Progress in surgical treatment of inferior patellar pole fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Chendong ,  HU Sunjun , CHANG Shimin

Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, P. R. China;

Corresponding author：

HU Sunjun, Email: husunjun@aliyun.com

Keywords：

Inferior patellar pole fracture; surgical treatment; internal fixation

DOI：

10.7507/1002-1892.202210021

Video：

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Objective To summarize the surgical treatment methods and progress of inferior patellar pole fractures and provide reference for clinical application. Methods The literature on surgical treatment of inferior patellar pole fractures was extensively reviewed, and the relevant research progress, advantages, and limitations were summarized. Results The inferior pole of the patella is an important part of the knee extension device, which can strengthen the force arm of the quadriceps. Inferior patellar pole fractures are relatively rare and often comminuted, usually requiring surgical treatment. At present, there are various methods to treat inferior patellar pole fractures, including patellectomy of inferior pole, tension-band wiring technique, plate internal fixation, suture anchor fixation, claw-like shape memory alloy, separate vertical wiring technique. Different methods have their own characteristics, advantages, and disadvantages. The single internal fixation method has more complications and is easy to cause fixation failure. Therefore, the trend of combining various internal fixation methods is developing at present. Conclusion When the main fragment of the inferior patellar pole fracture is large and mainly distributed transversely, the combination protocol based on tension-band wiring technique can be regarded as an ideal choice. When the fragments are severely damaged and small, the comprehensive protocol based on suture fixation can result in a better postoperative functional recovery.

Citation： LIU Chendong, HU Sunjun, CHANG Shimin. Progress in surgical treatment of inferior patellar pole fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(1): 115-119. doi: 10.7507/1002-1892.202210021 Copy

1.	Kastelec M, Veselko M. Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection. J Bone Joint Surg (Am), 2004, 86(4): 696-701.
2.	Lazaro LE, Wellman DS, Pardee NC, et al. Effect of computerized tomography on classification and treatment plan for patellar fractures. J Orthop Trauma, 2013, 27(6): 336-344.
3.	Matejčić A, Puljiz Z, Elabjer E, et al. Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy. Arch Orthop Trauma Surg, 2008, 128(4): 403-408.
4.	Veselko M, Kastelec M. Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection. Surgical technique. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 1): 113-121.
5.	王显林, 冉学军, 邓长青, 等. 髌韧带减张与髌骨下极切除治疗髌骨下极粉碎性骨折疗效比较. 临床骨科杂志, 2010, 13(3): 295-297.
6.	Marder RA, Swanson TV, Sharkey NA, et al. Effects of partial patellectomy and reattachment of the patellar tendon on patellofemoral contact areas and pressures. J Bone Joint Surg (Am), 1993, 75(1): 35-45.
7.	McCurnin DM, Slusher R. Tension-band wiring of a fractured patella (a photographic essay). Vet Med Small Anim Clin, 1975, 70(11): 1321-1323.
8.	Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma, 1997, 11(5): 351-356.
9.	Chang SM, Ji XL. Open reduction and internal fixation of displaced patella inferior pole fractures with anterior tension band wiring through cannulated screws. J Orthop Trauma, 2011, 25(6): 366-370.
10.	Smith ST, Cramer KE, Karges DE, et al. Early complications in the operative treatment of patella fractures. J Orthop Trauma, 1997, 11(3): 183-187.
11.	Wurm S, Bühren V, Augat P. Treating patella fractures with a locking patella plate—first clinical results. Injury, 2018, 49 Suppl 1: S51-S55.
12.	Ling M, Zhan S, Jiang D, et al. Where should Kirschner wires be placed when fixing patella fracture with modified tension-band wiring? A finite element analysis. J Orthop Surg Res, 2019, 14(1): 14. doi: 10.1186/s13018-019-1060-x.
13.	Zhang ZS, Li PF, Zhou F, et al. Comparison of a novel tension band and patellotibial tubercle cerclage in the treatment of comminuted fractures of inferior pole of the patella. Orthop Surg, 2020, 12(1): 224-232.
14.	Lu M, Zhan S, Zhang C, et al. “Fishing net” suture augmenting tension-band wiring fixation in the treatment of inferior pole fracture of the patella. Arch Orthop Trauma Surg, 2021, 141(11): 1953-1961.
15.	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.
16.	Gao Z, Long N, Yao K, et al. A novel technique for the treatment of inferior pole fractures of the patella: A preliminary report. Orthop Surg, 2022, 14(11): 3092-3099.
17.	Matejčić A, Smiljanić B, Bekavac-Beslin M, et al. The basket plate in the osteosynthesis of comminuted fractures of distal pole of the patella. Injury, 2006, 37(6): 525-530.
18.	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-S90.
19.	Krkovic M, Bombac D, Balazic M, et al. Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament-a biomechanical analysis. Knee, 2007, 14(3): 188-193.
20.	Du B, Ma T, Bai H, et al. Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture. Front Bioeng Biotechnol, 2022, 10: 1010508. doi: 10.3389/fbioe.2022.1010508.
21.	Ma XY, Cui D, Liu B, et al. Treating inferior pole fracture of patella with hand plating system: First clinical results. Orthop Surg, 2022. https://doi.org/10.1111/os.13539.
22.	Fan M, Wang D, Sun K, et al. Study of double button plate fixation in treatment of inferior pole of patella fracture. Injury, 2020, 51(3): 774-778.
23.	He QF, Pan GB, Yu ZF, et al. Novel rim plating tchnique for treatment of the inferior pole fracture of the patella. Orthop Surg, 2021, 13(2): 651-658.
24.	Jang JH, Cho YJ, Choi YY, et al. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res, 2021, 107(3): 102866. doi: 10.1016/j.otsr.2021.102866.
25.	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, 2021, 141(11): 1889-1897.
26.	Zhu L, Wang H, Song L, et al. Clinical application of suture anchor combined with Kirschner wires fixation for patella inferior-pole fractures. Asian J Surg, 2022, 45(7): 1418-1419.
27.	Yu H, Dong H, Ruan B, et al. Clinical effect of suture anchor and double-pulley technique in the treatment of inferior patellar fracture. Comput Math Methods Med, 2021, 2021: 4964195. doi: 10.1155/2021/4964195.
28.	Xie J, Fu Y, Li J, et al. Anchor and Krackow-“8” suture for the fixation of distal pole fractures of the patella: Comparison to Kirschner wire. Orthop Surg, 2022, 14(2): 374-382.
29.	Gaines RJ, Grabill SE, DeMaio M, et al. Patellar tendon repair with suture anchors using a combined suture technique of a Krackow-Bunnell weave. J Orthop Trauma, 2009, 23(1): 68-71.
30.	Hao W, Zhou L, Sun Y, et al. Treatment of patella fracture by claw-like shape memory alloy. Arch Orthop Trauma Surg, 2015, 135(7): 943-951.
31.	史凤之, 孙国荣, 吴成如, 等. 聚髌器治疗髌骨下极撕脱性骨折对患者术后膝关节功能的改善效果. 解放军预防医学杂志, 2018, 36(6): 729-731, 735.
32.	王攀峰, 章云童, 夏琰, 等. 两种内固定方法治疗髌骨下极粉碎性骨折的病例对照研究. 中国骨伤, 2021, 34(10): 920-924.
33.	Yang KH, Byun YS. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. J Bone Joint Surg (Br), 2003, 85(8): 1155-1160.
34.	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.
35.	Yan SG, Li D, Cui Y, et al. Management of comminuted inferior patellar pole fractures with cerclage-wire-augmented separate vertical wiring: a retrospective clinical study. Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-04034-4.
36.	He S, Huang X, Yan B, et al. Modified technique of separate vertical wiring for the fixation of patellar inferior pole fracture. J Orthop Trauma, 2018, 32(4): e145-e150.

1. Kastelec M, Veselko M. Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection. J Bone Joint Surg (Am), 2004, 86(4): 696-701.
2. Lazaro LE, Wellman DS, Pardee NC, et al. Effect of computerized tomography on classification and treatment plan for patellar fractures. J Orthop Trauma, 2013, 27(6): 336-344.
3. Matejčić A, Puljiz Z, Elabjer E, et al. Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy. Arch Orthop Trauma Surg, 2008, 128(4): 403-408.
4. Veselko M, Kastelec M. Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection. Surgical technique. J Bone Joint Surg (Am), 2005, 87 Suppl 1(Pt 1): 113-121.
5. 王显林, 冉学军, 邓长青, 等. 髌韧带减张与髌骨下极切除治疗髌骨下极粉碎性骨折疗效比较. 临床骨科杂志, 2010, 13(3): 295-297.
6. Marder RA, Swanson TV, Sharkey NA, et al. Effects of partial patellectomy and reattachment of the patellar tendon on patellofemoral contact areas and pressures. J Bone Joint Surg (Am), 1993, 75(1): 35-45.
7. McCurnin DM, Slusher R. Tension-band wiring of a fractured patella (a photographic essay). Vet Med Small Anim Clin, 1975, 70(11): 1321-1323.
8. Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma, 1997, 11(5): 351-356.
9. Chang SM, Ji XL. Open reduction and internal fixation of displaced patella inferior pole fractures with anterior tension band wiring through cannulated screws. J Orthop Trauma, 2011, 25(6): 366-370.
10. Smith ST, Cramer KE, Karges DE, et al. Early complications in the operative treatment of patella fractures. J Orthop Trauma, 1997, 11(3): 183-187.
11. Wurm S, Bühren V, Augat P. Treating patella fractures with a locking patella plate—first clinical results. Injury, 2018, 49 Suppl 1: S51-S55.
12. Ling M, Zhan S, Jiang D, et al. Where should Kirschner wires be placed when fixing patella fracture with modified tension-band wiring? A finite element analysis. J Orthop Surg Res, 2019, 14(1): 14. doi: 10.1186/s13018-019-1060-x.
13. Zhang ZS, Li PF, Zhou F, et al. Comparison of a novel tension band and patellotibial tubercle cerclage in the treatment of comminuted fractures of inferior pole of the patella. Orthop Surg, 2020, 12(1): 224-232.
14. Lu M, Zhan S, Zhang C, et al. “Fishing net” suture augmenting tension-band wiring fixation in the treatment of inferior pole fracture of the patella. Arch Orthop Trauma Surg, 2021, 141(11): 1953-1961.
15. 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.
16. Gao Z, Long N, Yao K, et al. A novel technique for the treatment of inferior pole fractures of the patella: A preliminary report. Orthop Surg, 2022, 14(11): 3092-3099.
17. Matejčić A, Smiljanić B, Bekavac-Beslin M, et al. The basket plate in the osteosynthesis of comminuted fractures of distal pole of the patella. Injury, 2006, 37(6): 525-530.
18. 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-S90.
19. Krkovic M, Bombac D, Balazic M, et al. Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament-a biomechanical analysis. Knee, 2007, 14(3): 188-193.
20. Du B, Ma T, Bai H, et al. Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture. Front Bioeng Biotechnol, 2022, 10: 1010508. doi: 10.3389/fbioe.2022.1010508.
21. Ma XY, Cui D, Liu B, et al. Treating inferior pole fracture of patella with hand plating system: First clinical results. Orthop Surg, 2022. https://doi.org/10.1111/os.13539.
22. Fan M, Wang D, Sun K, et al. Study of double button plate fixation in treatment of inferior pole of patella fracture. Injury, 2020, 51(3): 774-778.
23. He QF, Pan GB, Yu ZF, et al. Novel rim plating tchnique for treatment of the inferior pole fracture of the patella. Orthop Surg, 2021, 13(2): 651-658.
24. Jang JH, Cho YJ, Choi YY, et al. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res, 2021, 107(3): 102866. doi: 10.1016/j.otsr.2021.102866.
25. 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, 2021, 141(11): 1889-1897.
26. Zhu L, Wang H, Song L, et al. Clinical application of suture anchor combined with Kirschner wires fixation for patella inferior-pole fractures. Asian J Surg, 2022, 45(7): 1418-1419.
27. Yu H, Dong H, Ruan B, et al. Clinical effect of suture anchor and double-pulley technique in the treatment of inferior patellar fracture. Comput Math Methods Med, 2021, 2021: 4964195. doi: 10.1155/2021/4964195.
28. Xie J, Fu Y, Li J, et al. Anchor and Krackow-“8” suture for the fixation of distal pole fractures of the patella: Comparison to Kirschner wire. Orthop Surg, 2022, 14(2): 374-382.
29. Gaines RJ, Grabill SE, DeMaio M, et al. Patellar tendon repair with suture anchors using a combined suture technique of a Krackow-Bunnell weave. J Orthop Trauma, 2009, 23(1): 68-71.
30. Hao W, Zhou L, Sun Y, et al. Treatment of patella fracture by claw-like shape memory alloy. Arch Orthop Trauma Surg, 2015, 135(7): 943-951.
31. 史凤之, 孙国荣, 吴成如, 等. 聚髌器治疗髌骨下极撕脱性骨折对患者术后膝关节功能的改善效果. 解放军预防医学杂志, 2018, 36(6): 729-731, 735.
32. 王攀峰, 章云童, 夏琰, 等. 两种内固定方法治疗髌骨下极粉碎性骨折的病例对照研究. 中国骨伤, 2021, 34(10): 920-924.
33. Yang KH, Byun YS. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. J Bone Joint Surg (Br), 2003, 85(8): 1155-1160.
34. 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.
35. Yan SG, Li D, Cui Y, et al. Management of comminuted inferior patellar pole fractures with cerclage-wire-augmented separate vertical wiring: a retrospective clinical study. Arch Orthop Trauma Surg, 2021. doi: 10.1007/s00402-021-04034-4.
36. He S, Huang X, Yan B, et al. Modified technique of separate vertical wiring for the fixation of patellar inferior pole fracture. J Orthop Trauma, 2018, 32(4): e145-e150.

Chinese Journal of Reparative and Reconstructive Surgery

Progress in surgical treatment of inferior patellar pole fractures

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