Biomechanics test of fixation of star-shaped six-part patellar fractures with petal-shaped poly-axial locking plate_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MENG Depeng , OUYANG Yueping , CHEN Huihao , ZHOU Jun , XIE Zheng , LIN Yaofa , LIN Haodong ,  HOU Chunlin

Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, 200003, P.R.China;

Corresponding author：

HOU Chunlin, Email: chunlin_hou@163.com

Keywords：

Comminuted patellar fracture; poly-axial locking plate; biomechanics

DOI：

10.7507/1002-1892.201708041

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ObjectiveTo compare the biomechanical difference between petal-shaped poly-axial locking plate and tension band wire cerclage in fixing star-shaped 6-part patellar fractures in cadaver model, and provide the experimental data for clinical use.MethodsThe paired 12 knee specimens from 6 human cadavers were randomly divided into 2 groups (the control group and the test group) after a star-shaped 6-part patellar fracture model was established. The specimens were weighted, and the control group was fixed with tension band wire cerclage and the test group was fixed with petal-shaped poly-axial locking plate. The specimens were connected to CMT5105 biomechanics test machine by a customized fixture, the total fracture gap of patellar fracture blocks was measured before testing. The knee extensor load test was performed to record the extensor load of knees at 90° flexion to extension. Then the anti gravity physiological knee extension process at 90° flexion was stimulated according to the knee extensor load. The cyclic times until failure and the total fracture gap of patellar fracture blocks after failure were recorded.ResultsThe specimens weight and the total fracture gap of patellar fracture blocks before testing between 2 groups had no significant difference (t=0.410, P=0.690; t=0.650, P=0.530). In the biomechanical test, there was no significant difference of knee extension load between 2 groups (t=0.490, P=0.638). The total fracture gap after failure in test group was significantly smaller than that in control group (t=3.026, P=0.013), and the cyclic times until failure in test group was significantly more than that in control group (t=2.277, P=0.046). The failure reasons in control group were all the wires slipped off the Kirschner wires, while the failure reasons in test group were the screws pulled out from the upper pole in 5 cases (83.3%) and from the lower pole in 1 case (16.7%).ConclusionThe petal-shaped poly-axial locking plate has better biomechanical stiffness to fix the star-shaped 6-part patellar fractures when compared with tension band wire cerclage method. However, this type of fracture is a serious comminuted type, and the early excessive activity still carries the risk of displacement.

Citation： MENG Depeng, OUYANG Yueping, CHEN Huihao, ZHOU Jun, XIE Zheng, LIN Yaofa, LIN Haodong, HOU Chunlin. Biomechanics test of fixation of star-shaped six-part patellar fractures with petal-shaped poly-axial locking plate. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(3): 311-315. doi: 10.7507/1002-1892.201708041 Copy

1.	Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
2.	Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect, 1994, 43: 97-108.
3.	Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl, 1972, 143: 1-80.
4.	郝建桥, 申云龙, 王合围. 克氏针" 8”字张力带钢丝结合环形钢丝内固定治疗髌骨粉碎性骨折. 中国骨与关节损伤杂志, 2015, (S1): 93-94.
5.	汤晓正, 胡建民, 余坤民, 等. 五角网缝合术治疗髌骨骨折. 中国骨伤, 2007, 20(11): 741-743.
6.	Zhao QM, Yang HL, Wang L, et al. Treatment of comminuted patellar fracture with the nitinol patellar concentrator. Minim Invasive Ther Allied Technol, 2016, 25(3): 171-175.
7.	明立功, 明新文, 明立德, 等. 自体腱膜条网状张力带治疗髌骨粉碎性骨折. 中国修复重建外科杂志, 2010, 24(4): 498-499.
8.	蒙德鹏, 欧阳跃平, 侯春林. 花瓣状多轴锁定板固定髌骨 Y 形骨折的有限元分析. 中国修复重建外科杂志, 2017, 31(12): 1456-1461.
9.	Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma, 1997, 11(5): 351-356.
10.	Scilaris TA, Grantham JL, Prayson MJ, et al. Biomechanical comparison of fixation methods in transverse patella fractures. J Orthop Trauma, 1998, 12(5): 356-359.
11.	王亦璁. 髌骨骨折治疗方法的选择和评价. 骨与关节损伤杂志, 1995, 10(4): 208-209.
12.	Matejcic 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.
13.	Yang L, Yueping O, Wen Y. Management of displaced comminuted patellar fracture with titanium cable cerclage. Knee, 2010, 17(4): 283-286.
14.	管志海, 王勤业, 王以进, 等. 髌骨骨折内固定板的生物力学性能. 中国组织工程研究, 2014, 18(4): 559-564.
15.	Thelen S, Betsch M, Schneppendahl J, et al. Fixation of multifragmentary patella fractures using a bilateral fixed-angle plate. Orthopedics, 2013, 36(11): e1437-1443.
16.	张忠新, 王国选, 郑鹏, 等. 空心螺钉治疗髌骨骨折分析. 临床医学, 2009, 29(6): 71-72.
17.	Grelsamer RP, Weinstein CH. Applied biomechanics of the patella. Clin Orthop Relat Res, 2001, (389): 9-14.
18.	Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg (Am), 1984, 66(5): 715-724.

1. Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
2. Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect, 1994, 43: 97-108.
3. Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl, 1972, 143: 1-80.
4. 郝建桥, 申云龙, 王合围. 克氏针" 8”字张力带钢丝结合环形钢丝内固定治疗髌骨粉碎性骨折. 中国骨与关节损伤杂志, 2015, (S1): 93-94.
5. 汤晓正, 胡建民, 余坤民, 等. 五角网缝合术治疗髌骨骨折. 中国骨伤, 2007, 20(11): 741-743.
6. Zhao QM, Yang HL, Wang L, et al. Treatment of comminuted patellar fracture with the nitinol patellar concentrator. Minim Invasive Ther Allied Technol, 2016, 25(3): 171-175.
7. 明立功, 明新文, 明立德, 等. 自体腱膜条网状张力带治疗髌骨粉碎性骨折. 中国修复重建外科杂志, 2010, 24(4): 498-499.
8. 蒙德鹏, 欧阳跃平, 侯春林. 花瓣状多轴锁定板固定髌骨 Y 形骨折的有限元分析. 中国修复重建外科杂志, 2017, 31(12): 1456-1461.
9. Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma, 1997, 11(5): 351-356.
10. Scilaris TA, Grantham JL, Prayson MJ, et al. Biomechanical comparison of fixation methods in transverse patella fractures. J Orthop Trauma, 1998, 12(5): 356-359.
11. 王亦璁. 髌骨骨折治疗方法的选择和评价. 骨与关节损伤杂志, 1995, 10(4): 208-209.
12. Matejcic 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.
13. Yang L, Yueping O, Wen Y. Management of displaced comminuted patellar fracture with titanium cable cerclage. Knee, 2010, 17(4): 283-286.
14. 管志海, 王勤业, 王以进, 等. 髌骨骨折内固定板的生物力学性能. 中国组织工程研究, 2014, 18(4): 559-564.
15. Thelen S, Betsch M, Schneppendahl J, et al. Fixation of multifragmentary patella fractures using a bilateral fixed-angle plate. Orthopedics, 2013, 36(11): e1437-1443.
16. 张忠新, 王国选, 郑鹏, 等. 空心螺钉治疗髌骨骨折分析. 临床医学, 2009, 29(6): 71-72.
17. Grelsamer RP, Weinstein CH. Applied biomechanics of the patella. Clin Orthop Relat Res, 2001, (389): 9-14.
18. Huberti HH, Hayes WC. Patellofemoral contact pressures. The influence of q-angle and tendofemoral contact. J Bone Joint Surg (Am), 1984, 66(5): 715-724.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanics test of fixation of star-shaped six-part patellar fractures with petal-shaped poly-axial locking plate

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