Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Peizhao ^1,2 , HAN Xu ² , WANG Xiao ² , YU Jinyang ² , YUAN Yanhao ² ,  TAN Honglue ²

1. Henan University of Chinese Traditional Medicine, Zhengzhou Henan, 450046, P.R.China;
2. The 3rd Department of Knee Injury, Henan Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China;

Corresponding author：

TAN Honglue, Email: hnlc.love@163.com

Keywords：

Inferior patella fracture; non-absorbable suture; patella claw; internal fixation

DOI：

10.7507/1002-1892.202003178

Video：

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Objective To investigate the effectiveness of non-absorbable suture cerclage combined with patella claw fixation for the treatment of inferior patella fractures.Methods Between September 2016 and January 2019, 22 patients with inferior patella fractures were treated. There were 12 males and 10 females, with a mean age of 49.1 years (range, 32-67 years). The causes of injury were traffic accident in 8 cases, falling in 12 cases, and other causes in 2 cases. The interval from injury to operation was 3-7 days (mean, 4.4 days). For the operation, 3 or 4 longitudinal tunnels were drilled backward from the surface of the proximal fracture fragment with Kirschner wires; under the guidance of lumbar puncture needles and steel wires, non-absorbable suture passed through the tunnels and encircled the inferior fracture fragment, then tighten to achieve a satisfactory reduction of the fracture; finally, the patella claw was used to strengthen the fixation. During the follow-up, complications were observed, maximum motion range of the knee joint was measured, X-ray examination was performed and fracture healing time was recorded. The knee function was evaluated according to Böstman scores.Results All the 22 patients were followed up 12-36 months (mean, 19.4 months). No infection, joint stiffness, bone nonunion, loss of reduction, or displacement of internal fixation occurred. All fractures were clinically healed, and the bone healing time was 2-3 months (mean, 2.6 months). At last follow-up, the maxium motion range of knee joint was 130°-135°, with an average of 132.6°. The Böstman score of the affected knee was 28-30 (mean, 29.2). All cases were graded as excellent results.Conclusion Non-absorbable suture cerclage combined with patella claw fixation for inferior patella fractures has the advantages of simple operation, reliable fixation, and few complications, and the clinical results are satisfactory.

Citation： WANG Peizhao, HAN Xu, WANG Xiao, YU Jinyang, YUAN Yanhao, TAN Honglue. Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1243-1247. doi: 10.7507/1002-1892.202003178 Copy

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2.	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.
3.	Gwinner C, Märdian S, Schwabe P, et al. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW, 2016, 5: Doc01. doi: 10.3205/iprs000080. eCollection 2016.
4.	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.
5.	Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
6.	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.
7.	张建, 杨小勇. 经髌骨胫骨结节环形钛缆治疗髌骨下极骨折的效果分析. 中华骨与关节外科杂志, 2018, 11(2): 115-117, 123.
8.	潘明芒, 薛锋, 唐果, 等. 不同类型髌骨下极骨折的手术治疗. 中国矫形外科杂志, 2016, 24(8): 745-747.
9.	张志新, 周君东, 程明加, 等. 髌骨爪与张力带治疗老年髌骨下极骨折疗效分析. 中国骨与关节损伤杂志, 2016, 31(6): 92-93.
10.	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.
11.	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.
12.	蒙德鹏, 欧阳跃平, 陈汇浩, 等. 花瓣状多轴锁定内固定板固定星形六部分髌骨骨折的力学研究. 中国修复重建外科杂志, 2018, 32(3): 311-315.
13.	高翔, 刘辉, 郑吉湘, 等. 钢丝垂直间断缝合结合带线锚钉固定治疗髌骨下极粉碎性骨折. 中华创伤骨科杂志, 2017, 19(2): 169-172.
14.	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.
15.	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.
16.	时欣, 赵建宏, 严建军, 等. 聚酯编织线结合带锁扣线缆治疗严重髌骨粉碎性骨折. 中国组织工程研究, 2014, (3): 482-487.
17.	王健, 唐晓波, 董佩龙, 等. 高强度缝线内固定治疗髌骨横形骨折的疗效观察. 中国修复重建外科杂志, 2018, 32(6): 694-697.
18.	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.
19.	张钦, 田玉景, 丁涛, 等. 钢丝垂直间断缝合结合钛缆环扎固定治疗髌骨下极骨折. 实用骨科杂志, 2019, 25(11): 1042-1044.

1. 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.
2. 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.
3. Gwinner C, Märdian S, Schwabe P, et al. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW, 2016, 5: Doc01. doi: 10.3205/iprs000080. eCollection 2016.
4. 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.
5. Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
6. 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.
7. 张建, 杨小勇. 经髌骨胫骨结节环形钛缆治疗髌骨下极骨折的效果分析. 中华骨与关节外科杂志, 2018, 11(2): 115-117, 123.
8. 潘明芒, 薛锋, 唐果, 等. 不同类型髌骨下极骨折的手术治疗. 中国矫形外科杂志, 2016, 24(8): 745-747.
9. 张志新, 周君东, 程明加, 等. 髌骨爪与张力带治疗老年髌骨下极骨折疗效分析. 中国骨与关节损伤杂志, 2016, 31(6): 92-93.
10. 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.
11. 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.
12. 蒙德鹏, 欧阳跃平, 陈汇浩, 等. 花瓣状多轴锁定内固定板固定星形六部分髌骨骨折的力学研究. 中国修复重建外科杂志, 2018, 32(3): 311-315.
13. 高翔, 刘辉, 郑吉湘, 等. 钢丝垂直间断缝合结合带线锚钉固定治疗髌骨下极粉碎性骨折. 中华创伤骨科杂志, 2017, 19(2): 169-172.
14. 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.
15. 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.
16. 时欣, 赵建宏, 严建军, 等. 聚酯编织线结合带锁扣线缆治疗严重髌骨粉碎性骨折. 中国组织工程研究, 2014, (3): 482-487.
17. 王健, 唐晓波, 董佩龙, 等. 高强度缝线内固定治疗髌骨横形骨折的疗效观察. 中国修复重建外科杂志, 2018, 32(6): 694-697.
18. 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.
19. 张钦, 田玉景, 丁涛, 等. 钢丝垂直间断缝合结合钛缆环扎固定治疗髌骨下极骨折. 实用骨科杂志, 2019, 25(11): 1042-1044.

Chinese Journal of Reparative and Reconstructive Surgery

Clincal observation of non-absorbable suture cerclage combined with patella claw fixation for treatment of inferior patella fractures

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