A new fluoroscopic view to evaluate the medial and lateral articular reduction quality in patella fractures during internal fixation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Weibin ¹ , HAN Xinyou ¹ , FU Qingsong ¹ , YUAN Xinhua ¹ ,  CHANG Shimin ²

1. Department of Orthopaedic Trauma, Ningbo No.2 Hospital, Ningbo Zhejiang, 315010, P. R. China;
2. Department of Orthopaedics, Yangpu Hospital, Tongji University School of Medicine, Shanghai, 200090, P. R. China;

Corresponding author：

CHANG Shimin, Email: shiminchang11@aliyun.com

Keywords：

Patella fracture; intraoperative fluoroscopy; articular surface; fracture reduction

DOI：

10.7507/1002-1892.202403124

Video：

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Objective To introduce a new fluoroscopic method for assessing the quality of medial and lateral joint surface reduction during internal fixation of patellar fractures and to summarize the clinical outcomes of patients treated using this method. Methods A retrospective analysis was conducted on the clinical data of 52 patients with patellar fractures treated between January 2018 and January 2022 who met the inclusion criteria. There were 27 male and 25 female patients, aged 21-75 years, with an average age of 62 years. The types of patellar fractures included 9 transverse fractures, 37 comminuted fractures, and 6 longitudinal fractures. According to the AO/Orthopaedic Trauma Association (AO-OTA)-2018 fracture classification, there were 21 cases of type 34A, 6 cases of type 34B, and 25 cases of type 34C. The time from injury to operation ranged from 1 to 5 days, with an average of 2.3 days. Treatments included internal fixation with hollow screws or hollow screw tension bands, with or without anchor repair. During operation, the medial and lateral joint surfaces of the patella were observed using the tangential fluoroscopic method to assess the smoothness of reduction of the median ridge, lateral joint surface, medial joint surface, and lateral joint edge. Patients were followed up regularly, and X-ray films were taken to observe fracture healing. Knee joint range of motion, Böstman score, and Lysholm score were used to evaluate functional recovery. Results The tangential fluoroscopic method for the medial and lateral joint surfaces of the patella during operation showed satisfactory reduction of the joint surfaces and good positioning of the implants. All patients were followed up 12-16 months, with an average of 13.4 months. During the follow-up, fracture displacement occurred in 1 case and titanium cable breakage in 1 case. All patella fractures healed successfully, with a healing time of 8-16 weeks (mean, 11.4 weeks). At last follow-up, knee joint range of motion ranged from 120° to 140°, with an average of 136°. The Böstman score ranged from 20 to 30, with an average of 28, yielding excellent results in 45 cases and good results in 7 cases. The Lysholm score ranged from 88 to 100, with an average of 93, yielding excellent results in 40 cases and good results in 12 cases. Conclusion The intraoperative application of the tangential fluoroscopic method for the medial and lateral joint surfaces of the patella can quickly determine the fluoroscopic plane of the patella, accurately assess the quality of fracture reduction and the position of internal fixator, thereby improving effectiveness.

Citation： WANG Weibin, HAN Xinyou, FU Qingsong, YUAN Xinhua, CHANG Shimin. A new fluoroscopic view to evaluate the medial and lateral articular reduction quality in patella fractures during internal fixation. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(7): 836-841. doi: 10.7507/1002-1892.202403124 Copy

1.	Hargett DI, Sanderson BR, Little MTM. Patella fractures: Approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
2.	Turgut A, Günal I, Acar S, et al. Arthroscopic-assisted percutaneous stabilization of patellar fractures. Clin Orthop Relat Res, 2001, (389): 57-61.
3.	Tandogan RN, Demirors H, Tuncay CI, et al. Arthroscopic-assisted percutaneous screw fixation of select patellar fractures. Arthroscopy, 2002, 18(2): 156-162.
4.	Berg EE. Extensile exposure of comminuted patella fractures using a tibial tubercle osteotomy: results of a new technique. J Orthop Trauma, 1998, 12(5): 351-355.
5.	Berkes MB, Little MT, Pardee NC, et al. Defining the lateral and accessory views of the patella: an anatomic and radiographic study with implications for fracture treatment. J Orthop Trauma, 2013, 27(12): 663-671.
6.	Ibrahim I, Suneja N, Alam JS, et al. Efficacy of accessory facet views in the detection of occult patellar malreduction: A biomechanical analysis. J Long Term Eff Med Implants, 2022, 32(4): 7-12.
7.	Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma, 2018, 32 Suppl 1: S1-S170.
8.	Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
9.	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
10.	Henrichsen JL, Wilhem SK, Siljander MP, et al. Treatment of patella fractures. Orthopedics, 2018, 41(6): e747-e755.
11.	刘晨东, 胡孙君, 张世民. 髌骨下极骨折手术治疗进展. 中国修复重建外科杂志, 2023, 37(1): 115-119.
12.	Howatt J, Liew AS, Wilkin G. Patellar fractures: Anatomy, mechanics, and surgical management. J Bone Joint Surg (Am), 2021. doi: 10.2106/JBJS.20.01478.
13.	Liu CD, Hu SJ, Chang SM, et al. Tension-band wiring through a single cannulated screw combined with suture anchors to treat inferior pole fracture of the patella. Injury, 2023, 54(4): 1203-1209.
14.	Li SJ, Tiwari SR, Chang SM, et al. Separate vertical wiring plus bilateral anchor girdle suturing fixation for the fractures of the inferior pole of the patella. J Orthop Surg Res, 2023, 18(1): 176. doi: 10.1186/s13018-023-03649-0.
15.	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.
16.	郭浩, 张军, 汤俊君, 等. 空心螺钉缝线固定治疗髌骨横形骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(12): 1055-1062.
17.	谢雪涛, 朱奕, 占宇, 等. 锁定钢板多维内固定治疗髌骨粉碎性骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(7): 604-609.
18.	Gardner MJ, Griffith MH, Lawrence BD, et al. Complete exposure of the articular surface for fixation of patellar fractures. J Orthop Trauma, 2005, 19(2): 118-123.

1. Hargett DI, Sanderson BR, Little MTM. Patella fractures: Approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
2. Turgut A, Günal I, Acar S, et al. Arthroscopic-assisted percutaneous stabilization of patellar fractures. Clin Orthop Relat Res, 2001, (389): 57-61.
3. Tandogan RN, Demirors H, Tuncay CI, et al. Arthroscopic-assisted percutaneous screw fixation of select patellar fractures. Arthroscopy, 2002, 18(2): 156-162.
4. Berg EE. Extensile exposure of comminuted patella fractures using a tibial tubercle osteotomy: results of a new technique. J Orthop Trauma, 1998, 12(5): 351-355.
5. Berkes MB, Little MT, Pardee NC, et al. Defining the lateral and accessory views of the patella: an anatomic and radiographic study with implications for fracture treatment. J Orthop Trauma, 2013, 27(12): 663-671.
6. Ibrahim I, Suneja N, Alam JS, et al. Efficacy of accessory facet views in the detection of occult patellar malreduction: A biomechanical analysis. J Long Term Eff Med Implants, 2022, 32(4): 7-12.
7. Meinberg EG, Agel J, Roberts CS, et al. Fracture and dislocation classification compendium-2018. J Orthop Trauma, 2018, 32 Suppl 1: S1-S170.
8. Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
9. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
10. Henrichsen JL, Wilhem SK, Siljander MP, et al. Treatment of patella fractures. Orthopedics, 2018, 41(6): e747-e755.
11. 刘晨东, 胡孙君, 张世民. 髌骨下极骨折手术治疗进展. 中国修复重建外科杂志, 2023, 37(1): 115-119.
12. Howatt J, Liew AS, Wilkin G. Patellar fractures: Anatomy, mechanics, and surgical management. J Bone Joint Surg (Am), 2021. doi: 10.2106/JBJS.20.01478.
13. Liu CD, Hu SJ, Chang SM, et al. Tension-band wiring through a single cannulated screw combined with suture anchors to treat inferior pole fracture of the patella. Injury, 2023, 54(4): 1203-1209.
14. Li SJ, Tiwari SR, Chang SM, et al. Separate vertical wiring plus bilateral anchor girdle suturing fixation for the fractures of the inferior pole of the patella. J Orthop Surg Res, 2023, 18(1): 176. doi: 10.1186/s13018-023-03649-0.
15. 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.
16. 郭浩, 张军, 汤俊君, 等. 空心螺钉缝线固定治疗髌骨横形骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(12): 1055-1062.
17. 谢雪涛, 朱奕, 占宇, 等. 锁定钢板多维内固定治疗髌骨粉碎性骨折的疗效分析. 中华创伤骨科杂志, 2022, 24(7): 604-609.
18. Gardner MJ, Griffith MH, Lawrence BD, et al. Complete exposure of the articular surface for fixation of patellar fractures. J Orthop Trauma, 2005, 19(2): 118-123.

Chinese Journal of Reparative and Reconstructive Surgery

A new fluoroscopic view to evaluate the medial and lateral articular reduction quality in patella fractures during internal fixation

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