ObjectiveTo investigate the effectiveness of the Krackow suture of patellar tendon with vertical fixation through bone tunnels combined with Kirschner wire tension band in the treatment of comminuted fractures of the inferior pole of the patella. Methods The clinical data of 62 patients with unilateral comminuted fractures of the inferior pole of the patella who were admitted between January 2023 and July 2024 and met the selection criteria were retrospectively analyzed. Of these patients, 31 were treated with Krackow suture of patellar tendon with vertical fixation through bone tunnels combined with Kirschner wire tension band fixation (group A), whereas the remaining 31 were treated with conventional Kirschner-wire tension-band fixation (group B). There was no significant difference between the two groups in baseline characteristics, including gender, age, side of injury, body mass index, interval from injury to surgery, preoperative visual analogue scale (VAS) score for anterior knee pain, and preoperative knee range of motion (P>0.05). The operation time, intraoperative blood loss, incision length, time to postoperative full weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. Anterior knee pain was assessed using the VAS before surgery, at 1 week and 1 month after surgery, and at last follow-up. Knee range of motion was measured before surgery, at 1 and 3 months after surgery, and at last follow-up. At last follow-up, the Insall-Salvati index was measured to assess patellar height, and knee function was evaluated using the Bostman score for patellar fractures. ResultsAll patients underwent surgery successfully. Group A had a shorter incision, a shorter operation time, and less intraoperative blood loss than group B, with significant differences between the two groups (P<0.05). All patients were followed up with the follow-up time (15.35±1.87) months in group A and (15.81±2.30) months in group B, showing no significant difference in follow-up time between the two groups (P>0.05). No complication, such as internal fixation failure or infection, occurred in group A. In group B, disengagement and failure of the internal fixation occurred in 1 patient, and implant irritation and activity-related pain caused by late posterior migration of the Kirschner wires occurred in 2 patients. The time to postoperative full weight-bearing and fracture healing time were significantly shorter in group A than in group B (P<0.05). In both groups, knee range of motion and VAS scores for anterior knee pain at all postoperative time points significantly improved when compared with the corresponding preoperative values (P<0.05). At each postoperative time point, group A had a greater knee range of motion and a lower VAS score for anterior knee pain than group B, with significant differences between the two groups (P<0.05). At last follow-up, both the Bostman score and the Insall-Salvati index were significantly higher in group A than in group B (P<0.05). ConclusionCompared with conventional Kirschner wire tension band fixation, Krackow suture of patellar tendon with vertical fixation through bone tunnels combined with Kirschner wire tension band fixation provides satisfactory fracture reduction and reliable fixation, facilitates early functional rehabilitation, and is associated with a lower risk of internal fixation failure. It may therefore serve as a safe and reliable fixation option for comminuted fractures of the inferior pole of the patella.
ObjectiveTo analyze the correlation between bone cement cortical leakage and injury degree of osteoporotic vertebral compression fracture (OVCF) after percutaneous kyphoplasty (PKP), and to provide guidance for reducing clinical complications. Methods A clinical data of 125 patients with OVCF who received PKP between November 2019 and December 2021 and met the selection criteria was selected and analyzed. There were 20 males and 105 females. The median age was 72 years (range, 55-96 years). There were 108 single-segment fractures, 16 two-segment fractures, and 1 three-segment fracture. The disease duration ranged from 1 to 20 days (mean, 7.2 days). The amount of bone cement injected during operation was 2.5-8.0 mL, with an average of 6.04 mL. Based on the preoperative CT images, the standard S/H ratio of the injured vertebra was measured (S: the standard maximum rectangular area of the cross-section of the injured vertebral body, H: the standard minimum height of the sagittal position of the injured vertebral body). Based on postoperative X-ray films and CT images, the occurrence of bone cement leakage after operation and the cortical rupture at the cortical leakage site before operation were recorded. The correlation between the standard S/H ratio of the injured vertebra and the number of cortical leakage was analyzed. Results Vascular leakage occurred in 67 patients at 123 sites of injured vertebrae, and cortical leakage in 97 patients at 299 sites. Preoperative CT image analysis showed that there were 287 sites (95.99%, 287/299) of cortical leakage had cortical rupture before operation. Thirteen patients were excluded because of vertebral compression of adjacent vertebrae. The standard S/H ratio of 112 injured vertebrae was 1.12-3.17 (mean, 1.67), of which 87 cases (268 sites) had cortical leakage. The Spearman correlation analysis showed a positive correlation between the number of cortical leakage of injured vertebra and the standard S/H ratio of injured vertebra (r=0.493, P<0.001). ConclusionThe incidence of cortical leakage of bone cement after PKP in OVCF patients is high, and cortical rupture is the basis of cortical leakage. The more severe the vertebral injury, the greater the probability of cortical leakage.
