Effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in treatment of inferior patellar pole avulsion fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIE Meiming ,  LIAO Dongfa , GONG Kai , HUANG Chen , CHEN Song , REN Yaming , ZHENG Wei

Department of Orthopedics, the General Hospital of the Western Theater Command, Chengdu Shichuan, 610083, P.R.China;

Corresponding author：

LIAO Dongfa, Email: 1532907286@qq.com

Keywords：

Inferior patellar pole avulsion fracture; steel wire; internal fixation

DOI：

10.7507/1002-1892.202008106

Video：

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Objective To explore the method and effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures.Methods Betweern January 2015 and January 2019, 22 patients with inferior patellar pole avulsion fractures were admitted and treated. There were 12 males and 10 females. The age ranged from 20 to 69 years, with an average age of 39.4 years. The causes of injury included 9 cases of traffic accident and 13 cases of falling. All of them were unilateral closed injury of knee joint, including 7 cases of skin contusion around patella. Preoperative range of motion of the affected knee was (20.82±7.16)° (range, 10°-35°). The time from injury to operation ranged from 3 to 12 days, with an average of 5.9 days. During the operation, the inferior patellar avulsion fracture was reduced with forceps; the patella was circumferentially ligated through the distal bone surface of the fracture with 0.8 mm diameter steel wire; then 3 longitudinal bone tunnels were made in the upper patella, respectively. The 0.8 mm diameter steel wire passed through the bone tunnel, and the longitudinal ring was attached to the ring to fix the upper and inferior patellar fracture. Tighten the transverse and longitudinal rings with No.2 tendon suture line, then longitudinally ringed and sutured to strengthen the patella. The knee range of motion, fracture healing time, and complications were recorded. The functional recovery of the knee joint was evaluated by Böstman score.Results All incisions healed by first intention, and no incision related complications occurred. All the 22 patients were followed up 13 months to 5 years with an average of 26.7 months. The fracture healing time was 9-12 weeks (mean, 10.9 weeks). At last follow-up, the knee range of motion was (129.77±2.35)° (range, 126°-135°), showing significant difference when compared with preoperative one (t=−67.022, P=0.000). The Böstman score ranged from 31 to 36, with an average of 34.3. No reduction loss, fracture of steel wire, failure of internal fixation, and other complications occurred during follow-up.Conclusion Multidirectionally three-dimensional steel wire ring sleeve fixation in the treatment of inferior patellar pole avulsion fractures has the advantages of reliable fixation, early functional recovery, and fewer complications, so the effectiveness is satisfactory.

Citation： XIE Meiming, LIAO Dongfa, GONG Kai, HUANG Chen, CHEN Song, REN Yaming, ZHENG Wei. Effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in treatment of inferior patellar pole avulsion fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(2): 183-187. doi: 10.7507/1002-1892.202008106 Copy

1.	Zhu W, Xie K, Li X, et al. Combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures. Injury, 2020, 51(3): 764-768.
2.	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, 2020. doi: 10.1007/s00402-020-03671-5.
3.	Song HK, Yoo JH, Byun YS, et al. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. Yonsei Med J, 2014, 55(3): 785-791.
4.	Huang HC, Su JY, Cheng YM. Modified basket plate for inferior patellar pole avulsion fractures: a report of three cases. Kaohsiung J Med Sci, 2012, 28(11): 619-623.
5.	Matejčić A, Ivica M, Jurišić D, et al. Internal fixation of patellar apex fractures with the basket plate: 25 years of experience. Injury, 2015, 46 Suppl 6: S87-90.
6.	Yang X, Wu Q, Lai CH, et al. Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System. Injury, 2017, 48(10): 2348-2353.
7.	Taylor BC, Mehta S, Castaneda J, et al. Plating of patella fractures: techniques and outcomes. J Orthop Trauma, 2014, 28(9): e231-235.
8.	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.
9.	Cho JW, Kent WT, Cho WT, et al. Miniplate augmented tension-band wiring for comminuted patella fractures. J Orthop Trauma, 2019, 33(4): e143-e150.
10.	Oh HK, Choo SK, Kim JW, et al. Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing. Injury, 2015, 46(12): 2512-2515.
11.	Avery MC, Jo S, Chang A, et al. Cannulated screw prominence in tension band wiring of patella fractures increases fracture gapping: A cadaver study. Clin Orthop Relat Res, 2019, 477(5): 1249-1255.
12.	何双建, 赵建宁. 髌骨下极骨折手术治疗进展. 实用骨科杂志, 2018, 24(1): 49-51.
13.	徐国浩, 宁显宗. 单枚带线锚钉内固定治疗髌骨下极粉碎性骨折. 中国骨与关节损伤杂志, 2020, 35(6): 619-620.
14.	耿震, 林永杰, 王国伟, 等. 带线锚钉结合髌骨爪治疗髌骨下极骨折. 中国矫形外科杂志, 2019, 27(14): 1330-1332.
15.	Patel VR, Parks BG, Wang Y, et al. Fixation of patella fractures with braided polyester suture: a biomechanical study. Injury, 2000, 31(1): 1-6.
16.	李富文, 黄小忠, 唐会莲, 等. Krachow 缝合联合改良环扎张力带固定髌骨下极粉碎性骨折. 中国骨科临床与基础研究杂志, 2019, 11(6): 343-347.

1. Zhu W, Xie K, Li X, et al. Combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures. Injury, 2020, 51(3): 764-768.
2. 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, 2020. doi: 10.1007/s00402-020-03671-5.
3. Song HK, Yoo JH, Byun YS, et al. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. Yonsei Med J, 2014, 55(3): 785-791.
4. Huang HC, Su JY, Cheng YM. Modified basket plate for inferior patellar pole avulsion fractures: a report of three cases. Kaohsiung J Med Sci, 2012, 28(11): 619-623.
5. Matejčić A, Ivica M, Jurišić D, et al. Internal fixation of patellar apex fractures with the basket plate: 25 years of experience. Injury, 2015, 46 Suppl 6: S87-90.
6. Yang X, Wu Q, Lai CH, et al. Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System. Injury, 2017, 48(10): 2348-2353.
7. Taylor BC, Mehta S, Castaneda J, et al. Plating of patella fractures: techniques and outcomes. J Orthop Trauma, 2014, 28(9): e231-235.
8. 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.
9. Cho JW, Kent WT, Cho WT, et al. Miniplate augmented tension-band wiring for comminuted patella fractures. J Orthop Trauma, 2019, 33(4): e143-e150.
10. Oh HK, Choo SK, Kim JW, et al. Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing. Injury, 2015, 46(12): 2512-2515.
11. Avery MC, Jo S, Chang A, et al. Cannulated screw prominence in tension band wiring of patella fractures increases fracture gapping: A cadaver study. Clin Orthop Relat Res, 2019, 477(5): 1249-1255.
12. 何双建, 赵建宁. 髌骨下极骨折手术治疗进展. 实用骨科杂志, 2018, 24(1): 49-51.
13. 徐国浩, 宁显宗. 单枚带线锚钉内固定治疗髌骨下极粉碎性骨折. 中国骨与关节损伤杂志, 2020, 35(6): 619-620.
14. 耿震, 林永杰, 王国伟, 等. 带线锚钉结合髌骨爪治疗髌骨下极骨折. 中国矫形外科杂志, 2019, 27(14): 1330-1332.
15. Patel VR, Parks BG, Wang Y, et al. Fixation of patella fractures with braided polyester suture: a biomechanical study. Injury, 2000, 31(1): 1-6.
16. 李富文, 黄小忠, 唐会莲, 等. Krachow 缝合联合改良环扎张力带固定髌骨下极粉碎性骨折. 中国骨科临床与基础研究杂志, 2019, 11(6): 343-347.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of multidirectionally three-dimensional steel wire ring sleeve fixation in treatment of inferior patellar pole avulsion fractures

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