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.
Objective To introduce a scout view scanning technique of back-forward bending CT (BFB-CT) in simulated surgical position for evaluating the remaining real angle and flexibility of thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture. Methods A total of 28 patients with thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture who met the selection criteria between June 2018 and December 2021 were included in the study. There were 6 males and 22 females with an average age of 69.5 years (range, 56-92 years). The injured vertebra were located at T10-L2, including 11 cases of single thoracic fracture, 11 cases of single lumbar fracture, and 6 cases of multiple thoracolumbar fractures. The disease duration ranged from 3 weeks to 36 months, with a median of 5 months. All patients received examinations of BFB-CT and standing lateral full-spine X-ray (SLFSX). The thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), local kyphosis of injured vertebra (LKIV), lumbar lordosis (LL), and the sagittal vertical axis (SVA) were measured. Referring to the calculation method of scoliosis flexibility, the kyphosis flexibility of thoracic, thoracolumbar, and injured vertebra were calculated respectively. The sagittal parameters measured by the two methods were compared, and the correlation of the parameters measured by the two methods was analyzed by Pearson correlation. Results Except LL (P>0.05), TK, TLK, LKIV, and SVA measured by BFB-CT were significantly lower than those measured by SLFSX (P<0.05). The flexibilities of thoracic, thoracolumbar, and injured vertebra were 34.1%±18.8%, 36.2%±13.8%, and 39.3%±18.6%, respectively. Correlation analysis showed that the sagittal parameters measured by the two methods were positively correlated (P<0.001), and the correlation coefficients of TK, TLK, LKIV, and SVA were 0.900, 0.730, 0.700, and 0.680, respectively. Conclusion Thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fracture shows an excellent flexibility and BFB-CT in simulated surgical position can obtain the remaining real angle which need to be corrected surgically.
