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The technique of anatomical plate application, (A) K-wire insertion after anatomical reduction, (B) Replacement of the anatomical patellar plate through the K-wires, then placement of the canulated cortical screw through the K-wire. (C) The anatomical patellar plate.
Source publication
Objective:
The aim of this study was to assess the safety and stability of our novel anatomical patella plate and to compare its stability with tension band-wire technique.
Methods:
A total of 12 cadaveric preserved knees (six right and six left patellae) with close patellar size were chosen to form two groups of six samples. Each group received...
Contexts in source publication
Context 1
... then a 3.5 mm tap is used to prepare the tract for lag screw insertion. After getting the appropriate plate and screw sizes, the proximal part of the plate is placed through the guide wire, whereas the distal part is inserted through the distal part of the guide wire to rest on the anterior surface of the patella to prepare for screw insertion (Fig. 2). A 1/3 threaded canulated cancellous 3.5 mm screw can then be advanced through the guide wire till it meets the threaded distal end of the plate to exert it's inter-fragmentary compression (Fig. ...
Context 2
... 3.5 mm titanium anatomical curved plate (TIPSAN CO. Company, Izmir-Turkey) has a 1 mm body thickness, 1 cm body width and two hook-like blocks at both ends. The anatomical patellar plate is available in eight variable lengths ranging from 25 mm to 60 mm, which were specifically designed to fit on the patellar anterior surface. One hole is present on each hook-like end blocks of the plate, the proximal hole of the plate is not threaded, designed to receive the screw head, whereas the distal hole is threaded to receive the threaded part of the screw. The plate is prebent in a semicircular shape to anatomically fit the anterior patellar surface. When the screw is introduced through the prox- imal non-threaded block, it passes to the distal threaded block, where the screw can exert its lag effect. The flexible nature of the plate allows lag effect compression of the screw which happens between the head of the screw settled in the non-threaded prox- imal block and the threaded distal block. Additionally it maintains the reduction by buttressing the anterior surface of the patella against deforming forces. After reduction of the transverse fracture, two 1.6 mm guide K-wires are placed parallel to each other's to stabilize the fracture. A 3.2 mm canulated drill pit is used to open the tract for screw entrance, then a 3.5 mm tap is used to prepare the tract for lag screw insertion. After getting the appropriate plate and screw sizes, the proximal part of the plate is placed through the guide wire, whereas the distal part is inserted through the distal part of the guide wire to rest on the anterior surface of the patella to prepare for screw insertion (Fig. 2). A 1/3 threaded canulated cancellous 3.5 mm screw can then be advanced through the guide wire till it meets the threaded distal end of the plate to exert it's inter-fragmentary compression (Fig. ...
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Introduction
Patella fractures account for approximately 1% of all bone fractures. The tension band wiring technique has been used in surgical treatment. However, there is no clear information about the location of the K-wires in sagittal plane. Thus, a transverse fracture line was created in the patella finite element model and fixed with Kirchner...
Background:
Cannulated screws with an anterior wire are currently used for managing transverse patellar fracture. However, the addition of anterior wiring with various types of screws via open surgery to increase the mechanical stability is yet to be determined. Hence, this study aimed to compare the mechanical behaviors of a fractured patella fix...
Os acromiale occur frequently in the population and can be a cause of significant shoulder dysfunction and rotator cuff impingement. When symptomatic os acromiale fail conservative management, surgical intervention may become necessary. The purpose of this article is to describe our preferred surgical technique for osteosynthesis of os acromiale us...
: There is an increasing trend of ankle fractures in young as well as elderly patients recently. This study aimed to compare the advantages and disadvantages of tension band wiring with screw fixation for medial malleolar fractures.
: All the cases of suspected ankle fractures were taken up for the study. Then the patient’s radiographs were taken,...
Introduction
We encountered a patient with a reverse oblique olecranon fracture in whom redisplacement occurred after osteosynthesis using routine tension band wiring (TBW). In this case report, methods for stable fixation used during reoperation are reported with a review of the literature.
Case Report
A 60-year-old male got the left olecranon fr...
Citations
... The tension band approach, the most generally used method for transverse patellar fracture repair, may not produce appropriate stability in handling inferior patellar pole fractures [20]. Plate attachment may be regarded as an effective method for overcoming the drawbacks of tension band wiring [20][21][22]. The patient in this report was given a physical rehabilitation intervention plan, which was planned by a qualified musculoskeletal physiotherapist. ...
The hip is a ball-and-socket joint surrounded by strong and well-balanced muscles that allow for a wide range of motion in many physical planes. Iliofemoral, ischiofemoral, and pubofemoral are the three major ligaments of the hip joint that provide stability to the joint. Supracondylar femoral fractures are common in old age and can be caused in young people due to accidents or traumatic causes. These types of fractures are complicated to fix surgically due to different architectural designs. If not treated appropriately, these can cause malunion or non-union of the joint. The knee joint is a synovial joint of the hinge type. It has two major degrees of movement, which are flexion and extension. However, rotation in both the medial and lateral directions is possible to some extent in the joint. Patellar fractures can be transverse, vertical, comminuted, marginal, or osteochondral. In this case report, we present a 43-year-old male patient who had a history of falling from a bike. He was diagnosed with a comminuted supracondylar fracture of the left femur and a comminuted fracture of the patella on the left side on an X-ray. For this, he was managed with open reduction, internal fixation, and vacuum-assisted closure (VAC). Physiotherapy rehabilitation was programmed to attain a good and fast recovery for the patient to make him functionally independent and improve his quality of life.
... Whereas previous studies performed extensive biomechanical investigations on simple patella fracture plating [22,[26][27][28][29][30], the assessment of its efficacy for fixation of comminuted patella fractures is sparce [16,31,32]. The current study best compares to the one published by Kfuri et al. [16] in threefold manner, namely regarding the fracture model, the applied fixation techniques, and the type of investigation as follows. ...
Background
The aim of this study was to investigate the biomechanical performance of novel anterior variable-angle locking plates versus tension band wiring used for fixation of simple and complex patella fractures.
Methods
Sixteen pairs of human cadaveric knees were used to simulate two-part simple transverse AO/OTA 34-C1 and five-part complex AO/OTA 34-C3 patella fractures. The complex fracture pattern was characterized with a medial and a lateral proximal fragment, together with an inferomedial, an inferolateral and an inferior fragment mimicking comminution around the distal patella pole. Eight pairs with simple fractures were split for fixation via either tension band wiring (TBW) through two parallel cannulated screws or anterior variable-angle locked plating, whereas other eight pairs with complex fractures were split for either TBW through two parallel cannulated screws plus circumferential cerclage wiring, or anterior variable-angle locked plating using a cortical caudo-cranial polar screw. Each specimen was tested over 5000 cycles with a range of motion from 90° flexion to full extension by pulling on the quadriceps tendon. Interfragmentary movements were captured by motion tracking.
Results
For both fracture types, the longitudinal and shear articular displacements, measured between the proximal and distal fragments at the central patella aspect between 1000 and 5000 cycles, together with the relative rotations of these fragments around the mediolateral axis were all significantly smaller following anterior variable-angle locked plating versus TBW, p ≤ 0.01.
Conclusions
From a biomechanical perspective, anterior locked plating of both simple and complex patella fractures resulted in less interfragmentary displacement under extended cyclic loading.
... [19] Some other forms like titanium anatomical curved plating have also been developed with thin profile and two hook-like blocks at both ends for respective screws. [20] Complication rates of 13% (5 out of 38 cases) in a series were noted like reactive prepatellar bursitis, chronic infection, and loss of reduction on account of pole fragment dislocations in three cases. [21] Mesh plating for intra-articular fractures and a mini-plate shaped like a basket (basket plate) for inferior pole fractures is also used and as per the recent systematic review, plating records better clinical outcome, fewer complications, and high union rates as compared to TBW. [22] ...
Plate osteosynthesis involves open reduction and internal fixation of fractures with plate application
abiding various principles of fixation. The conventional plates currently in widespread use are
dynamic compression plate, tubular pates, and locking compression plates. There have always
been modifications and advancements in implant development and the plates have also undergone
various updates. Many of these developments are in vogue but many are in their primary stages. The
newer technical developments and newer implants enrich the surgical armamentarium and address
a critical issue in their usage and application. As part of the continuous professional development,
working knowledge of key recent advances and new implant development is important for a relevant
orthopedic practice.
Keywords: Advances, carbon fiber plates, fracture fixation, outcome, plan osteosynthesis,
polyetheretherketone
... The loading conditions of the patella differ during walking, and the direction of the muscle force changes during knee flexion and extension. In most previous studies, a worst-case loading condition of the fractured patella was assumed, and the gap opening distance was demonstrated at specific knee flexion angles [12,32,34]. In this simulation, the loading condition was extended to the entire walking cycle. ...
Background
A minimally invasive technique with various screw configurations without open surgery is currently used for the fixation of transverse patellar fractures. Percutaneous crossing screw configuration has been reported to have a good bone union rate in patellar fractures. However, the difference in mechanical stability of the fractured patella between different screw-included angles has not been fully investigated. Hence, this study aims to compare the mechanical stability of parallel and crossing screw fixations with different screw-included angles for the fixation of transverse patellar fractures during level walking.
Methods
A finite element knee model containing a patella with a transverse fracture is created. Two headless compression screws with different angles (0°, 30°, 60°, and 90°) are used to fix the fracture. The loading conditions of the knee joint during level walking are used to compare the stability of the fractured patella with different fixation screw configurations.
Results
The results indicate that the maximum fracture gap opening distance increased with an increase in the included angle. Two parallel screws yield the smallest gap distance among all screw configurations. The maximum gap opening distances at the anterior leading edge of the fractured patella with two parallel screws and two screws having an included angle of 90° are 0.73 mm and 1.31 mm, respectively, at 15% walking cycle.
Conclusions
Based on these results, the superior performance of two parallel screws over crossing screw fixations in the fixation of transverse patellar fractures is established. Furthermore, the smaller the angle between the crossing screws, the better is the stability of the fractured patella.
... Plate fixation could be considered as an effective technique that overcomes the shortcomings of tension band wiring. [14][15][16] Biomechanical studies have demonstrated that this method is more effective than tension band constructs. [14][15][16] Moreover, there are some published studies with successful experience of hook plates being used to manage avulsion fractures, [17][18][19] but most of the cases are suffered from phalangeal fractures. ...
... [14][15][16] Biomechanical studies have demonstrated that this method is more effective than tension band constructs. [14][15][16] Moreover, there are some published studies with successful experience of hook plates being used to manage avulsion fractures, [17][18][19] but most of the cases are suffered from phalangeal fractures. Therefore, it is meaningful to design a convenient and effective construct by combination of hook plate fixation with cable cerclage augmentation for the management of inferior patellar pole fractures. ...
... Biomechanical testing with transverse patellar fracture models showed that plates have an even better treatment effect compared to tension band techniques. [14][15][16] The plate construct demonstrated the lowest amount of fracture gapping under cyclic load compared with either Kirschner wire or cannulated screw tension band constructs. 22 Thus, plating could be considered as an ideal option to resist the strong tension of the extensor mechanism. ...
Objectives:
To present a new method consisting of cable cerclage and hook plate for fixating the comminuted inferior patellar pole fracture and evaluate the outcomes.
Methods:
A total of 16 consecutive patients who were treated with the construct of a cable cerclage in combination with a hook plate between January 2018 and September 2020 were included in the study. Mechanism of injury, duration, and technical details of the operation were reviewed. Plain radiographs and computerized tomography (CT) scans were routinely taken to evaluate the fracture pattern. The primary outcome measures included bony healing time, pain intensity-numerical rating scale (PI-NRS), range of motion (ROM), and the Bostman score at the final follow-up.
Results:
Eight males and eight females with an average age of 55.6 ± 12.0 years (range, 41 to 73 years) were included. Bony union was achieved in all the patients, with an average healing time of 10.8 ± 2.4 weeks (range, 8-16 weeks). With the average follow-up of 20.1 ± 5.3 months, 12 patients (75%) had no pain (PI-NRS score of 0), and the remaining four patients (25%) reported mild pain (three with a PI-NRS score of 1 and one with a score of 2). The final Bostman score was 27.8 ± 3.0 (range, 20-30) on average, and all the patients showed excellent or good results. The average range of motion was 127.5° ± 13.9° (range, 90°-140°). No implant failure or hardware irritation was found during the follow-up.
Conclusion:
The fixation of cable cerclage combined with hook plate resulted as a reliable method for managing the inferior patellar pole fractures, allowing immediate rehabilitation and weight-bearing.
... The outcomes following operative treatment of patellar fractures have remained unsatisfactory in the majority of the cases often due to prominent and painful implants, residual knee discomfort including knee stiffness despite low rates of non-union, and implant failures [9,10]. In an attempt to improve, plate osteosynthesis of patella fracture came into existence and evolved over the years from the start of the 20th century, wherein mesh plate, basket plates, even nitinol (NiTi)-patellar concentrator (NT-PC) for patella and locked plates have come into the picture [11][12][13][14][15]. Multiple biomechanical studies have shown the superiority of the plate structure compared to other forms of treatment in transverse as well as comminuted or inferior pole fractures [16][17][18]. ...
IntroductionTo perform a systematic review and assess the indications, outcomes, complications, and union rates associated with plate osteosynthesis in patellar fractures compared to tension band wiring.Methods
The systematic search was conducted for articles in PubMed, Embase Biomedical, Cochrane central, and LILACS databases (date of inception to July 30, 2020). Articles were included if they were randomized control trials, cohort studies, case-control studies, and case series (with more than five cases), which focused on the clinical outcomes of patients with plate osteosynthesis as a treatment for fracture of the patella and had a minimum follow-up of 3 months. All studies were assessed according to their level of evidence, the number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Meta-analysis could only be done for two parameters (complications and reoperations) due to the paucity of data and heterogeneity of studies’ limited statistical analysis. The data are presented as a review table with the key points summarized.ResultsTwenty studies (seven prospective and 13 retrospective articles) identified 533 patients with 534 fractures who had undergone plate osteosynthesis for fracture of the patella. The most common fracture treated with plate osteosynthesis was 34C.Conclusion
Basket plate was most commonly used for inferior pole fractures, while mesh plates were for intra-articular patella fractures. Overall plating was associated with better clinical outcomes, fewer complication rates, and high union rates compared to tension band wiring for patella fractures.
... Previous studies have reported superior biomechanical performance of locking plating versus tension band wiring of simple transverse fracture types [8,12,17]. Nevertheless, to the best of our knowledge, this is the first biomechanical study that compares these constructs for fixation of comminuted and unstable patellar fractures. ...
Background:
Comminuted patellar fractures represent a challenging clinical problem. Treatment aims to restore the integrity of the extensor mechanism and the congruity of patellofemoral joint. Controversy exists regarding the ideal fixation method. Metallic constructs aiming to convert pulling forces on the anterior aspect of the patella into compression forces across the fracture site are the standard of care. More recently, low profile plates have been described in the management of comminuted patellar fractures. The aims of this study were to (1) develop a novel unstable patellar fracture model and (2) to compare biomechanically three different constructs for fixation comminuted patellar fractures. We hypothesized that an orthogonal biplanar disposition of the screws within an anteriorly placed locking plate provides the best biomechanical properties in the management of comminuted fractures.
Methods:
Six-part complex AO 34-C3 patella fractures were simulated in 18 human cadaveric knees by means of osteotomies including comminution around the distal patellar pole. The specimens were randomly assigned to 3 fixation techniques (n = 6) for either anterior plating, antero-lateral plating, or tension band wiring (TBW). Biomechanical testing was performed over 5000 cycles in active extension and passive flexion, followed by ultimate destructive quasi-static testing. Interfragmentary movements were captured by means of optical motion tracking.
Results:
Displacement between the proximal and distal medial patella fragments was lower after anterior plating compared to both antero-lateral plating (P = 0.084) and TBW (P < 0.001). Moreover, displacement between the proximal and distal lateral fragments was significantly lower after anterior plating compared to both other techniques (P ≤ 0.032). In addition, it was significantly lower for antero-lateral plating versus TBW (P < 0.001). Rotation around the medio-lateral axis between the proximal and distal medial fragments was significantly lower after anterior plating compared to TBW (P = 0.017).
Conclusions:
Anterior mesh plating with biplanar placement of locking screws provides superior stability for fixation of comminuted patellar fractures when compared to both antero-lateral mesh plating and TBW. The latter is associated with considerably inferior performance.
... The minimal invasiveness can reduce damage to the blood supply of patellar fracture fragments, which also make arthroscopic treatment of patellar fractures as an alternative [22]. The newly designed low profile mesh plates is also a novel technique for the treatment of patellar fractures [23][24][25][26][27]. ...
Objective:
This study aimed to investigate the effectiveness of a three-dimensional strapping reduction in the treatment of patellar fractures.
Methods:
Between January 2015 and June 2017, a total of 56 patients were randomly allocated to the three-dimensional strapping reduction group (trial group) and towel clamp reduction group (control group). There were no significant differences in age, gender, injury side, the interval time from injury to surgery, fracture pattern, and cause of injury (P > 0.05). The operation time, fluoroscopy time, bone union time, postoperative Hospital for Special Surgery (HSS) scores, and complications were recorded and analyzed.
Results:
All incisions achieved primary union. All patients in both groups completed a follow-up with an average of 12.5 months (range 11-15 months). Both operation time and fluoroscopy time in the trial group were significantly shorter than those in the control group (P < 0.001). All patellar fractures achieved bone union, and there was no significant difference in bone union time between the two groups (P > 0.05). Bone nonunion, infection, and fixation failure were not found in both groups. HSS scores of the trial group (90.9 ± 4.2) were higher than those of the control group (86.6 ± 5.2) (P < 0.01).
Conclusion:
Compared with towel clamp reduction, the three-dimensional strapping reduction in the treatment of patellar fractures has advantages of shorter operation time and fluoroscopy time, better knee function after surgery, and satisfactory fracture healing.
... Application of the low-profile C-shape plate compressed with additional screws driven through the bone fragments has brought promising outcomes [9]. ...
... Intra-articular fractures always require anatomical reposition of the bone fragments and their stable fixation allowing for the implementation of early kinesiatrics and physical therapy [1]. There are many different means of treatment of the patella fracture but currently a large num-ber of authors recommend application of flexible and resistant fixing materials that do not have to be removed due to the complaints caused by the pressure the metal implant on the periarticular tissues [2][3][4][5][6][7][8][9][10][11][12][13][14][15]. ...
