Effectiveness of cerclage and a figure-of-eight tension band by a single titanium wire in treatment of patellar fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Chunyong , YE Junjian , XIE Yun , LIN Zhangxiong , XIE Qiyang , QIU Yaoyu , WU Gui ,  WANG Fasheng

Department of Orthopaedic Trauma, the First Affiliated Hospital of Fujian Medical University, Trauma Center of Fujian, Fuzhou Fujian, 350004, P.R.China;

Corresponding author：

WANG Fasheng, Email: wfshine@foxmail.com

Keywords：

Patellar fracture; tension band; titanium wire; internal fixation

DOI：

10.7507/1002-1892.201702021

Video：

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ObjectiveTo estimate the outcome of cerclage followed by a figure-of-eight tension band with a single titanium wire for the treatment of patellar fracture.MethodsA retrospective analysis was made on the clinical data of 46 patients with patellar fractures treated between June 2012 and November 2014. There were 30 males and 16 females, aged 20-86 years (mean, 54 years). The fracture causes included falling in 27 cases, traffic accident in 16 cases, and knock in 3 cases. There were 41 cases of closed fractures and 5 cases of open fracture. The injury located at the left side in 24 cases and the right side in 22 cases. According to AO classification, fracture was rated as type 34-A in 3 cases, as type 34-B in 1 case, as type 34-C1 in 7 cases, as type 34-C2 in 13 cases, and as type 34-C3 in 22 cases. The time between injury and operation ranged 1-12 days (mean, 3.7 days). During operations, a single titanium wire was used to pass around the patellar, followed a figure-of-eight wrapping, to tight and fix at the tension of 35 kg.ResultsAll incisions healed primarily. The patients were followed up 20.6 months on average (range, 6-24 months). Partial wire loosening was found in 2 cases, irritation of skin or soft tissue in 1 case. The X-ray examination showed bony healing at 3 months after operation, without breakage of titanium wire. The internal fixation was removed in 38 cases at 12 months after operation. According to the Böstman rating score, the mean score was 28.34 (range, 24-30) at 12 months after ope-ration; the results were excellent in 42 cases and good in 4 cases, with an excellent and good rate of 100%.ConclusionFor patellar fracture, cerclage followed by a figure-of-eight tension band with a single titanium wire is able to achieve an effective stability and to allow early motion for patient with less complication.

Citation： CHEN Chunyong, YE Junjian, XIE Yun, LIN Zhangxiong, XIE Qiyang, QIU Yaoyu, WU Gui, WANG Fasheng. Effectiveness of cerclage and a figure-of-eight tension band by a single titanium wire in treatment of patellar fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(7): 805-809. doi: 10.7507/1002-1892.201702021 Copy

1.	Schuett DJ, Hake ME, Mauffrey C, et al. Current Treatment Strategies for Patella Fractures. Orthopedics, 2015, 38(6): 377-384.
2.	Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg, 2011, 19(4): 198-207.
3.	Rüedi TR. AO principles of fracture management. 2nd ed. Davos: Thieme Medical Publisher, 2007: 598-607.
4.	Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
5.	Schneider MM, Nowak TE, Bastian L, et al. Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection. Int Orthop, 2014, 38(4): 847-855.
6.	Larsen P, Court-Brown CM, Vedel JO, et al. Incidence and Epidemiology of Patellar Fractures. Orthopedics, 2016, 39(6): e1154-e1158.
7.	Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instructional course lectures, 1994, 43(10): 97-108.
8.	Xu F, Wang AQ, Min HW, et al. Patellar fracture fixation: biomechanical characteristics of static and dynamic compression. Journal of Clinical Rehabilitative Tissue Engineering Research, 2014, 18(31): 5004-5010.
9.	Fortis AP, Milis Z, Kostopoulos V, et al. Experimental investigation of the tension band in fractures of the patella. Injury, 2002, 33(6): 489-493.
10.	吴志强, 高宜军, 王渊, 等. 空心螺钉结合 Cable-Ready 钢缆针张力带治疗髌骨骨折. 中华创伤骨科杂志, 2015, 17(5): 449-451.
11.	李春江. 带孔克氏针钢丝缠绕加压张力带治疗髌骨骨折疗效观察. 中国修复重建外科杂志, 2015, 29(12): 1466-1468.
12.	Dickman CA, Papadopoulos SM, Crawford NR, et al. Comparative mechanical properties of spinal cable and wire fixation systems. Spine (Phila Pa 1976), 1997, 22(6): 596-604.
13.	Dickens AJ, Salas C, Rise L, et al. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury, 2015, 46(6): 1001-1006.
14.	Downey MW, Duncan K, Kosmopoulos V, et al. Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study. Scientifica (Cairo), 2016, 2016: 3201678.
15.	徐海栋, 陈勇, 赵建宁. 医用钛缆应用在髌骨粉碎性骨折治疗中. 中国组织工程研究, 2013, 17(22): 4070-4075.
16.	Doran SE, Papadopoulos SM, Miller LD. Internal fixation of the spine using a braided titanium cable: clinical results and postoperative magnetic resonance imaging. Neurosurgery, 1996, 38(3): 493-497.
17.	Matsuo T, Watari T, Naito K, et al. Percutaneous cerclage wiring for the surgical treatment of displaced patella fractures. Strategies Trauma Limb Reconstr, 2014, 9(1): 19-23.
18.	Li Y, Ouyang YP, Wen Y. Management of displaced comminuted patellar fracture with titanium cable cerclage. Knee, 2010, 17(4): 283-286.

1. Schuett DJ, Hake ME, Mauffrey C, et al. Current Treatment Strategies for Patella Fractures. Orthopedics, 2015, 38(6): 377-384.
2. Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg, 2011, 19(4): 198-207.
3. Rüedi TR. AO principles of fracture management. 2nd ed. Davos: Thieme Medical Publisher, 2007: 598-607.
4. Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
5. Schneider MM, Nowak TE, Bastian L, et al. Tension band wiring in olecranon fractures: the myth of technical simplicity and osteosynthetical perfection. Int Orthop, 2014, 38(4): 847-855.
6. Larsen P, Court-Brown CM, Vedel JO, et al. Incidence and Epidemiology of Patellar Fractures. Orthopedics, 2016, 39(6): e1154-e1158.
7. Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instructional course lectures, 1994, 43(10): 97-108.
8. Xu F, Wang AQ, Min HW, et al. Patellar fracture fixation: biomechanical characteristics of static and dynamic compression. Journal of Clinical Rehabilitative Tissue Engineering Research, 2014, 18(31): 5004-5010.
9. Fortis AP, Milis Z, Kostopoulos V, et al. Experimental investigation of the tension band in fractures of the patella. Injury, 2002, 33(6): 489-493.
10. 吴志强, 高宜军, 王渊, 等. 空心螺钉结合 Cable-Ready 钢缆针张力带治疗髌骨骨折. 中华创伤骨科杂志, 2015, 17(5): 449-451.
11. 李春江. 带孔克氏针钢丝缠绕加压张力带治疗髌骨骨折疗效观察. 中国修复重建外科杂志, 2015, 29(12): 1466-1468.
12. Dickman CA, Papadopoulos SM, Crawford NR, et al. Comparative mechanical properties of spinal cable and wire fixation systems. Spine (Phila Pa 1976), 1997, 22(6): 596-604.
13. Dickens AJ, Salas C, Rise L, et al. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury, 2015, 46(6): 1001-1006.
14. Downey MW, Duncan K, Kosmopoulos V, et al. Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study. Scientifica (Cairo), 2016, 2016: 3201678.
15. 徐海栋, 陈勇, 赵建宁. 医用钛缆应用在髌骨粉碎性骨折治疗中. 中国组织工程研究, 2013, 17(22): 4070-4075.
16. Doran SE, Papadopoulos SM, Miller LD. Internal fixation of the spine using a braided titanium cable: clinical results and postoperative magnetic resonance imaging. Neurosurgery, 1996, 38(3): 493-497.
17. Matsuo T, Watari T, Naito K, et al. Percutaneous cerclage wiring for the surgical treatment of displaced patella fractures. Strategies Trauma Limb Reconstr, 2014, 9(1): 19-23.
18. Li Y, Ouyang YP, Wen Y. Management of displaced comminuted patellar fracture with titanium cable cerclage. Knee, 2010, 17(4): 283-286.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of cerclage and a figure-of-eight tension band by a single titanium wire in treatment of patellar fracture

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