However, the steel wire used in these two techniques can easily cause a stimulation reaction in soft tissues, which seriously affects the function of the knee joint and patients’ quality of life. Compared to Kirschner wire, cannulated screws show better stability in the fixation of a patellar fracture, and have lower incidences of needle withdrawal and deformation ( 6). Currently, a modified treatment method for patellar fracture that combines cannulated screws with tension band wiring is widely used around the world ( 5). After fixing the patella using this method, the knee extensor muscles convert the tension on the patella surface into axial pressure on the fractured end to promote fracture healing when the patient flexes and extends the knee joint. The Kirschner wire combined with tension band wiring is a classic method for the treatment of patellar fractures in clinical settings, and this approach can be applied to almost all types of patellar fractures ( 4). The goal of surgical treatment of the patellar fracture is to restore the smoothness of the articular surface, and the integrity of the knee extension mechanism to enable knee joint function to recover sufficiently to satisfy the patients’ needs in life and work. At present, it is widely accepted that the surgical indications for patellar fracture include a fracture displacement >3 mm, combined ligament injury, an articular step-off >2 mm, and an open fracture ( 3). Patellar fracture is an intra-articular fracture, accounts for about 1% of all fractures in adults, and is most commonly caused by direct, indirect, or mixed forces ( 2). As an important component of the knee extensor mechanism, the patella plays a key role in increasing the moment arm of the quadriceps tendon, protecting the articular surface, and maintaining the appearance of the knee joint ( 1). The patella is the largest sesamoid bone in the human body. Keywords: Patellar fracture closed reduction high-strength suture Nice knot One patient (1/24) in the CRIF-NK group, and all patients (24/24) in the ORIF-TBW group required internal fixation removal.Ĭonclusions: The percutaneous minimally invasive technique using cannulated screws combined with high-strength sutures and Nice knots exhibited some superiority to traditional open reduction with cannulated screws and tension band wiring for treatment of transverse patellar fractures in terms of efficacy and safety by reducing soft-tissue stimulating complications and promoting functional recovery. The union rate was 100% (24/24) in both groups. No significant differences were observed between the two groups in terms of operative time, Böstman scale score at 1-year follow-up, or fracture healing time. The mean VAS scores at 4 and 8 weeks and the mean Böstman scale score at 8 weeks after surgery were significantly better in the CRIF-NK group (3.52☐.42, 1.47☐.40 and 28.13☐.94, respectively) than the ORIF-TBW group (5.16☐.68, 3.14☐.72 and 26.33☑.00, respectively all P<0.001). The mean intraoperative blood loss of the CRIF-NK group (35.21☖.16 mL) was significantly less than that of the ORIF-TBW group (75.42☗.92 mL P<0.001). Results: Average follow up was 21.9 months (range, 16–29 months). The clinical evaluation was performed using the Böstman scale and the Visual Analogue Scale (VAS) for pain. All the patients were underwent a regularly clinical and radiological follow-up. The operative time and intraoperative blood loss for each patient were recorded. All patients were treated either by closed reduction and internal fixation using cannulated screws combined with high-strength sutures and Nice knots (the CRIF-NK group, n=24), or traditional open reduction and internal fixation using cannulated screws and tension band wiring (the ORIF-TBW group, n=24). Methods: This retrospective study comprised 48 patients who had been treated for unilateral closed transverse patellar fracture, type 34C1 according to the AO Foundation and Orthopaedic Trauma Association (AO/OTA) classification, between June 2018 to June 2020. An alternative is to utilize cannulated screws and high-strength sutures by the minimally invasive technique. Policy of Dealing with Allegations of Research Misconductīackground: Patella fractures treated with traditional open approach and tension band fixation are associated with a significant rate of soft tissues complications, including hardware irritation, postoperative adhesions and non-cosmetic scar.Policy of Screening for Plagiarism Process.
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