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Article: Comparing 3 Different Techniques of Patella Fracture Fixation and Their Complications

TitleComparing 3 Different Techniques of Patella Fracture Fixation and Their Complications
Authors
Keywordstrauma surgery
geriatric trauma
biomechanics
patella fracture
suture fixation
Issue Date2019
PublisherSAGE Publications (UK and US): Open Access Titles. The Journal's web site is located at http://gos.sagepub.com/
Citation
Geriatric Orthopaedic Surgery & Rehabilitation, 2019, v. 10, article no. 2151459319827143 How to Cite?
Abstractntroduction: Patella fractures managed by fixation with metal implants often cause local soft tissue irritation and necessitate implant removal. An alternative is to utilize suture-based fixation methods. We have adopted suture and hybrid fixation in the routine management of patella fractures. Here, we compare the results of 3 fixation techniques. Materials and Methods: Eighty-seven eligible patients underwent patella fracture fixation over a 3-year period. As determined by fracture configuration, patients received (1) suture fixation (transosseous sutures and figure-of-eight tension banding with FiberWire), (2) hybrid fixation (transosseous FiberWire sutures and metal tension banding), or (3) metal fixation. Primary outcome measures included reoperation rate and soft tissue irritation. Secondary outcomes included surgical complications, radiological, and functional parameters. Results: Reoperation rate was highest for metal fixation (25/57, 43.9%) and lowest for suture fixation (2/13, 15.4%). Soft tissue irritation necessitating implant removal was the predominant reason for reoperation and was significantly less prevalent following suture fixation (1/13, 7.7%, P < .01). Hybrid fixation resulted in similar rates of soft tissue irritation (6/17, 35.3%) and implant removal (7/17, 41.2%) as compared to metal fixation. There was a significant increase in patella baja (13/17, 76.5%) and reduction in Insall-Salvati ratio (0.742; 95% confidence interval: 0.682-0.802) following hybrid fixation as compared to the other 2 fixation methods (P < .05). Discussion: Suture fixation results in the least amount of soft tissue irritation and lowest reoperation rate, but these advantages are negated with the addition of a metal tension band wire. Hybrid fixation also unbalances the extensor mechanism. Conclusion: Patients should be counseled as to the expected sequelae of their fixation method. Suture fixation is the favored means to fix distal pole fractures of the patella. An additional metal tension band loop may confer additional stability but should be applied with caution.
Persistent Identifierhttp://hdl.handle.net/10722/276221
ISSN
2023 Impact Factor: 1.6
2023 SCImago Journal Rankings: 0.500
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorShea, GKH-
dc.contributor.authorSo, KHT-
dc.contributor.authorTam, KW-
dc.contributor.authorYee, DKH-
dc.contributor.authorFang, C-
dc.contributor.authorLeung, F-
dc.date.accessioned2019-09-10T02:58:27Z-
dc.date.available2019-09-10T02:58:27Z-
dc.date.issued2019-
dc.identifier.citationGeriatric Orthopaedic Surgery & Rehabilitation, 2019, v. 10, article no. 2151459319827143-
dc.identifier.issn2151-4585-
dc.identifier.urihttp://hdl.handle.net/10722/276221-
dc.description.abstractntroduction: Patella fractures managed by fixation with metal implants often cause local soft tissue irritation and necessitate implant removal. An alternative is to utilize suture-based fixation methods. We have adopted suture and hybrid fixation in the routine management of patella fractures. Here, we compare the results of 3 fixation techniques. Materials and Methods: Eighty-seven eligible patients underwent patella fracture fixation over a 3-year period. As determined by fracture configuration, patients received (1) suture fixation (transosseous sutures and figure-of-eight tension banding with FiberWire), (2) hybrid fixation (transosseous FiberWire sutures and metal tension banding), or (3) metal fixation. Primary outcome measures included reoperation rate and soft tissue irritation. Secondary outcomes included surgical complications, radiological, and functional parameters. Results: Reoperation rate was highest for metal fixation (25/57, 43.9%) and lowest for suture fixation (2/13, 15.4%). Soft tissue irritation necessitating implant removal was the predominant reason for reoperation and was significantly less prevalent following suture fixation (1/13, 7.7%, P < .01). Hybrid fixation resulted in similar rates of soft tissue irritation (6/17, 35.3%) and implant removal (7/17, 41.2%) as compared to metal fixation. There was a significant increase in patella baja (13/17, 76.5%) and reduction in Insall-Salvati ratio (0.742; 95% confidence interval: 0.682-0.802) following hybrid fixation as compared to the other 2 fixation methods (P < .05). Discussion: Suture fixation results in the least amount of soft tissue irritation and lowest reoperation rate, but these advantages are negated with the addition of a metal tension band wire. Hybrid fixation also unbalances the extensor mechanism. Conclusion: Patients should be counseled as to the expected sequelae of their fixation method. Suture fixation is the favored means to fix distal pole fractures of the patella. An additional metal tension band loop may confer additional stability but should be applied with caution.-
dc.languageeng-
dc.publisherSAGE Publications (UK and US): Open Access Titles. The Journal's web site is located at http://gos.sagepub.com/-
dc.relation.ispartofGeriatric Orthopaedic Surgery & Rehabilitation-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjecttrauma surgery-
dc.subjectgeriatric trauma-
dc.subjectbiomechanics-
dc.subjectpatella fracture-
dc.subjectsuture fixation-
dc.titleComparing 3 Different Techniques of Patella Fracture Fixation and Their Complications-
dc.typeArticle-
dc.identifier.emailShea, GKH: gkshea@hku.hk-
dc.identifier.emailTam, KW: tamkw@hku.hk-
dc.identifier.emailYee, DKH: yeedns@hku.hk-
dc.identifier.emailFang, C: cfang@hku.hk-
dc.identifier.emailLeung, F: klleunga@hkucc.hku.hk-
dc.identifier.authorityShea, GKH=rp01781-
dc.identifier.authorityFang, C=rp02016-
dc.identifier.authorityLeung, F=rp00297-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1177/2151459319827143-
dc.identifier.pmid30858993-
dc.identifier.pmcidPMC6402069-
dc.identifier.hkuros303430-
dc.identifier.volume10-
dc.identifier.spagearticle no. 2151459319827143-
dc.identifier.epagearticle no. 2151459319827143-
dc.identifier.isiWOS:000489702600001-
dc.publisher.placeUnited States-
dc.identifier.issnl2151-4585-

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