Objective
To explore the effectiveness of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture.
Methods
Between October 2013 and July 2016, 25 cases with acute Achilles tendon rupture were repaired by simple Krackow suture via limited small incision. There were 21 males and 4 females with an average age of 33.6 years (range, 25-39 years). The left side was involved in 15 cases and the right side in 10 cases. The injury caused by sport in 22 cases and by falling in 3 cases. The time from injury to operation was 3-7 days (mean, 4.4 days). Physical examination showed that the Thompson sign and single heel raising test were positive.
Results
The operation time was 30-60 minutes with an average of 39.2 minutes. All incisions healed by first intention. There was no complication of wound infection, deep vein thrombosis, tendon re-rupture, and sural nerve injury. All patients were followed up 9-20 months (mean, 14.2 months). The ankle and hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) was 92-97 (mean, 94.9) after 9 months. The AOFAS score results were excellent in 13 cases, good in 9 cases, and fair in 3 cases. The range of motion of ankle joint was 49-58° with an average of 53.7°. All single heel raising tests were negative.
Conclusion
The method of simple Krackow suture via limited small incision has the advantages of minimal injury, less incidence of re-rupture and sural nerve injury, quicker recovery and so on.
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.
