Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella

• Published in: Journal of bone and joint surgery. British volume Vol. 85; no. 8; pp. 1155 - 1160
• Main Authors: YANG, K. H, BYUN, Y. S
• Format: Journal Article
• Language: English
• Published: London British Editorial Society of Bone and Joint Surgery 01.11.2003; British Editorial Society of Bone & Joint Surgery
• Edition: British volume
• Subjects: Adolescent; Adult; Biological and medical sciences; Biomechanical Phenomena; Bone Wires; Female; Fracture Fixation, Internal - methods; Fracture Healing; Fractures, Comminuted - diagnostic imaging; Fractures, Comminuted - physiopathology; Fractures, Comminuted - surgery; Humans; Injury Severity Score; Knee Injuries - diagnostic imaging; Knee Injuries - physiopathology; Knee Injuries - surgery; Knee Joint - physiopathology; Male; Medical sciences; Middle Aged; Orthopedic surgery; Patella - diagnostic imaging; Patella - injuries; Patella - surgery; Radiography; Range of Motion, Articular; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Suture Techniques; Human; Prognosis; Diseases of the osteoarticular system; Lower limb; Exploration; Comminuted fracture; Osteosynthesis; Experimental study; Wire; Trauma; In vitro; Knee disease; Biomechanics; In vivo; Orthopedic surgery; Fixation; Treatment; Patella; Bone; Technique; Cadaver
• ISSN: 0301-620X; 2049-4394; 2044-5377; 2049-4408
• DOI: 10.1302/0301-620X.85B8.14080

Comminuted and displaced fractures of the inferiorole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. We have evaluated the clinical effectiveness of the separate vertical wiring technique in acute comminuted fractures of the inferior pole of the patella. A biomechanical study was also performed using ten pairs of embalmed cadaver knees. A four-part fracture was made on the inferior pole of the patella and fixed by two separate vertical wires on one side and two pull-out sutures after partial patellectomy on the other. The ultimate load to failure in the first group was significantly higher than in the second (250.1+/- 109.7 N v 69.7 +/- 18.9 N, p < 0.002), as was the stiffness (279.9 +/- 76.4 N/mm v 23.2 +/- 11.4 N/mm, p < 0.001). The separate wire technique was used in 25 patients with comminuted fractures of the inferior pole of the patella who were followed up for a mean period of 22 months (10 to 50). All the fractures healed at a mean of seven weeks (6 to 10). No breakage of a wire or infection occurred. The mean grading at the final follow-up was 29.5 points (27 to 30) using the Böstman method. This technique preserved the length of the patella, fixed the comminuted fragments of the inferior pole and avoided long-term immobilisation of the knee.