Journal of Musculoskeletal Trauma

Clinical Outcomes of Triple Tension Band Wirings in Comminuted Patellar Fracture: A Comparison with Conventional Tension Band Wiring: Hyun-Cheol Oh, Han-Kook Yoon, Joong-Won Ha, Sang Hoon Park, Sungwoo Lee; J Korean Fract Soc 2024;37(2):82-86. Published online April 30, 2024; DOI: https://doi.org/10.12671/jkfs.2024.37.2.82

Abstract PDF: Purpose
This study devised triple tension band wirings (TTBW) fixation in patients with comminuted patella fractures to compare the clinical result of TTBW with that of tension band wiring (TBW).
Materials and Methods
This study was conducted on 91 patients who had undergone surgery diagnosed with acute patella fracture from January 2011 to December 2016. The study included 51 double TBW patients (Group 1) and 40 patients with TTBW (Group 2).
Results
Five out of 51 cases had a loss of reduction and fixation failure in Group 1, and no failure of fracture formation healing occurred in Group 2. Nonunion was noted in one case in Group 1 and no case in Group 2. Eight K-wire migration cases were observed in Group 1, which was not observed in Group 2. Six patients in Group 1 underwent revisional surgery. No patients in Group 2 had a reoperation. As a result of a one-year follow-up after the operation, the mean range of motion of the knee joint in groups 1 and 2 was 128.3°±11.3° and 127.9°±10.8°, respectively. The Lysholm’s scores for groups 1 and 2 were 90.8±4.2 and 90.3±3.8 points, respectively, which was not statistically significant.
Conclusion
TTBW is a helpful technique for the surgical treatment of comminuted patella fractures. The TTBW method has less reoperation due to nonunion and fixation failure. After a one-year followup, the clinical results were similar to the conventional TBW method.

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Usefulness of Percutaneous Cannulated Screws with Tension Band Wiring for Minimally Displaced Fractures of the Patella: Ho Min Lee, Jong Pil Kim, Phil Hyun Chung, Eun Woo Bae; J Korean Fract Soc 2022;35(4):142-150. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.142

Abstract PDF: Purpose
To evaluate the usefulness of percutaneous cannulated screws with tension band wiring (PC-STBW), a minimally invasive surgical technique, compared to conservative treatment for a minimally displaced patella transverse fracture.
Materials and Methods
The subjects included patients from 2010 to 2019 with transverse patella fractures, who were diagnosed as minimally displaced fractures, and were followed up for at least 1 year. Of these, 61 patients who were treated with cylinder casts were classified as Group A, and 53 patients who were treated with PCSTBW were classified as Group B. The clinical evaluation was carried out by evaluation of the radiographic bone union and calculation of the Bostman knee score. Any complications observed were investigated.
Results
All patients in both groups showed no further displacement of the fracture gap, and the bone union was achieved in all cases. The functional evaluation of the knee joint measured at the 8- and 12-week follow-up showed superior results in Group B wherein subjects were treated with surgery, and similar results were seen in both groups during the 6 months and 1-year follow-up. One case in Group A suffered the complication of knee stiffness.
Conclusion
For the treatment of minimally displaced transverse patellar fractures, both conservative treatment and PCSTBW showed similar good results at the 6-month and one-year follow-up. However, the PCSTBW technique showed superior clinical results in the early stage follow-up within 12 weeks.

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Is It Essential to Apply Tension Band Wire Fixation in Non-Comminuted Displaced Transverse Fractures of the Olecranon (Mayo Type 2A)?: In-Tae Hong, Cheungsoo Ha, Seongmin Jo, Wooyeol Ahn, Soo-Hong Han; J Korean Fract Soc 2022;35(3):97-102. Published online July 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.3.97

Abstract PDF: Purpose
Various problems have been reported with tension-band wire (TBW) fixation. With the devel-opment of anatomical plates and the improvement of fixation forces, plate fixation is currently being performed for non-comminuted, displaced, transverse olecranon fractures (Mayo Type 2A). This study compared the usefulness of the above two procedures applied in non-comminuted, displaced, transverse olecranon fractures.
Materials and Methods
Fifty-three patients with Mayo Type 2A were studied retrospectively. Twenty-nine patients underwent TBW fixation, while the other 24 underwent plate fixation. The averageoutpatient follow-up period was 10 months for both groups. Both groups were analyzed radiologically and clinically. The radiological assessment included the time to bone union, joint stability, and presence of traumatic osteoarthritis at the final follow-up. The clinical assessment included the operation time,range of motion of the elbow joint, Mayo Elbow Performance Score (MEPS), Disability of the Arm, Shoulder and Hand (DASH) score, and the presence of postoperative complications.
Results
Both groups showed stable elbow joints, proper union of fractures, and no traumatic osteo-arthritis at the final follow-up. The range of motion for the TBW fixation group was 142° (range, 3°-145°), while that of the plate fixation group was 135° (range, 4°-139°) at the final follow-up (p=0.219). The MEPS was 98.2 and 97.7 for the TBW fixation and plate fixation groups, respectively (p=0.675). The DASH score was 10.7 and 13.9 for the TBW fixation and plate fixation groups, respectively. Both groups showed excellent results, and the differences were not statistically significant (p=0.289).
Conclusion
TBW fixation and plate fixation were compared in non-comminuted, displaced, transverse olecranon fractures, and good results were obtained without significant differences between the two groups. Hence, surgeons should choose a technique they are more confident with and can be applied more efficiently.

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Tension Band Wiring Technique for Distal Radius Fracture with a Volar Articular Marginal Fragment: Technical Note: Neunghan Jeon, Jong Keon Oh, Jae Woo Cho, Youngwoo Kim; J Korean Fract Soc 2020;33(1):38-42. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.38

Abstract PDF: Most distal radius fractures are currently being treated with anterior plating using anatomical precontoured locking compression plates via the anterior approach. However, it is difficult to fix the volar articular marginal fragment because these anatomical plates should be placed proximally to the watershed line. There were just a few methods of fixation for this fragment on medical literature. Herein, we introduced a tension band wiring technique for fixation of a volar articular marginal fragment in the distal radius.

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Treatment of Isolated Lateral Malleolar Fractures Using Locking Compression Plate Fixation and Tension Band Wiring Fixation: Woojin Shin, Seondo Kim, Jiyeon Park; J Korean Fract Soc 2020;33(1):16-21. Published online January 31, 2020; DOI: https://doi.org/10.12671/jkfs.2020.33.1.16

Abstract PDF: PURPOSE
The purpose of this study was to compare the clinical and radiological outcomes of locking compression plate (LCP)-screw fixation and tension band wiring (TBW) fixation in isolated lateral malleolar fractures.
MATERIALS AND METHODS
From May 2016 to August 2018, 52 patients with isolated lateral malleolar fracture were retrospectively reviewed. They were divided into 30 cases of the LCP fixation group (Group I) and 22 cases of the TBW fixation group (Group II). The clinical and radiological results of those groups were compared. Pearson chi-square tests and independent t-tests were used in the statistical analysis.
RESULTS
The mean length of the surgical incision was 8.3 cm in Group I and 4.9 cm in Group II. Radiological union was obtained at a mean of 8.4 weeks in both groups. The mean American Orthopaedic Foot and Ankle Society score was 90 (range, 85â€“97) and 92 (range, 85â€“100) in Groups I and II, respectively, at the last follow up.
CONCLUSION
Both the LCP-screw and TBW techniques revealed excellent results in isolated lateral malleolar fractures. The tension band technique may be a fine alternative method of fixation in the treatment of isolated lateral malleolar fracture.

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Comparison of the Treatment Results between Reduction with Percutaneous Wiring and Reduction without Percutaneous Wiring in Reverse Oblique Trochanteric Fractures (AO Classification 31-A3.3): Jae Woo Park, Oog Jin Shon, Seung Wan Lim; J Korean Fract Soc 2017;30(4):192-197. Published online October 31, 2017; DOI: https://doi.org/10.12671/jkfs.2017.30.4.192

Abstract PDF: PURPOSE
The aim of this study was to investigate the utility of percutaneous wiring in the reduction of reverse oblique trochanteric fractures (AO classification 31-A3.3) by analyzing the treatment results with or without the use of percutaneous wiring.
MATERIALS AND METHODS
Thirty-five cases from January 2008 to August 2014 that could be followed-up for at least one year were selected among patients with unstable trochanteric fractures who underwent either internal fixation or open reduction. Seventeen patients underwent surgery with percutaneous wire fixation but another 18 patients underwent surgery without it. All patients received a closed reduction and internal fixation with an intramedullary nail. The factors evaluated were as follows: the length of operation, loss of blood, length of in-hospital stay, lower limb function scale, return to preinjury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, time taken for bone attachment, quality of post-operative reduction, and complications.
RESULTS
No significant difference in the mean operative time, loss of blood, length of in hospital stay, lower limb function scale, return to pre-injury daily life, change in femur neck shaft angle, postoperative gap of the fracture site, and quality of postoperative reduction was observed between the two groups. A significant difference was noted in the time taken for bone attachment (p=0.032). Bone attachment took 13.3 weeks (9â€“17 weeks) on average when fixed with percutaneous wiring and no patient was found to have any complications. When treated without percutaneous wiring, however, bone attachment took 17.8 weeks (12.5â€“28.0 weeks) on average and three cases resulted in delayed union.
CONCLUSION
Percutaneous wiring is a recommended treatment option for patients with an unstable trochanteric fracture.

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Usefulness of the Additional K-Wire Fixation and Suture for Reinforce the Treatment of Distal Clavicle Fracture Using Modified Tension Band Wiring: Seung Bum Chae, Chang Hyuk Choi, Dong Young Kim; J Korean Fract Soc 2016;29(2):107-113. Published online April 30, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.2.107

Abstract PDF

PURPOSE
We attempted to evaluate the clinical results of modified tension band wiring (MTBW) with additional K-wire fixation and suture for distal clavicle fracture.
MATERIALS AND METHODS
Fifty-nine patients with a distal clavicle fracture from May 2009 to December 2013 treated with MTBW were enrolled in this study. Their fracture types were type 2, 12; and type 3, 33; type 4, 8; and type 5, 6 according to Craig classification group II; average age was 47.2 years with a mean follow-up period of 27.9 months. The operations were performed within a mean of 3.1 days a fter t rauma. The c linical results were evaluated u sing University of California at Los Angeles scores (UCLA), American Shoulder and Elbow Surgeons scores (ASES) and Korean Shoulder Society scores (KSS) at 1 year after surgery.
RESULTS
Radiographic bone union was achieved at a mean of 3.7 months after the operation. In the last observation, their range of motion was forward flexion 159.0Â°, external rotation 59.8Â°, and internal rotation 4.3 points, and there were 2 cases of nonunion. Each average functional score was UCLA 31.3 points, KSS 91.6 points, and ASES 93.0 points.
CONCLUSION
For the surgical treatment of distal clavicle fractures, MTBW with additional K-wire fixation and suture is a useful technique allowing early range of motion exercises, minimizing soft tissue damage, and preserving the acromio-clavicular joint.

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Treatment Results for Unstable Distal Clavicle Fractures Using Hybrid Fixations with Finger Trap Wire and Plate
Jeong-Seok Yu, Bong-Seok Yang, Byeong-Mun Park, O-Sang Kwon
Journal of the Korean Orthopaedic Association.2022; 57(2): 135. CrossRef
Comparison of Locking Compression Plate Superior Anterior Clavicle Plate with Suture Augmentation and Hook Plate for Treatment of Distal Clavicle Fractures
Jun-Cheol Choi, Woo-Suk Song, Woo-Sung Kim, Jeong-Muk Kim, Chan-Woong Byun
Archives of Hand and Microsurgery.2017; 22(4): 247. CrossRef

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Results of Tension Band Wiring and Additional Circumferential Wiring in Treatment of Comminuted Patella Fracture: Young Min Lee, Kook Jin Chung, Ji Hyo Hwang, Hong Kyun Kim, Yong Hyun Yoon; J Korean Fract Soc 2014;27(3):206-212. Published online July 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.3.206

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the results of tension band wiring and additional circumferential wiring in treatment of comminuted patella fractures.
MATERIALS AND METHODS
A retrospective study of 67 patients with follow-up period longer than six months who underwent tension band wiring and additional circumferential wiring for comminuted patellar fracture from January 2004 to December 2012 was conducted. Analysis was based on radiological evaluation of bony union and articular surface displacement, and clinically by evaluating the postoperative function of the knee joint using the Levack scoring system.
RESULTS
Only one case out of 67 (1.5%) showed nonunion without metal breakage while good bone union was achieved in all other cases. Excluding the nonunion case, range of motion was 90 degrees minimum, 135 maximum, 129 on average. Average displacement was less than 2 mm, and 64 out of 67 cases showed satisfactory outcome with excellent functional score according to the Levack scoring system.
CONCLUSION
Tension band wiring and additional circumferential wiring technique for treatment of comminuted patella fractures can be considered as an effective treatment for achievement of good bone union and restoration of normal knee function.

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A Novel Technique in Comminuted Patella Fractures: Minimally Invasive Pericerclage Osteosynthesis Using Drainage Trocar
Fırat Fidan, Abdülkadir Polat, Cengiz Kazdal, Emre Bal
Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy.2022; 18(4): 427. CrossRef
Current Treatment Strategies for Patella Fractures
David J. Hak, Philip F. Stahel, Dustin J. Schuett, Mark E. Hake, Cyril Mauffrey, E. Mark Hammerberg, Philip F. Stahel, David J. Hak
Orthopedics.2015; 38(6): 377. CrossRef

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Tension Band Wiring for Distal Clavicle Fracture: Radiologic Analysis and Clinical Outcome: Seong Cheol Moon, Chul Hee Lee, Jong Hoon Baek, Nam Su Cho, Yong Girl Rhee; J Korean Fract Soc 2014;27(2):127-135. Published online April 30, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.2.127

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the radiologic and clinical outcomes after tension band wire fixation of Neer type II distal clavicle fractures.
MATERIALS AND METHODS
Twenty-six patients with Neer type II distal clavicle fractures who underwent tension band wire fixation from March 2002 to May 2011 were included in the study. Fifteen cases were classified as Neer type IIa and 11 cases as type IIb. The postoperative mean follow-up period was 14.3 months. Clinical and radiologic evaluation was performed at two weeks, six weeks, three months, six months, and 12 months postoperatively.
RESULTS
Bony union on X-rays was observed at an average of 11.7 weeks (range 8-20 weeks) postoperatively. The overall visual analogue scale score for pain was 1.23+/-2.75 postoperatively. The overall postoperative University of California at Los Angeles score increased to 33.5+/-2.15 from the preoperative score of 21.6+/-1.91 (p<0.05).
CONCLUSION
Among various methods of treatment for Neer type II distal clavicle fracture, K-wire and tension band fixation was used and relatively satisfactory radiological and clinical results were obtained. This surgical method yields excellent clinical results, owing to its relatively easy technique, fewer complications, and allowance of early rehabilitation.

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Clinical and Radiologic Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Kirschner's Wire Transfixation and Locking Hook Plate Fixation
Yong Girl Rhee, Jung Gwan Park, Nam Su Cho, Wook Jae Song
Clinics in Shoulder and Elbow.2014; 17(4): 159. CrossRef

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Circumferential Wiring Combined with Tension Band Wiring in the Operative Treatment of Patella Fracture: Jae Chun Sim, Sung Sik Ha, Ki Do Hong, Tae Ho Kim, Min Chul Sung; J Korean Fract Soc 2014;27(1):65-71. Published online January 31, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.1.65

Abstract PDF

PURPOSE
The purpose of this study is to evaluate the radiographic and clinical results of patella fractures using a circumferential wiring combined with tension band wiring.
MATERIALS AND METHODS
Between January 2005 and June 2012, 22 (male 14, female 8) patients with patella fracture treated with circumferential wiring combined with tension band wiring were analyzed retrospectively. The mean age of patients was 51 years (range, 28 to 72 years). Controlled passive range of motion exercise was started at three weeks from the postoperative day. The patients were evaluated using radiographs, clinical examination, and Levack's scoring system.
RESULTS
All fractures healed and mean time elapsed for union was 11.5 weeks (range, 10 to 14 weeks). Complete union without displacement and full range of motion was achieved in all cases. Clinical results according to Levack's scoring system were excellent in 20 cases and good in two cases. We found broken wire in one case. In this case, results of clinical evaluation after reoperation were good.
CONCLUSION
Circumferential wiring combined with tension band wiring is appropriate for patella fractures.

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Patellar fracture fixation using cannulated screws and Fiber Wire tension band
Elsayed M Bayomy, Mohamed Y Shaheen
Egyptian Orthopaedic Journal.2023; 58(1): 15. CrossRef

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Efficacy of Percutaneous Cerclage Wiring in Intramedullary Nailing of Subtrochanteric Femur Fracture: Technical Note: Ki Chul Park, Hee Soo Kim; J Korean Fract Soc 2013;26(3):212-216. Published online July 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.3.212

Abstract PDF

The subtrochanteric fractures of femur have high rates of delayed union or nonunion due to less-dense cancellous bone, insufficient cortical blood flow and high stress concentration. Anatomical reduction and rigid internal fixation are important in this region; however, an open reduction might damage the biological environment at the fracture site as well as increase the risk of nonunion. We present our experience with nine cases of subtrochanteric femur fractures surgically fixated with intramedullary nailing after percutaneous cerclage wiring through minimal incision.

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The stabilising effect by a novel cable cerclage configuration in long cephalomedullary nailing of subtrochanteric fractures with a posteromedial wedge
Pavel Mukherjee, Jan Egil Brattgjerd, Sanyalak Niratisairak, Jan Rune Nilssen, Knut Strømsøe, Harald Steen
Clinical Biomechanics.2019; 68: 1. CrossRef
Factors Affecting Time to Bony Union of Femoral Subtrochanteric Fractures Treated with Intramedullary Devices
Jung-Yoon Choi, Yerl-Bo Sung, Jin-Hee Yoo, Sung-Jae Chung
Hip & Pelvis.2014; 26(2): 107. CrossRef

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Anatomically Percutaneous Wiring Reduction in Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: Young Mo Kim, Chan Kang, Deuk Soo Hwang, Yong Bum Joo, Woo Yong Lee, Jung Mo Hwang; J Korean Fract Soc 2011;24(3):230-236. Published online July 31, 2011; DOI: https://doi.org/10.12671/jkfs.2011.24.3.230

Abstract PDF: PURPOSE
To report the method of anatomical reduction and its maintenance by percutaneous wiring reduction in minimally invasive plate osteosynthesis for distal tibial fractures.
MATERIALS AND METHODS
17 cases that were diagnosed oblique, spiral or transverse fracture of distal tibia from August 2007 to February 2010 and were able to anatomically reduce by the method of percutanous wiring reduction in minimally invasive plate osteosynthesis were included in this study. Mean age was 50, and mean follow up period was 18 months. We investigated the period until bone union was achieved, degree of angulation angle, and complications. For postoperative evaluation, Olerud and Molander ankle score and VAS pain score in daily living were checked.
RESULTS
The mean varus/valgus angulation after bone union on AP radiograph was 0.9 degrees and the mean anterior/posterior angulation on lateral radiograph was 2.0 degrees The mean Olerud and Molander ankle score was 89.4, and mean pain score due to walk adjacent to metal plate was 0 points.
CONCLUSION
By the method of percutaneous wiring reduction in distal tibial fracture, anatomical reduction is easily acquired, and only by wire itself, reduction could be maintained, so that without additional manual reduction, plate could be easily fixed.

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Cerclage Wiring in Internal Fixation of Displaced Acetabular Fractures: Chong Kwan Kim, Jin Woo Jin, Jong Ho Yoon, Sung Won Jung, Jung Wook Peang; J Korean Fract Soc 2008;21(2):95-102. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.95

Abstract PDF

PURPOSE
To evaluate the usefulness of wire fixation in displaced acetabular fractures.
MATERIALS AND METHODS
From January 2000 to December 2005, 19 cases of displaced acetabular fracture were treated with wire fixation. According to Letournel's classification there were 9 both column fracture, 5 transverse fracture, 3 anterior column with posterior hemitransverse and 2 T-type fracture. Only wire fixation in 13 cases and wire with plate or wire with screw fixation in 6 cases.
RESULTS
We evaluate the accuracy of reduction by Matta' criteria, anatomical reduction in 12 cases, incomplete reduction in 4 cases, poor reduction in 2 cases and surgical secondary congruence in 1 case. The clinical results showed excellent in 12 cases, good in 4 cases, fair in 2 cases and poor in 1 case. The radiological results showed excellent in 10 cases, good in 4 cases, fair in 3 cases and poor in 2 cases. There were 4 cases of complication; wound infection in 1case, post-traumatic arthritis in 1 case and heterotopic ossification in 2 cases.
CONCLUSION
The cerclage wiring is a preferable method in internal fixation of displaced acetabular fractures that can facilitate reduction and achieve stable fixation.

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Cerclage Clamping Using Cerclage Passer for Reduction of Anterior and Posterior Column Fracture
Ki Chul Park, Hyun Joong Cho, Hun Chul Kim, Kyung-Sik Min, Hae Won Jeong
Journal of the Korean Orthopaedic Association.2016; 51(6): 486. CrossRef
Comparative Results of Acetabular Both Column Fracture According to the Fixation Method
Kyung-Jae Lee, Byung-Woo Min, Eun-Seok Son, Hyuk-Jun Seo, Jin-Hyun Park
Hip & Pelvis.2011; 23(2): 131. CrossRef

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Double Tension Band Wiring for Olecranon Fractures: Suk Kang, Chung Soo Hwang, Phil Hyun Chung, Young Sung Kim, Jin Wook Chung, Jong Pil Kim; J Korean Fract Soc 2008;21(2):130-134. Published online April 30, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.2.130

Abstract PDF

PURPOSE
To evaluate the clinical results of double tension band wiring for communited olecranon fractures involving proximal 1/3.
MATERIALS AND METHODS
We reviewed 9 cases of communited olecranon fractures involving proximal 1/3 treated with double tension band wiring followed for minimum 10 months. There were 2 cases of olecranon fractures involving only proximal 1/3, 6 cases of olecranon fractures involving from proximal 1/3 to middle 1/3 and 1 case of olecranon fractures involving from proximal 1/3 to distal 1/3. We analyzed the bone union time, radiologic results for gap, reduction loss, pin migration, pain, range of motion, complications and functional outcomes at last follow up.
RESULTS
All patients had solid bone union without additional surgery and average union time was 10.3 weeks. Anatomical reduction could be obtained in 8 of 9 cases but there was 1 mm step off in one case. 36 pins were used to fix the fractures, 1 pin of 18 distal pins and 2 pins of 18 proximal pins were migrated to backward but there was no reduction loss. Only 1 distal pin needed early removal due to skin irritation. Average range of motion ranged from flexion contracture 3.3 degrees to further flexion 137.8 degrees. On functional analysis, we got 8 cases of good result, 1 case of fair result and there was no poor result.
CONCLUSION
Double tension band wiring for comminuted olecranon fracture involving proximal 1/3 was concluded to give a firm fixation of the fracture site as bone union could be acquired without serious pin problems.

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Treatment of Olecranon Fractures with Proximal Ulna Comminution Using Locking Compression Plates
Ki-Do Hong, Tae-Ho Kim, Jae-Cheon Sim, Sung-Sik Ha, Min-Chul Sung, Jong-Hyun Jeon
Journal of the Korean Fracture Society.2015; 28(1): 59. CrossRef
Olecranon Nonunion after Operative Treatment of Fracture
Ho-Jung Kang, Ji-Sup Kim, Myung-Ho Shin, Il-Hyun Koh, Yun-Rak Choi
Journal of the Korean Fracture Society.2015; 28(1): 30. CrossRef

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Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients: Duk Hwan Kho, Ju Yong Shin, Ki Hwan Kim, Jun Hyuck Lee, Dong Heon Kim; J Korean Fract Soc 2007;20(2):129-134. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.129

Abstract PDF

PURPOSE
To evaluate the results after fixation with figure of eight and cerclage wiring for comminuted trochanteric fracture. Because comminution of the femoral trochanteric fracture in elderly patients is severer in the operating field than x-ray findings, so the fixation is more difficult.
MATERIALS AND METHODS
Between March 1998 and March 2004, the clinical records on twenty-eight patients more than 70 years old who underwent the bipolar hemiarthroplaty using calcar replacement type of femoral stem and followed more than 24 months were reviewed. Figure of eight and cerclage wiring was used for the comminuted trochanteric fracture of the femoral intertrochanteric fracture. The mean age was 80.4 (70~103) years. 19 cases were female, 9 cases were male. Mean follow-up period was 58 (24~92) months. We evaluated the results by modified Harris hip score, walking ability, activity of daily living, radiologic findings and union of the fracture.
RESULTS
The mean duration of bony union was 12 weeks. The mean postoperative modified Harris hip score was 82.3. Preoperative walking ability was recovered in 23 cases (82%). Also basic activity of daily living was recovered in 22 cases (79%). Nonunion of trochanter was found in only one case by radiologic evaluation but clinical correlation was not significant.
CONCLUSION
We consider fixation with figure of eight and cerclage wiring for unstable intertrochanteric fracture of femur in the elderly patient is more appropriate in terms of convenience of fixation, duration of union, early ambulation and cost effectiveness.

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Outcomes of dynamic hip screw augmented with trochanteric wiring for treatment of unstable type A2 intertrochanteric femur fractures
Chetan Puram, Chetan Pradhan, Atul Patil, Vivek Sodhai, Parag Sancheti, Ashok Shyam
Injury.2017; 48: S72. CrossRef
Fixation of Greater Trochanter Using an AO Trochanteric Reattachment Device (AO TRD) in Arthroplasty for Intertrochanteric Femur Fracture of Elderly Patients
Weon-Yoo Kim, Young-Yul Kim, Jae-Jung Jeong, Do-Joon Kang
Hip & Pelvis.2013; 25(4): 274. CrossRef
Bipolar Hemiarthroplasty Using the Greater Trochanter Reattachment Device (GTRD) for Comminuted Intertrochanteric Femur Fracture in Elderly Patients
Jin-Wan Kim, Young-Chul Ko, Chul-Young Jung, Il-Soo Eun, Hyeon-Soo Choi, Ok-Gul Kim, Young-June Kim
Journal of the Korean Fracture Society.2009; 22(4): 232. CrossRef

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Modified Phemister Technique with Tension Band Wiring in Acromioclaviculr Joint Dislocation: Yu Jin Kim, Hun Kyu Shin, Ji Won Lee; J Korean Fract Soc 2006;19(4):431-436. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.431

Abstract: PURPOSE
To evaluate the clinical and radiological result of surgical treatment of acromioclavicular joint dislocation, using modified Phemister technique with tension band wiring.
MATERIALS AND METHODS
We chose 17 patients who were able to follow up 1 year or more among the patients who were diagnosed as acromioclavicular joint dislocation in our hospital through January 2000 to Feburary 2005 and took modified Phemister technique with tension band wiring. Evaluation of the surgical results was done with the condition of pain, activity of daily living, range of motion, muscle tone by constant score system, and with preoperative, postoperative and last follow up radiographs.
RESULTS
Clinical evaluation was average 92 point by Constant score system from 84 point to 100 point. Subjective evaluation was 11 excellent (65%), 6 good (35%). Radiological evaluation was 9 excellent (54%), 6 good (38%), 2 fair (12%), and no poor group. On the final follow up, two cases showed inflammatory reaction at where pins were inserted, but after the removal of the pins, the inflammation was subsided.
CONCLUSION
The modified Phemister surgery for acromioclavicular dislocation is one of effective techniques, we can obtain firm fixation, exercise full range of motion early and there is no complication of re-dislocation.

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The Treatement of the Unstable Proximal Humerus Fracture Using Bifurcate Angled Blade Plate with Tension Band Wiring: Kuen Tak Suh, Hyoung Lok Roh, Myung Soo Youn, Jung Sub Lee; J Korean Fract Soc 2006;19(4):424-430. Published online October 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.4.424

Abstract

PURPOSE
To evaluate the results of internal fixation with bifurcate angled blade plate and tension band wiring of greater tuberosity or rotator cuff for the unstable proximal humerus fracture.
MATERIALS AND METHODS
Nineteen cases of unstable proximal humerus fracture who were followed up for more than 1 year were treated using bifurcate angled blade plate and tension band wiring between March 2003 and March 2005. Average age of the patients was 46.5 years (range, 24 to 69), and there were 9 male and 10 female patients. The radiological results were evaluated by bony union and neck shaft angle. In addition, the clinical results were evaluated by Neer's evaluation criteria.
RESULTS
In 18 out of 19 cases, bony union was obtained in average 12.5 weeks after operation. The neck shaft angles of sixteen cases were between 120 and 140 degrees by Paavolainen method. According to Neer's evaluation criteria, 17 cases showed excellent or good results.
CONCLUSION
The patients treated using bifurcate angled blade plate and tension band wiring could exercise earlier because of good initial stability. Also, the radiological and clinical results were relatively good. The treatment of unstable proximal humerus fracture with bifurcate angled blade plate and tension band wiring was considered as a good method.

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Hemiarthoplasty with Bone Block Graft and Low Profile Prosthesis for the Comminuted Proximal Humerus Fractures
Chung Hee Oh, Joo Han Oh, Sae Hoon Kim, Ki Hyun Jo, Sung Woo Bin, Hyun Sik Gong
Journal of the Korean Fracture Society.2008; 21(3): 213. CrossRef

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Treatment of Displaced Transverse Patellar Fractures with Cannulated Screws and Figure-Eight Wiring: Shin Kwon Choi, Dong Kil Ham, Moon Sup Yim, Kwang Yul Kim, Hung Sup Shin; J Korean Fract Soc 2005;18(2):149-154. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.149

Abstract PDF

PURPOSE
To evaluate the radiographic and clinical results of displaced transverse patellar fractures using a tensioned anterior figure-eight wire placed through two cannulated screws MATERIALS AND METHODS: 9 patients with displaced transverse patellar fractures treated with cannulated screws and figure-eight wiring were analyzed retrospectively. The mean age was 53 years (range, 22 to 68 years). Controlled passive range of motion exercise were started on the first postoperative day. Full weight bearing was allowed as tolerated. The patients were evaluated with radiographs, clinical examination and Levack's scoring system.
RESULTS
All fractures healed and mean time elapsed for union was 9.4 weeks (range, 8 to 12 weeks). All patients regained full knee range of motion. Clinical results according to the Levack's scoring system were excellent in 8 cases and good in 1 case. We found no complications like loss of reduction and soft tissue irritation caused by the wire and screw, loosening or migration of hardware.
CONCLUSION
Anterior figure-eight wiring through paired cannulated screws is appropriate for transverse patellar fractures, is possible early knee motion exercise and weight bearing.

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Results of Tension Band Wiring and Additional Circumferential Wiring in Treatment of Comminuted Patella Fracture
Young Min Lee, Kook Jin Chung, Ji Hyo Hwang, Hong Kyun Kim, Yong Hyun Yoon
Journal of the Korean Fracture Society.2014; 27(3): 206. CrossRef

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Treatment of Comminuted Femoral Shaft Fracture by Interlocking Intramedullary Nailing: Comparision of results between open reduction with cerclage wiring and closed reduction: Jeung Tak Suh, Hyoung Lok Roh, Jeung Il Kim, Chong Il Yoo; J Korean Fract Soc 2005;18(1):6-11. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.6

Abstract PDF: PURPOSE
To compare of results between open interlocking intramedullary nailing combined with cerclage wiring and closed interlocking intramedullary nailing in treatment of femoral shaft comminuted fracture, we reviewed retrospectively 62 femoral shaft fractures.
MATERIALS AND METHODS
We reviewed retrospectively 62 femoral shaft comminuted fractures, who had been followed up for a minimum one year including Winquist-Hansen classification II, III, IV from January 1996 to December 2002. The group I include the patients who treated with closed interlocking intramedullary nailing. The group II include the patients who treated with open interlocking intramedullary nailing combined with cerclage wiring.
RESULTS
The average bone union time was 18.6 weeks in group I, 27.6 weeks in group II. The complication included 3 delayed unions, 1 nonunion and shortening of more than two centimeters in 1 patents in group I. In group II, The complication included 2 infections, 7 delayed unions and 3 nonunions.
CONCLUSION
We can use open interlocking intramedullary nailing with cerclage wiring in some femur shaft comminuted fractures, but there are many problems and complications. So we must consider it carefully before using this method.

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Modified Tension Band Wiring using Cortical Screw for Medial Malleolar Fractures: Ho Rim Choi, Hyun Woo Doh, Byoung Heum Kim, Kyou Hyeun Kim, Jong Seok Park, Joon Min Song; J Korean Fract Soc 2004;17(4):319-322. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.319

Abstract PDF: PURPOSE
To evaluate the clinical results of modified tension band wire technique using cortical screw for treatment of displaced medial malleolar fractures of the ankle.
MATERIALS AND METHODS
From January 2001 to January 2003, 24 patients were treated by modified tension band wiring using cortical screw for medial malleolar fracture. The follow-up period was 12~35 months (average 18 months). There were 13 males and 11 females, and the mean age was 46 years. Fractures were classified by Lauge-Hansen's classification. The results were analyzed by Meyer and Kumler's criteria.
RESULTS
There were 13 cases (54%) of excellent, 9 cases (38%) of good, and one case of fair because of limitation of motion of the ankle joint and one case of poor which showed post-traumatic arthritis of the ankle.
CONCLUSION
Modified tension band wire technique using cortical screw can be an effective operative method for the treatment of displaced medial malleolar fractures of the ankle.

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The Treatment of Patellar Fracture with Modified Tension Band Wiring, using Cannulated Screws: Chul Won Ha, Jong Il Sun; J Korean Fract Soc 2004;17(2):117-121. Published online April 30, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.2.117

Abstract PDF

PURPOSE
We have followed up the patients of the patellar fracture who had been treated with modified tension band wiring using cannulated screws. Since we have seen excellent clinical results, we would like to show the practical use of this operative method.
MATERIALS AND METHODS
We analyzed the operation time, the time elapsed for union, and complications of 9 cases of the patellar fracture who were treated with this operative method at our hospital recently.
RESULTS
Mean operation time (from the incision to the skin suture) was 68.3 min (40~120 min) and mean time elapsed for union was 9.7 weeks (8~12 wks). Mean time for full range of motion was 1 week in 5 cases of transverse fracture, 3 weeks (2~4 wks) in 3 cases of comminuted fracture. We found no complications like limitation of range of motion of the knee, loss of the reduction, irritation and migration of the hardware, and infection.
CONCLUSION
This surgical technique provides stable fixation, allowes early motion excercise by minimizing injury to extensor mechanism and accompanies reduced rate of complications such as loss of the reduction, irritation or displacement of the hardware

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Evolution in the Management of Patella Fractures
Mahak Baid, Sid Narula, Jonathan R. Manara, William Blakeney
Journal of Clinical Medicine.2024; 13(5): 1426. CrossRef
Results of Tension Band Wiring and Additional Circumferential Wiring in Treatment of Comminuted Patella Fracture
Young Min Lee, Kook Jin Chung, Ji Hyo Hwang, Hong Kyun Kim, Yong Hyun Yoon
Journal of the Korean Fracture Society.2014; 27(3): 206. CrossRef
Treatment of Transverse Patellar Fracture with Cannulated Screws
Jung-Man Kim, Ju-Seok Yoo, Yong-Jin Kwon, Jang-Ok Cheon
Journal of the Korean Fracture Society.2007; 20(2): 149. CrossRef

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Treatment of Distal Clavicle Type II Fracture using K-Wires and Tension Band Wiring: Whan Yong Chung, Woo Suk Lee, Taek Soo Jeon, Dae Hwan Kim, Kwang Kyoon Kim, Jae Woo Lim; J Korean Soc Fract 2003;16(2):215-221. Published online April 30, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.2.215

Abstract PDF

PURPOSE
This is a retrospective study to analyze the clinical results of the usefulness of K-wires and tension band wiring that fix the fracture fragment directly without passing the acromioclavicular joint in distal clacivle type II fractures.
MATERIALS AND METHODS
From May 2000 to May 2001, eleven patients with distal clavicle type II fracture were treated by open reduction and internal fixation with K-wires and tension band wiring. The clinical results were analyzed according to modified shoulder rating scale for distal clavicle freacture. Radiological union, complication, and range of motion of the shoulder were assessed.
RESULTS
All fractures were united at 10 weeks (8~12 weeks) in average. Finally, full range of motion of the shoulder joint was achieved in all patients. No complication was found and the modified shoulder rating scale for distal clavicle fracture were as follows: excellent 9 and good 2.
CONCLUSION
K-wires and tension band wiring can be a good treatment method for distal clavicle type II fractures.

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Tension Band Wiring for Distal Clavicle Fracture: Radiologic Analysis and Clinical Outcome
Seong Cheol Moon, Chul Hee Lee, Jong Hoon Baek, Nam Su Cho, Yong Girl Rhee
Journal of the Korean Fracture Society.2014; 27(2): 127. CrossRef

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Modified Tension Band Wiring using Cortical Screw for Displaced Medial Malleolar Fractures: Jong Oh Kim, Sang Hun Ko; J Korean Soc Fract 2002;15(4):459-464. Published online October 31, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.4.459

Abstract PDF: PURPOSE
To evaluate the clinical results of minimal incision and modified tension band wiring using 3.5mm cortical screw in the treatment of ankle fracture including displaced medial malleolar fractures MATERIALS AND METHODS: From March 1997 to May 2001, 77 patients were treated by modified tension band wiring using minimal incision about 4cm for medial malleolar fracture.
RESULTS
According to Lauge-Hansen classification, there were 47 supination-external rotation type fractures (61%), 14 supination -adduction type fractures (18.2%), 10 pronation-external rotation type(12.9%), 6 pronation-abduction type fracture(7.8%). The average time to union was 12.5weeks. In the functional outcome (according to Meyer and Kumler), 71 patients(92%) showed excellent results.
CONCLUSION
We concluded that modified tension band wiring using cortical screw proved effective fixation method in the treatment of the displaced medial malleolar fracture. The merits of this procedure are minimal incision about 4cm and preservation of blood supply on suprafracture area due to not injuried periosteum, stable fixation and early range of motion of joint, simple procedure and reduced surgical time.

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A Comparison of Interlocking Nail with Wiring versus Plate Fixation in Long Oblique or Spiral Fractures of Humeral Shaft: Phil Hyun Chung, Sang Ho Moon; J Korean Soc Fract 2000;13(3):555-561. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.555

Abstract PDF: PURPOSE
To compare functional results between interlocking intramedullary nail with wiring and plate for treating long oblique or spiral diaphyseal fractures of humerus.
MATERIALS AND METHODS
From April 1996 to February 1999, 9 long oblique or spiral fractures were treated with antegrade humeral locked nails and wiring after minimal open reduction, and another 9 fractures were fixed with plate and screws. Average age of patients was 45.8 years and average follow-up was 13.5 months.
RESULTS
Nail group showed earlier clinical and radiologic union than plate and screw group. All patients with plate and screw group(plate fixation) had clinical union within 5.8+/-2.5 weeks and radiologic union within 8.5+/-2.1 weeks. But, all patients with wiring had clinical union within 2.8+/-0.6 weeks and radiologic union within 5.5 +/-1.6 weeks. At last follow-up, average range of shoulder motion in plate group was larger than nailing group, but that was stastically insignificant. Plate fixations had more complications than nailing, for example, deep infection, non-union, implant failure and radial nerve injury.
CONCLUSION
Interlocking intramedullary nail with wiring has the advantages of minimal tissue trauma and scar formation, sufficient reduction and fixation, early union and fewer complication. So it can be a worthy alternative for the treatment of long oblique or spiral fractures of humerus.

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Arthroscopic Treatment of The Tibial Intercondylar Eminence Fractures: Han Chul Kim, Beom Kim; J Korean Soc Fract 2000;13(3):488-493. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.488

Abstract PDF: PURPOSE
To compare operative results between pull-out wiring and retrograde screw fixation for displaced tibial intercondylar eminence fracture.
MATERIALS AND METHODS
From March 1997 to February 1999, authors carried out pull-out wiring in 3 patients and retrograde screw fixation in 5 patients who sustained typeII and typeIII displaced tibial intercondylar eminence fractures follow up for 16 months(mean).
RESULTS
The Union time was mean 7 wk in pull-out wiring and 6.5 wk in retrograde screw fixation. Limitation of knee motion(1 case) developed in retrograde screw fixation group and reoperated for adhesiolysis. Pull-out wiring group were all full motion recovered. Anterior instability(1 case) developed in retrograde screw fixation group and pull-out wiring group had no instability. Operation time for retrograde screw fixation group was mean 98min and pull-out wiring group was 105 min.
CONCLUSION
The outcome of pull-out wiring group were superior to retrograde screw fixation group. It can be stably fixed and allow early motion exercise. Besides, in case of small bony fragment, it is difficult for fixation with screw. And even impossible. In child cases, the multiple percutaneous pinning can lead to good result. So authors believe that pull-out wiring is worthy for tibial intercondylar eminence fracture.

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Treatment of Acetabular Fracture with Wire: Chang Soo Kang, Dong Hwa Woo, Doo Hwan Oh; J Korean Soc Fract 2000;13(3):432-439. Published online July 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.3.432

Abstract PDF: PURPOSE
To evaluate the clinical and radiological results of wire fixation for acetabular fracture and its merits.
MATERIALS AND METHODS
From 1996 Jan. to 1998 Dec., 18 cases of being fixed by wire among 42 cases who being treated by surgical method were analyzed. We evaluated these cases after a mean follow up of 2.1 years. The fixation was done by wires in 11 cases, wires with plate in 3 cases and wires with screw in 4 cases.
RESULTS
According to Epstein's criteria, favorable results were achieved in 15 cases(83.3%) on clinical grade and 14 cases(77.7%) on radiographic grade.
CONCLUSION
The results of this study suggest that open reduction and internal fixation with wire is preferable method that can permit early ambulation, decrease postoperative complication and achieve firm fixation, comparing with open reduction and internal fixation with plate and screws, in treatment of displaced acetabular fractures.

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Treatment of patellar Fractures with Modified Tension Band Wiring: Myung Hwan Son, Byung Chul Kim, Nam Wook Kang, Tae Young Choi; J Korean Soc Fract 1999;12(4):872-878. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.872

Abstract PDF

The aim of treatment of patellar fracture is the restoration of knee joint function and quadriceps muscle power. Comminuted and displaced fracture of the patella, which are difficult to reduce accurately and to get stable internal fixation, may lead to traumatic osteoarthritis, chondromalacia, limited ROM of the knee joint. In this series, we treated 29 cases of displaced transverse and comminuted fractures with modified tension band wiring. In severely comminuted fractures, the fragments were indirectly reduced by cerclage wire and then fixed with modified tension band wiring. We could obtain stable fixation and early ROM of the knee joint. There were 5 complications including wire breakage and wire loosening. In this respect, we concluded that modified tension band wiring was a good method for displaced transverse and comminuted patellar fracture.

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Circumferential Wiring Combined with Tension Band Wiring in the Operative Treatment of Patella Fracture
Jae-Chun Sim, Sung-Sik Ha, Ki-Do Hong, Tae-Ho Kim, Min-Chul Sung
Journal of the Korean Fracture Society.2014; 27(1): 65. CrossRef

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Operative Treatment of patellar Fractures: Chang Kwan Kim, Jeong Hwan Kim, Sang Yup Lee, Young Hwan Kim, Chae Ik Chung, Jeong Gee Hong; J Korean Soc Fract 1999;12(4):858-864. Published online October 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.4.858

Abstract PDF: We studied 45 patients of patella fracture who were treated by surgical method from March 1990 to December 1991. The results were analysed to evaluate the functional results of the knee according to methods of fixation and severity of comminution. The results were as follows. 1. Out of 45 cases, 11 cases were tredted by tension band wiring, 19 cases by modified tension band wiring, 5 cases by tension band wiring by circumferential wiring, 8 cases by circumferential wiring, and 2 cases by screw fixation. 2. The mean fracture healing period was 6.9 weeks in cases of tension band wiring, 6.5 weeks in cases of modified tension band wiring, 5.2 weeks in cases of tension band wiring with circumferential wiring, and 7.3 weeks in cases of circumferential wiring. 3. The most favorable result was obtained in cases which were fixed with tension band wiring and circumferential wiring. 4. Modified tension band wiring seems to be a good method for displaced transverse fracture and comminuted fracture with large fragments and tension band wiring with circumferential wiring is for severely comminuted fracture with small fragments.

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Operative Treatment of Fracture of the Body of the Scapula: Moon Gu Choi, Hyoung Min Kim, Youn Soo Kim, Kee Haeng Lee, Chang Hoon Chung, Kwang Yeol Lee; J Korean Soc Fract 1999;12(3):698-703. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.698

Abstract PDF: PURPOSE
Although fracture of the body of the scapula have been treated successfully by conservative treatment but residual deformity was high and related to the residual symptom. Authors had done open reduction and internal fixation with wiring in the case of severe displacement of the fracture fragment of the body of scapula and analyzed that results. MATERIAL AND METHODS: Authors treated 18 cases of fracture of the body of the scapula in 17 patients from October, 1985 to June, 1996. Conservatively treated group was 12 cases which has less than 2cm displacement and operatively treated group was 6 cases which has more than 2cm displacement of the fracture fragment. Internal fixation was done with wiring. All cases was followed up average 1 year 9 months(from 13 months to 8 year 8 months) and evaluated by McGinnis assessment system.
RESULTS
All cases united within ten weeks. Five cases in the operatively treated six cases got anatomic reduction and stable fixation with wiring and had no operation related complication. Operatively treated group has average 2.83 associated injury and conservatively treated group has average 1.87 Neurovascular complication compromised the results.
CONCLUSION
Operative treatment of the fracture of the scapular body can reduce the residual deformity and residual symptom in the severely displaced case and facilitate early rehabilitation.

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Surgical Treatment of Comminuted Interior Patellar Pole Fractures by Separate Vertical Wirings: A New Method of Internal Fixation: Young Soo Byun, Hong Tae Kim, Chan Hoon Yoo, Hyun MiH Kim, Yeon Min Park, Sang Chul Shin; J Korean Soc Fract 1999;12(3):584-592. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.584

Abstract PDF: The inferior pole fragments of patellar fractures should be reduced anatomically whenever possible because any resection of the inferior pole fragments results in patella baja and abnormal patellofemoral biomechanics. However, there are still no effective methods of stable fixation for comminuted inferior patellar pole fractures. The purpose of this study is to introduce a new method of internal fixation of separate vertical wirings for comminuted inferior patellar pole fractures and to present the results of the wirings. Thirteen patients with comminuted inferior patellar pole fracture were treated with 2 to 4 separate vertical wirings, which provided the sufficient strength to allow early motion without loss of reduction during fracture healing. All the fractures were healed in anatomical position and all the patients regained full range of motion of the knee. Loss of fixation occurred in a patient by foiling on the ground, but the fracture was healed by the wirings again. There were no patients with radiographic evidence of posttraumatic osteoarthritis at the final follow-up. Overall result was rated as excellent in all the patients. The results of this study indicate that separate vertical wirings are an effective method of stable fixation enough to allow early motion without loss of reduction during fracture healing for comminuted inferior patellar pole fractures.

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