Outcome Analysis of Fixed Angle Locking Plate in Patella Fractures: A Single Centre Experience from North India

BackgroundTension band wiring supposedly is the most commonly used technique for displaced patella fractures, but is not effective in comminuted fractures and osteoporotic bones. It often leads to loosening of wires, dislocation of fracture, hardware problem and failure of osteosynthesis, resulting in knee stiffness and post-traumatic osteoarthritis. The aim of the study is to evaluate clinical outcome in patients with acute patella fractures (< 3 week) treated with unidirectional angle fixed low-profile titanium patella locking plate.Materials and methodsTwenty patients who presented with displaced patella fractures, aged between 18–70 years were included in the study. All fractures were reduced and fixed with unidirectional angle fixed stable low-profile titanium patella locking plate. Knee Range of motion and Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL) was used to evaluate the outcome.ResultsWe were able to achieve union in 19 out of 20 patients. One patient with comminuted patella fracture had failure of fixation, which was revised. Mean flexion at final follow-up was 124° (110°–130°) and none of the patients had extensor lag. The final radiograph revealed complete union in all patients.ConclusionThis technique offers an option of fixation in comminuted patella fracture and in osteoporotic individuals. It provides mechanical stability for fracture fixation resulting in anatomical reduction, good functional outcome, lower incidence of symptomatic implant or failure of osteosynthesis.     

Pyrford钢丝环扎张力带内固定治疗髌骨骨折的生物力学分析及临床研究

[目的] 测试Pvrford钢丝环扎加张力带内固定治疗髌骨骨折的生物力学特性，为临床治疗提供理论依据。[方法] 采集新鲜牛尸体膝关节标本，制成髌骨骨折模型，用Pyrford钢丝环扎加张力带固定，并与克氏针张力带、单纯钢丝环扎进行对照比较。[结果]Pyrford钢丝环扎加张力带内固定其强度和刚度相当于传统的8字形克氏针张力带，而且髌骨的应变、位移很小。临床应用Pyrford钢丝环扎加张力带内固定治疗髌骨骨折105例，随访6～23个月，优良率达98％。[结论]Pyrford钢丝环扎加张力带固定完全符合髌骨的生物力学性能，且能达到解剖复位，操作简便，固定牢固，适应早期功能锻炼的目的。     

Complete exposure of the articular surface for fixation of patellar fractures

Anterior tension band fixation constructs are among the mainstay of treatment of patella fractures and lead to reliable results with simple transverse fracture patterns. However, comminuted fractures of the patella require much more extensive articular reconstruction than interdigitating two large fragments to achieve a good result. In this report, we describe a technique for exposure, reduction, and stabilization of patella fractures that allows for direct visual reduction of the articular surface. Subsequent devices are applied directly to the bony surfaces of the patella without soft-tissue interposition, which distinguishes it from traditional approaches. This technique may be used to ensure articular surface congruity in simple transverse fractures and may be particularly useful in comminuted fractures when patellar excision would otherwise be considered.     

镍钛形状记忆合金蟹爪式聚髌器的研制及生物力学研究

目的　研究一种治疗髌骨骨折的新的内固定方法。　方法　根据国人髌骨的统计数据 ,采用镍钛形状记忆合金制做蟹爪式聚髌器 ,并进行生物力学研究。　结果　对髌骨横行骨折 ,蟹爪式聚髌器的固定作用明显优于改良张力带钢丝固定 (P <0 .0 0 1) ;对髌骨粉碎性骨折 ,聚髌器的固定作用亦明显优于环形钢丝固定 (P <0 .0 0 1)。　结论　蟹爪式聚髌器设计符合髌骨的解剖和生物力学特点 ,其对髌骨骨折的固定强度可满足临床应用之需要。     

Olekranonfrakturen

Olecranon fractures represent a common elbow injury and they are usually treated operatively. Depending on fracture morphology conservative therapy can be considered in geriatric patients. When surgical treatment is performed the anatomical features of the proximal ulna have to be taken into consideration. Tension band wiring is considered a standard procedure for simple fractures and provides good clinical results. Plate osteosynthesis is indicated for more complex fracture patterns. Nowadays, many surgeons prefer plate fixation over tension band wiring even for simple fractures as it leads to a more stable fixation. Both methods frequently require hardware removal for persisting soft tissue irritation. The use of modern low-profile plates could reduce the need for implant removal due to better soft tissue coverage. The available clinical data regarding low-profile plates are promising but limited.     

Frakturen der Kniescheibe

Fractures of the patella account for 0.5–1.5% of all skeletal fractures. Common mechanisms of injury are a direct fall onto the knee and dashboard injuries. Standard antero-posterior, lateral and tangential plain radiographic views confirm the diagnosis. Patellar fractures are most commonly classified according to the pattern of fracture into transverse, vertical, and comminuted fractures. The goals of operative treatment are accurate reduction, rigid fixation and the possibility of early motion of the knee. Nonoperative treatment is only justified when there is no displacement of the fragments. Tension band wiring is currently the standard operative method, although some experimental data do not support the theoretical principles behind this technique. Other operative options are screw fixation, Kirschner wires or combinations of these methods. In one-third of cases good results are achieved, while in 5–36% poor results must be expected. The most common postoperative problems are painful retropatellar arthrosis nonunion and a limited range of motion. Patellectomy is an option that yields acceptable long-term results in the treatment of comminuted fractures.     

钢丝环形加“8”字内固定治疗髌骨骨折

为对髌骨骨折钢丝环形加“８”字内固定进行生物力学评价，本实验采用截肢获得的６个髌骨标本进行研究。保留股四头肌腱和髌韧带。于髌骨纵向中点横形锯开，造成横形骨折。髌骨骨折四种内固定方法即：钢丝环形加“８”字、钢丝“８”字、钢丝环形和克氏针加钢丝“８”字内固定。使固定的髌骨韧带标本屈曲９０°，应用电测法对固定性能进行测试。载荷—应变评价结果表明，钢丝环形加“８”字固定效果最好。因此，从１９８８年３月～１９９１年７月应用此法治疗１２７例髌骨骨折，获得随访９６例，优、良结果占９５．８％。     

The basket plate in the osteosynthesis of comminuted fractures of distal pole of the patella

The purpose of this study was to evaluate the basket plate in the treatment of comminuted fractures of the distal pole of the patella (patellar apex fracture). The basket plate was designed by Smiljani? Branimir M.D., Clinical Professor of Surgery, at the Department of Surgery, The University Hospital Sestre milosrdnice, Zagreb, Croatia. In the period from 1988 to 2003, more than 100 patients with comminuted patellar apex fractures had been treated with basket plate osteosynthesis in the Department of Surgery. Only 51 patients were subsequently available for knee examination. For evaluation of the knee, we used a modified Cincinnati knee rating system, using a manual dynamometer in the evaluation of the knee extension. The results were excellent in 30 patients, good in 16 and satisfactory in 5 patients; no poor results were observed. The stability of the osteosynthesis by basket plate allows osseous consolidation if the fracture and permits loading the leg with full body weight early in the postoperative period.     

Comparative study of knee function after patellectomy and osteosynthesis with a tension band wire following patellar fractures

In order to assess the relative merits of patellectomy and osteosynthesis with tension band wires in patellar fractures, 66 patients given patellectomy and 30 given tension band wiring for almost identical fractures of the patella have been analysed. Following patellectomy only about half the patients achieved excellent results while after osteosynthesis excellent results were in 80%. We, therefore, recommend that whenever possible patellar fractures should be treated by accurate reduction and tension band wiring. When needed patellectomy should be performed without hesitation as the operation produces a negligible number of poor results, although excellent results will be achieved in only about half the cases.     

Lateral malleolus hook plate for comminuted Weber A and B fractures: A retrospective study

Background:

The goal of managing the comminuted fracture of lateral malleolus is to restore length, rotation and alignment which might be more challenging with extensive comminution around the area of the distal tip. The common osteosynthesis techniques such as the one-third tubular plate, tension band wiring, K-wires, screws, or intramedullary nail may be insufficient in cases with a comminuted lateral malleolus. The anatomical hook plate is an alternative implant in such cases. We present our results of the comminuted lateral malleolar fractures (Weber A, B), managed by open reduction and internal fixation (ORIF) with an anatomical hook plate of lateral malleolus (Königsee Implant Company, Germany).

Materials and Methods:

We retrospectively reviewed 20 patients of comminuted fracture of distal lateral malleolus between 2008 and 2010. There were 12 males and 8 females, right side was involved in 18 patients and left in 2. The mean age was 51.9 years (range 18-75 years). The fractures were categorized by Denis-Weber classification type A (n=1), B1 (n=1), B2 (n=13) and B3 (n=5). Nineteen cases were of closed injury and one of open injury (Gustilo Anderson type II). These patients underwent ORIF with a lateral malleolus anatomical hook plate. Followup including radiographs and clinical examinations were performed. The American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot scores were documented at followups.

Results:

The mean followup was 21.4 months (range 16-27 months). The average AOFAS score was 94.3 (range 78-100) points. A stable anatomic reduction and bony union were obtained in all the cases. The average time was 3.1 months (range 2.5-4 months). Four cases had complications like posttraumatic osteoarthritis, hardware impingement and superficial wound infection.

Conclusion:

A reasonably good stability can be obtained in distal most comminuted fractures of lateral malleolus with a lateral malleolus anatomical hook plate. We believe this method to be a reasonable treatment option for a distal lateral comminuted malleolar fracture when other common fixations are insufficient to fix the fragments.     

髌骨牵引配合手术治疗陈旧性髌骨骨折合并股四头肌挛缩

目的:探讨髌骨牵引配合手术治疗陈旧性髌骨骨折合并股四头肌挛缩的疗效。方法:陈旧性髌骨骨折合并股四头肌挛缩患者13例,男9例,女4例;年龄20~46岁,平均37岁。受伤至手术时间6周~8个月,平均4个月。骨折分类:横形骨折8例,粉碎性骨折4例,髌骨下极骨折1例。骨折分离移位情况:<2cm者4例,2~3cm者7例,>3cm者2例。被动屈膝10°~20°者5例,21°~50°者7例,>50°者1例。用克氏针在骨折块的上1/3处行骨牵引,牵引过程中可同时配合CPM锻炼膝关节。1~2周后拍片证实两断端靠近后再行切开复位内固定术。结果:13例均获得随访,随访时间8~36个月。根据王亦璁改良膝关节功能评分法,本组优8例,良4例,可1例。骨折均获得I期愈合,髌骨的解剖结构恢复,功能恢复良好。结论:陈旧性髌骨骨折合并股四头肌挛缩骨折端分离,I期手术复位困难,而先行髌骨牵引后再行切开复位张力带固定,不但解决了股四头肌挛缩,有利于骨折的复位固定,而且保留了髌骨结构,保证了伸膝装置的完整性。     

Cable-pin索绑系统治疗粉碎性髌骨骨折疗效分析

[目的]探讨应用Cable-pin索绑系统内固定治疗粉碎性髌骨骨折的临床疗效.[方法]自2008年3月～2010年7月在本科治疗的闭合性粉碎性髌骨骨折45例,随机分成Cable-pin索绑系统内固定组(A组),AO张力带内固定组(B组)和镍钛聚髌器内固定组(C组),每组15例.随访11～24个月,平均12.5个月.观察指标包括切口长度、手术时间、术中出血量、手术后并发症及术后膝关节功能HSS评分,并进行统计学分析.[结果]三种方法治疗组切口长度、手术时间及术中出血量差异无统计学意义(P＞0.05).三组在手术后并发症及术后膝关节功能比较差异有统计学意义(P＜0.05).[结论]Cable-pin索绑系统内固定治疗髌骨粉碎性骨折,具有术后并发症少,膝关节功能恢复好等优点,该技术符合生物力学内固定的原则,且操作简单,值得临床推广.     

Severely comminuted femoral shaft fractures: treatment by bridging-plate osteosynthesis

We report on 71 severely comminuted femoral shaft fractures that were operated on between 1980 and 1984 at the Berufsgenossenschaftliche Unfallklinik Duisburg-Buchholz. The method of operative stabilization was plate osteosynthesis in two variations: In one group 39 fractures (ten open) were stabilized by plate osteosynthesis after anatomical reduction of the fractured area. The other group comprised 32 fractures (six open) fixed with a bridging-plate osteosynthesis, without preparation of the fracture zone. The rate of postoperative complications was strikingly diminished after bridging-plate osteosynthesis. Fracture healing occurred within 23 (16-32) weeks after bridging-plate osteosynthesis and within 36 (32-40) weeks after anatomical reduction. No special instrumentation or equipment is necessary to perform a bridging-plate osteosynthesis. The patient rests in a supine position. There is no need for intraoperative image-intensifier control. For operative treatment of severely comminuted femoral fractures we consider the technique of bridging-plate osteosynthesis advantageous, especially in multiply injured patients.     

髌骨骨折不同改良方式张力带钢丝固定的生物力学研究及临床应用

【摘要】目的 为临床选择有效的骸骨骨折内固定方式提供实验依据。方法 取4具外伤截肢后下肢,保留股四头肌健、骸骨、骸韧带及关节囊,将股骨、腔骨固定在材料试验机上,维持腔股关节屈曲36”位,通过牵拉肌腥产生张力,用线性运动传感器测定骨折移位,移位3rum为固定失效,测AO张力带钢丝、昏氏张力带钢丝、“8”字张力带钢丝和Magnt,&x)tl钢丝4种固定法。结果“8”字张力带钢丝和肯氏张力带钢丝固定效果最好,AO张力带钢丝次之,三者均能承受294N以上牵张力,允许术后早期活动,M哪——钢丝不能承受294N以上牵张力,固定欠可靠。临床应用“8”字张力带钢丝固定治疗骸骨骨折42例,其中横断骨折36例,粉碎性骨折6例,随访6~26个月,优良率达95.2%。结论 克氏针“8”字张力带钢丝固定是治疗骸骨骨折首选方法,其固定效果可靠,疗效高。     

可吸收线网兜样编织结合张力带钢丝在髌骨下极粉碎性骨折中的临床应用

目的:探讨可吸收线网兜样编织结合张力带钢丝固定治疗髌骨下极粉碎性骨折的临床疗效。方法 :自2012年1月至2016年12月,采用可吸收线网兜样编织结合张力带钢丝治疗髌骨下极粉碎性骨折80例,其中男45例,女35例;年龄25～60(45.0±2.0)岁,所有骨折为新鲜闭合性骨折。术后6周采用疼痛视觉模拟评分(VAS)、膝关节屈伸活动范围评估手术预后,术后12个月采用膝关节HSS评分进行疗效评价。结果:患者手术时间(50.2±10.1) min,出血量(20.3±5.2) ml。术后40例患者获得随访,时间12～24(16.0±0.5)个月。术后6周VAS评分为1.8±0.4,膝关节屈伸活动范围为(120.6±1.5)°。所有骨折获得骨性愈合,时间(3.0±0.8)个月。术后12个月膝关节HSS评分95.6±0.6。结论:可吸收线网兜样编织结合张力带钢丝固定治疗髌骨下极粉碎性骨折具有操作简单、固定可靠、能够恢复髌骨解剖形态,可早期功能锻炼达到快速康复,愈后效果良好等优点,是治疗髌骨下极粉碎性骨折的理想方法之一。     

Management of periprosthetic patellar fractures. A systematic review of literature

Despite advances in surgical technique and implant design, complications involving the extensor mechanism and patellofemoral joint after total knee arthroplasty (TKA) continue to be the most common cause of pain and the most commonly cited reason for revision surgery. Periprosthetic patellar fractures occur in 1.19% of all reported cases after TKA, with a clear correlation with resurfacing of the patella. In 88.32% of the cases reported the fracture is not associated with a traumatic event and it is identified at the follow-up examination during the first 2 years after knee replacement. Predisposing factors for fracture include lateral release, excessive bone removal, peg fixation and cementation, improper patellar tracking and prosthesis malpositioning. More than 50% of fractures are associated with a loose implant which complicates the fracture management. Non-operative treatment seems to offer acceptable functional results and pain relief, especially in cases of minimal displacement and stable implant fixation. However, when surgical reconstruction is undertaken, open reduction and internal fixation with tension band or cerclage wiring should not be the first choice of treatment as the rate of failure and subsequent non-union may be as high as 90%.     

Biomechanical evaluation of various forms of fixation of transverse patellar fractures

A study was undertaken to evaluate the strength and ease of application of four different forms of patellar fracture fixation. Modified tension band, screw fixation, Lotke longitudinal anterior band (LAB), and Magnusson wiring were examined using a Materials Testing System. Using cadaver lower extremities, the tibia was mounted in a fixed base and the tibiofemoral joint was fixed at 36 degrees. Tension was applied to the patella through the quadriceps tendon and fracture displacement was measured with linear motion transducers. Based on the results, we recommend screw fixation for transverse patellar fractures in patients with adequate bone stock. In patients with patellar fractures with comminution and/or osteopenia, modified tension band fixation is recommended. Simple wiring techniques alone may not provide sufficient fixation to allow immediate range of motion.     

Severely comminuted femoral shaft fractures: Treatment by bridging-plate osteosynthesis

Summary We report on 71 severely comminuted femoral shaft fractures that were operated on between 1980 and 1984 at the Berufsgenossenschaftliche Unfallklinik Duisburg-Buchholz. The method of operative stabilization was plate osteosynthesis in two variations: In one group 39 fractures (ten open) were stabilized by plate osteosynthesis after anatomical reduction of the fractured area. The other group comprised 32 fractures (six open) fixed with a bridging-plate osteosynthesis, without preparation of the fracture zone. The rate of postoperative complications was strikingly diminished after bridging-plate osteosynthesis. Fracture healing occurred within 23 (16–32) weeks after bridging-plate osteosynthesis and within 36 (32–40) weeks after anatomical reduction. No special instrumentation or equipment is necessary to perform a bridging-plate osteosynthesis. The patient rests in a supine position. There is no need for intraoperative image-intensifier control. For operative treatment of severely comminuted femoral fractures we consider the technique of bridging-plate osteosynthesis advantageous, especially in multiply injured patients.     

柱状植骨结合微型钛板内固定治疗严重粉碎性掌骨骨折

目的：探讨柱状植骨结合微型钛板治疗严重粉碎性掌骨骨折的可行性及临床疗效。方法对7例严重粉碎性掌骨骨折行柱状植骨结合微型钛板内固定治疗。结果所有病例随访18个月,骨折均获愈合,达到解剖复位,植骨块塑形良好。结论柱状植骨结合微型钛板内固定治疗严重粉碎性掌骨骨折临床疗效满意,骨折可获得良好复位及内固定,促进骨折早期愈合,利于手部功能恢复,值得临床推广。     

Patella rings for treatment of patellar fracture

To evaluate a new fixation technique for patellar fracture using patella rings. A total of 75 patients (average age of 51.3 years) with comminuted or transverse patellar fractures were treated by fixation with patella rings. The Böstman scores at the time of bone union and at 12 months postoperatively were recorded, as was the degree of pain on a visual analogue scale (VAS), the range of motion of the knee at 12 months postoperatively, and any signs of postoperative complications. The average Böstman scores for patients in the transverse fracture group were 25.2 and 29.4 at 3 and 12 months postoperatively, respectively, while the scores for patients in the comminuted fracture group were 27.6 and 28.7, at the same time points. Böstman scores were graded as excellent and good in more than 90 % for patients with either a transverse or comminuted fracture. At the time of 12 months after surgery, the VAS score for patients with comminuted fractures was 0.38, whereas the score for patients in the transverse fracture group was 0.35. No statistically significant difference was found in the range of motion between the affected and uninjured knee at 12 months after surgery for patients in both groups (P > 0.05). This new fixation technique using a patella ring resulted in good outcomes for both transverse fracture and comminuted fracture and is beneficial for patients wishing to commence early functional activity.