Abstract
Objective: We aimed to share our radiological and clinical results with a mid-term follow-up on patella fractures treated with tension band wiring (TBW).
Methods: Patients surgically treated with TBW for AO type 34-A1/C1/C2/C3 patella fractures between January 2013 and June 2021 at a level 1 trauma center were included. For radiological evaluation, radiographs obtained at the routine follow-up were analyzed for complications (such as nonunion, malunion, loss of reduction, malreduction, patella baja, elongated patella, implant failure), Insall-Salvati Index (ISI), and Patellar Morphology Ratio (PMR). The Knee Injury and Osteoarthritis Score (KOOS) was utilized for functional evaluation, which includes five subscales: pain, symptoms, activities of daily living (ADL), sports/recreation, and quality of life (QOL). The clinical assessment also included the range of motion (ROM), thigh circumference (TC), and complications such as implant irritation (II).
Results: This study reviewed 42 eligible patients (10 females, 32 males) with a mean age of 42.6 ± 16.1 years and a mean follow-up of 35.4 ± 24.1 months. There were 28 patients (66.7%) with at least one complication (II: 66.7%, flexion deficit: 61.9%, malunion: 40.5%, elongated patella/patella baja: 16.7%). The reoperation rate was high at 69.1% due to the high implant removal rate for II. There were statistically significant differences between injured (I) and uninjured contralateral healthy knees (UI) in terms of mean KOOS subscale scores (symptoms: I: 72.3, UI: 89.8; pain: I: 70.4, UI: 89.4; ADL : I: 72.1, UI: 90; sports: I: 61.4, UI: 84.8; QOL: I: 67.9, UI: 86.2), mean flexion degrees (I: 126.2°, UI: 135.4°), mean ISI (I: 0.9, UI: 1.0), and mean PMR (I: 1.5, UI: 1.4) (all p < 0.01). There was no difference in mean extension degrees and TC (all p > 0.05). All fractures achieved union.
Conclusion: Firstly, the mid-term clinical results of patellar fractures treated with TBW were significantly worse than the contralateral healthy knee; secondly, implant irritation, knee flexion deficit, malunion, and patella baja were the significant complications, and efforts should be made to manage these problems; thirdly, patellar fractures are susceptible to developing interesting cases of the elongated patella.
Keywords
Patella fracture Tension band wiring Radiological and clinical results Complications Implant irritation Flexion deficit Malunion Patella baja Elongated patella Malreduction Implant fail.
References
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- 2. Neumann M, Niemeyer P, Südkamp N, Strohm P. Patellar fractures--a review of classification, genesis and evaluation of treatment. [Internet]. Acta Chir. Orthop. Traumatol. Cech. 2014;81(5):303–312.
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- 7. Zhang Y, Xu Z, Zhong W, Liu F, Tang J. Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: A meta-analysis. J. Orthop. Surg. Res. 2018;13(1). doi:10.1186/s13018-018-0919-6
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- 14. Noyes F, Wojtys E, Marshall M. The early diagnosis and treatment of developmental patella infera syndrome. [Internet]. Clin. Orthop. Relat. Res. 1991;265(1):241–252.
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- 16. Nurdan PAKER, Derya BUĞDAYCI,Feride SABIRLI, Sevda ÖZEL SE. Knee Injury and Osteoarthritis Outcome Score: reliability and validation of the Turkish version [Internet]. Turkiye Klin. J Med Sci [published online ahead of print: 2007];http://www.koos.nu/KOOS Turkish.pdf. cited March 19, 2019
- 17. Shymon SJ et al. Functional Outcomes of Patella Fractures Treated With Anterior Plate Osteosynthesis at One Year. J. Orthop. Trauma 2021;35(1). doi:10.1097/BOT.0000000000001868
- 18. Lorich DG et al. Superior Outcomes After Operative Fixation of Patella Fractures Using a Novel Plating Technique: A Prospective Cohort Study [Internet]. J. Orthop. Trauma 2017;31(5):241–247.
- 19. Chiang CC et al. Comparison of a minimally invasive technique with open tension band wiring for displaced transverse patellar fractures. J. Chinese Med. Assoc. 2011;74(7):316–321.
- 20. Mao N, Liu D, Ni H, Tang H, Zhang Q. Comparison of the cable pin system with conventional open surgery for transverse patella fractures knee. Clin. Orthop. Relat. Res. 2013;471(7):2361–2366.
- 21. Sebastian P et al. Influence of patella height after patella fracture on clinical outcome: a 13-year period [Internet]. Arch. Orthop. Trauma Surg. [published online ahead of print: 2021]; doi:10.1007/S00402-021-03871-7
- 22. Shea GK-H et al. Comparing 3 Different Techniques of Patella Fracture Fixation and Their Complications [Internet]. Geriatr. Orthop. Surg. Rehabil. 2019;10:215145931982714.
Abstract
References
- 1. Schuett DJ et al. Current treatment strategies for patella fractures. Orthopedics 2015;38(6):377–384.
- 2. Neumann M, Niemeyer P, Südkamp N, Strohm P. Patellar fractures--a review of classification, genesis and evaluation of treatment. [Internet]. Acta Chir. Orthop. Traumatol. Cech. 2014;81(5):303–312.
- 3. Bostrom A. Fracture of the patella. A study of 422 patellar fractures [Internet]. Acta Orthop. Scand. Suppl. 1972;143(sup143):1–80.
- 4. Larsen P, Court-Brown CM, Vedel JO, Vistrup S, Elsoe R. Incidence and epidemiology of patellar fractures. Orthopedics 2016;39(6):e1154–e1158.
- 5. Vedel JO, Vistrup S, Larsen P, Elsoe R. Altered long-term health-related quality of life in patients following patella fractures: a long-term follow-up study of 49 patients [Internet]. Eur. J. Trauma Emerg. Surg. 2018;44(5):707–716.
- 6. Hargett DI, Sanderson BR, Little MTM. Patella Fractures: Approach to Treatment. J. Am. Acad. Orthop. Surg. 2021;29(6):244–253.
- 7. Zhang Y, Xu Z, Zhong W, Liu F, Tang J. Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: A meta-analysis. J. Orthop. Surg. Res. 2018;13(1). doi:10.1186/s13018-018-0919-6
- 8. Müller M, Perren S, Allgöwer M, Müller M. Manual of internal fixation: techniques recommended by the AO-ASIF group [Internet]. Berlin: Springer; 1991:
- 9. Eggink KM, Jaarsma RL. Mid-term (2-8 years) follow-up of open reduction and internal fixation of patella fractures: Does the surgical technique influence the outcome?. Arch. Orthop. Trauma Surg. 2011;131(3):399–404.
- 10. Lebrun CT, Langford JR, Sagi HC. Functional outcomes after operatively treated patella fractures [Internet]. J. Orthop. Trauma 2012;26(7):422–426.
- 11. Lin T, Liu J, Xiao B, Fu D, Yang S. Comparison of the outcomes of cannulated screws vs. modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures. BMC Musculoskelet. Disord. 2015;16(1). doi:10.1186/s12891-015-0719-7
- 12. Chiang CC et al. Arthroscopically assisted percutaneous osteosynthesis of displaced transverse patellar fractures with figure-eight wiring through paired cannulated screws [Internet]. Arch. Orthop. Trauma Surg. 2011;131(7):949–954.
- 13. Visuri T, Pihlajamäki HK, Mattila VM, Kiuru M. Elongated patellae at the final stage of Osgood-Schlatter disease: A radiographic study. Knee 2007;14(3):198–203.
- 14. Noyes F, Wojtys E, Marshall M. The early diagnosis and treatment of developmental patella infera syndrome. [Internet]. Clin. Orthop. Relat. Res. 1991;265(1):241–252.
- 15. Grelsamer RP, Proctor CS, Bazos AN. Evaluation of patellar shape in the sagittal plane. A clinical analysis [Internet]. Am. J. Sports Med. 1994;22(1):61–66.
- 16. Nurdan PAKER, Derya BUĞDAYCI,Feride SABIRLI, Sevda ÖZEL SE. Knee Injury and Osteoarthritis Outcome Score: reliability and validation of the Turkish version [Internet]. Turkiye Klin. J Med Sci [published online ahead of print: 2007];http://www.koos.nu/KOOS Turkish.pdf. cited March 19, 2019
- 17. Shymon SJ et al. Functional Outcomes of Patella Fractures Treated With Anterior Plate Osteosynthesis at One Year. J. Orthop. Trauma 2021;35(1). doi:10.1097/BOT.0000000000001868
- 18. Lorich DG et al. Superior Outcomes After Operative Fixation of Patella Fractures Using a Novel Plating Technique: A Prospective Cohort Study [Internet]. J. Orthop. Trauma 2017;31(5):241–247.
- 19. Chiang CC et al. Comparison of a minimally invasive technique with open tension band wiring for displaced transverse patellar fractures. J. Chinese Med. Assoc. 2011;74(7):316–321.
- 20. Mao N, Liu D, Ni H, Tang H, Zhang Q. Comparison of the cable pin system with conventional open surgery for transverse patella fractures knee. Clin. Orthop. Relat. Res. 2013;471(7):2361–2366.
- 21. Sebastian P et al. Influence of patella height after patella fracture on clinical outcome: a 13-year period [Internet]. Arch. Orthop. Trauma Surg. [published online ahead of print: 2021]; doi:10.1007/S00402-021-03871-7
- 22. Shea GK-H et al. Comparing 3 Different Techniques of Patella Fracture Fixation and Their Complications [Internet]. Geriatr. Orthop. Surg. Rehabil. 2019;10:215145931982714.
Details
| Primary Language | English |
|---|---|
| Subjects | Orthopaedics |
| Journal Section | Research Article |
| Authors | |
| Publication Date | October 1, 2022 |
| Submission Date | June 16, 2022 |
| Published in Issue | Year 2022Volume: 13 Issue: 4 |
