in treating inferior pole patellar fractures. Methods A retrospective analysis was conducted on 36 patients with inferior patellar fractures, who were admitted between January 2018 and October 2024 and met the selective criteria. There were 15 males and 21 females with a mean age of 52.3 years (range, 23-81 years). The fracture were reduced and fixed using anchor suture combined with headless compression screws. The operation time, intraoperative blood loss, and the length of hospital stay were recorded. Functional recovery was assessed using knee range of motion (ROM), Hospital for Special Surgery (HSS) knee score, and B?stman patellar fracture score. Results The operation time ranged from 10 to 100 minutes, with an average of 57.6 minutes. The intraoperative blood loss was 10 to 120 mL, with an average of 73.3 mL. The length of hospital stay was 5 to 10 days, with an average of 6.3 days. All incisions healed by first intention. All 36 patients were followed up 18-24 months (mean, 20.6 months). Preoperative X-ray films indicated that the fractures had healed; no head compression screw breakage, anchor loosening, or implant foreign body rejection reactions occurred during follow-up. At last follow-up, the ROM of the affected knee joint was (136.0±2.3)°, and there was no significant difference compared with the healthy side (136.6±2.3)° (t=?1.944, P=0.060). The HSS score of the affected knee joint was 96-100 (mean, 99.1), and all cases were rated as excellent. The B?stman patellar fracture efficacy score was 27-30 (mean, 29.1), and 35 cases were rated as excellent and 1 as good. Conclusion The suture anchors combined with headless compression screws technique provides reliable fixation for inferior patellar fractures. This method combines surgical simplicity with excellent functional outcomes.

1.	Doig T, Fagan P, Frush T, et al. The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3606-3612.
2.	肖琦科, 張力鵬, 張永峰. 髕韌帶編織縫合聯合克氏針鋼絲張力帶內固定治療髕骨下極骨折療效觀察. 中國骨與關節損傷雜志, 2021, 36(6): 605-607.
3.	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.
4.	Jang JH, Cho YJ, Choi YY, et al. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res, 2021, 107(3): 102866. doi: 10.1016/j.otsr.2021.102866.
5.	劉晨東, 胡孫君, 張世民. 髕骨下極骨折手術治療進展. 中國修復重建外科雜志, 2023, 37(1): 115-119.
6.	Chang CH, Shih CA, Kuan FC, et al. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop, 2023, 10(1): 58. doi: 10.1186/s40634-023-00622-y.
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.	張如意, 唐佩福, 陶笙, 等. 錨釘技術治療髕骨下極撕脫骨折11例近期療效觀察. 中國矯形外科雜志, 2013, 21(10): 1046-1048.
9.	孔嘉琛, 柳直, 王猛, 等. 帶線錨釘穿骨張力帶與高強線環扎雙重固定治療髕骨骨折的療效觀察. 中國骨與關節雜志, 2024, 13(2): 118-122.
10.	馬翔宇, 項良碧, 劉兵, 等. 髕骨下極骨折部分切除治療進展. 臨床軍醫雜志, 2020, 48(4): 478-480.
11.	付堯, 瞿曉宏, 房小文, 等. 雙排錨釘縫線橋技術治療髕骨下極骨折療效觀察. 中國骨與關節損傷雜志, 2023, 38(6): 626-629.
12.	林學義, 林煜, 李平, 等. 改良張力帶鋼絲聯合可吸收帶線錨釘內固定治療髕骨下極撕脫骨折療效觀察. 中國骨與關節損傷雜志, 2020, 35(8): 833-835.
13.	張如意, 唐佩福, 張立海, 等. 錨釘技術治療髕骨下極撕脫骨折的療效分析. 中國矯形外科雜志, 2017, 25(8): 700-703.
14.	朱少兵, 葉鋒, 鄭曉東, 等. 間斷垂直鋼絲結合Krackow縫合法治療髕骨下極骨折. 臨床骨科雜志, 2021, 24(5): 739-741.
15.	Dong Z, Liu F, Pan Y, et al. Clinical analysis of an anchor nail combined with a titanium cable in the treatment of lower patella fractures. J Int Med Res, 2020, 48(4): 300060519873505. doi: 10.1177/0300060519873505.
16.	周繼輝, 李新志, 周游, 等. 髕骨骨折修復內植物選擇的多重問題. 中國組織工程研究, 2021, 25(9): 1440-1445.
17.	Wang C, Zhu Y, Liu Z, et al. Causal associations of obesity related anthropometric indicators and body compositions with knee and hip arthritis: A large-scale genetic correlation study. Front Endocrinol (Lausanne), 2022, 13: 1011896. doi: 10.3389/fendo.2022.1011896.
18.	Rupp S, Seil R, Schneider A, et al. Ligament graft initial fixation strength using biodegradable interference screws. J Biomed Mater Res, 1999, 48(1): 70-74.
19.	陳松, 謝慶云, 劉金標, 等. 髕骨下極骨折治療的現狀分析. 中國骨與關節雜志, 2021, 10(12): 900-904.
20.	王培召, 韓旭, 王嘯, 等. 不可吸收縫合線捆扎結合髕骨爪固定治療髕骨下極骨折療效觀察. 中國修復重建外科雜志, 2020, 34(10): 1243-1247.
21.	李旭, 李石倫, 李升, 等. 全切術和部分切除術對髕骨粉碎性骨折的遠期療效比較. 河北醫藥, 2020, 42(12): 1809-1812.
22.	Hargett DI, Sanderson BR, Little MTM. Patella fractures: approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
23.	徐希斌, 何雙建, 楊照耀, 等. 改良獨立垂直鋼絲聯合鋼絲環扎內固定治療髕骨下極骨折療效分析. 中國骨與關節損傷雜志, 2023, 38(2): 177-179.
24.	Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
25.	王強, 呂欣, 李興業, 等. 帶線錨釘+空心釘內固定治療髕骨骨折的療效. 臨床骨科雜志, 2024, 27(2): 257-260.
26.	袁建敏, 陶周善, 楊民, 等. 帶線錨釘聯合髕骨橫向鉆孔修復股四頭肌腱骨腱結合部斷裂. 中國骨傷, 2020, 33(1): 71-75.
27.	王軍, 王陶, 石波, 等. 空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折. 華西醫學, 2012, 27(2): 230-233.
28.	Thelen S, Schneppendahl J, Jopen E, et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury, 2012, 43(8): 1290-1295.
29.	杜軍, 魯成, 孔楊. 雙結克氏針張力帶固定治療髕骨骨折. 臨床骨科雜志, 2024, 27(6): 876-879.

1. Doig T, Fagan P, Frush T, et al. The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3606-3612.
2. 肖琦科, 張力鵬, 張永峰. 髕韌帶編織縫合聯合克氏針鋼絲張力帶內固定治療髕骨下極骨折療效觀察. 中國骨與關節損傷雜志, 2021, 36(6): 605-607.
3. 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.
4. Jang JH, Cho YJ, Choi YY, et al. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res, 2021, 107(3): 102866. doi: 10.1016/j.otsr.2021.102866.
5. 劉晨東, 胡孫君, 張世民. 髕骨下極骨折手術治療進展. 中國修復重建外科雜志, 2023, 37(1): 115-119.
6. Chang CH, Shih CA, Kuan FC, et al. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop, 2023, 10(1): 58. doi: 10.1186/s40634-023-00622-y.
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. 張如意, 唐佩福, 陶笙, 等. 錨釘技術治療髕骨下極撕脫骨折11例近期療效觀察. 中國矯形外科雜志, 2013, 21(10): 1046-1048.
9. 孔嘉琛, 柳直, 王猛, 等. 帶線錨釘穿骨張力帶與高強線環扎雙重固定治療髕骨骨折的療效觀察. 中國骨與關節雜志, 2024, 13(2): 118-122.
10. 馬翔宇, 項良碧, 劉兵, 等. 髕骨下極骨折部分切除治療進展. 臨床軍醫雜志, 2020, 48(4): 478-480.
11. 付堯, 瞿曉宏, 房小文, 等. 雙排錨釘縫線橋技術治療髕骨下極骨折療效觀察. 中國骨與關節損傷雜志, 2023, 38(6): 626-629.
12. 林學義, 林煜, 李平, 等. 改良張力帶鋼絲聯合可吸收帶線錨釘內固定治療髕骨下極撕脫骨折療效觀察. 中國骨與關節損傷雜志, 2020, 35(8): 833-835.
13. 張如意, 唐佩福, 張立海, 等. 錨釘技術治療髕骨下極撕脫骨折的療效分析. 中國矯形外科雜志, 2017, 25(8): 700-703.
14. 朱少兵, 葉鋒, 鄭曉東, 等. 間斷垂直鋼絲結合Krackow縫合法治療髕骨下極骨折. 臨床骨科雜志, 2021, 24(5): 739-741.
15. Dong Z, Liu F, Pan Y, et al. Clinical analysis of an anchor nail combined with a titanium cable in the treatment of lower patella fractures. J Int Med Res, 2020, 48(4): 300060519873505. doi: 10.1177/0300060519873505.
16. 周繼輝, 李新志, 周游, 等. 髕骨骨折修復內植物選擇的多重問題. 中國組織工程研究, 2021, 25(9): 1440-1445.
17. Wang C, Zhu Y, Liu Z, et al. Causal associations of obesity related anthropometric indicators and body compositions with knee and hip arthritis: A large-scale genetic correlation study. Front Endocrinol (Lausanne), 2022, 13: 1011896. doi: 10.3389/fendo.2022.1011896.
18. Rupp S, Seil R, Schneider A, et al. Ligament graft initial fixation strength using biodegradable interference screws. J Biomed Mater Res, 1999, 48(1): 70-74.
19. 陳松, 謝慶云, 劉金標, 等. 髕骨下極骨折治療的現狀分析. 中國骨與關節雜志, 2021, 10(12): 900-904.
20. 王培召, 韓旭, 王嘯, 等. 不可吸收縫合線捆扎結合髕骨爪固定治療髕骨下極骨折療效觀察. 中國修復重建外科雜志, 2020, 34(10): 1243-1247.
21. 李旭, 李石倫, 李升, 等. 全切術和部分切除術對髕骨粉碎性骨折的遠期療效比較. 河北醫藥, 2020, 42(12): 1809-1812.
22. Hargett DI, Sanderson BR, Little MTM. Patella fractures: approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
23. 徐希斌, 何雙建, 楊照耀, 等. 改良獨立垂直鋼絲聯合鋼絲環扎內固定治療髕骨下極骨折療效分析. 中國骨與關節損傷雜志, 2023, 38(2): 177-179.
24. Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
25. 王強, 呂欣, 李興業, 等. 帶線錨釘+空心釘內固定治療髕骨骨折的療效. 臨床骨科雜志, 2024, 27(2): 257-260.
26. 袁建敏, 陶周善, 楊民, 等. 帶線錨釘聯合髕骨橫向鉆孔修復股四頭肌腱骨腱結合部斷裂. 中國骨傷, 2020, 33(1): 71-75.
27. 王軍, 王陶, 石波, 等. 空心拉力螺釘聯合鋼絲張力帶治療髕骨骨折. 華西醫學, 2012, 27(2): 230-233.
28. Thelen S, Schneppendahl J, Jopen E, et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury, 2012, 43(8): 1290-1295.
29. 杜軍, 魯成, 孔楊. 雙結克氏針張力帶固定治療髕骨骨折. 臨床骨科雜志, 2024, 27(6): 876-879.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesTreatment of inferior pole patellar fractures with suture anchors and headless compression screws

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