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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Intra-Articular Alterations after Suprapatellar Nailing in Tibial Shaft Fractures: An Arthroscopic Evaluation: GwangChul Lee, Sung Hun Yang, Sung Min Jo, Jeong Min Kook; J Korean Fract Soc 2022;35(4):129-134. Published online October 31, 2022; DOI: https://doi.org/10.12671/jkfs.2022.35.4.129

Abstract PDF: Purpose
This study attempted to study the intra-articular changes due to intramedullary nailing through the suprapatellar approach by evaluating the joint cartilage damage and presence of foreign bodies through a comparison of the pre- and post-operative status evaluated by knee arthroscopy.
Materials and Methods
This retrospective study analyzed fifteen patients who underwent intramedullary nailing through the suprapatellar approach for proximal tibial shaft fracture from January 2017 to March 2020. The condition of the joint cartilage and the presence of foreign substances in the patellofemoral joint were evaluated. The cartilage status of the patellofemoral joint was evaluated using the International Cartilage Repair Society (ICRS) grading system. Data from the ICRS grading and the visual analogue scale (VAS) scores of the femoral and patellar cartilage were compared to each independent variable surveyed.
Results
All the intra-articular structures before nailing were normal. In all cases after nailing, articular cartilage damage of the patellofemoral joint and intra-articular debris were observed. The average VAS score was 0.6 (0-1) before surgery and 2.27 (0-4) after surgery. There were no statistically significant differences except for the correlation in the diameter of the tibia nail and femoral ICRS grade (p=0.001) and the damage to the cartilage was greater in the femoral cartilage than that to the patella (p=0.001).
Conclusion
Intra-articular damage appears to be unavoidable in suprapatellar nailing. Further research is needed on the long-term effects of intra-articular damage and on methods to reduce this damage.

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Acute Patellar Osteomyelitis in a Child after a Blunt Trauma: Case Report: Hoe Jeong Chung, Doo Sup Kim, Jun Seop Yeom, Young Hwan Jang; J Korean Fract Soc 2016;29(4):270-275. Published online October 31, 2016; DOI: https://doi.org/10.12671/jkfs.2016.29.4.270

Abstract PDF

Osteomyelitis of the patella is a very uncommon condition that occurs mostly in the pediatric population. In addition to its rarity, nonspecific and variable clinical presentations usually lead to postponement in making the correct diagnosis. Moreover, it is often missed as prepatellar bursitis or septic arthritis of the knee. Nonetheless making early diagnosis and initiating prompt treatment is most important to preventing this condition from becoming chronic. In this case report, the authors encountered this rare condition of the patella in a child that was first misdiagnosed with pyogenic arthritis or prepatellar bursitis of the knee. The delay in making the diagnosis led to intractable progression of the disease, and sequestrectomy was required to stabilize the condition.

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Osteomyelitis of the Patella With Extension Into Parapatellar Soft Tissues in a Six-Year-Old Boy: A Case Report
Abdulla Abdelwahab, Faatimah Irfaanah Muzammil, Abdulla Nidal, Mason Alnouri, Sattar Alshryda
Cureus.2024;[Epub] 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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Pulmonary Embolism Complication after Surgical Treatment of Patella Fracture: A Case Report: Yong Beom Kim, Hyung Suk Choi, Dong Ill Chun, Jung Moo Seo, Byung Ill Lee; J Korean Fract Soc 2014;27(2):162-166. Published online April 30, 2014; DOI: https://doi.org/10.12671/jkfs.2014.27.2.162

Abstract PDF: Deep vein thrombosis and pulmonary embolism are serious and fatal complications in orthopedic surgery. Most cases of symptomatic pulmonary embolism in knee surgery have been reported after total knee arthroplasty, but rarely after patella fracture. We report on a case of symptomatic pulmonary embolism after surgical treatment of a patella fracture in a 42-year-old female patient.

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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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Modified Tension Band Wiring Combined with Anti-Gliding Loop Augmentation Technique for the Treatment of Comminuted Patellar Fracture: Technical Note and Report of Early Results: Technical Note: Han Jun Lee, Jae Jun Yang, Ho Joong Jung, Hyoung Seok Jung; J Korean Fract Soc 2013;26(4):321-326. Published online October 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.4.321

Abstract PDF: In order to investigate the feasibility of a modified tension band combined with anti-gliding loop augmentation technique for the treatment of comminuted patellar fracture, 21 patients with comminuted patellar fracture were enrolled in this study. After the modified tension band wiring of patellar fracture, a cerclage wire was passed around the patella. Anti-gliding loops were made on the bending sites of Kirshner-wires. A knot was tied using both ends of the anti-gliding loops, and the cerclage wire was tightened using proximal knots. Bone union was achieved at 4.5+/-1.5 months postoperatively without nonunion. The Lysholm score was 87.1+/-2.8, and the range of motion of the knee was 2.1degrees+/-3.4degrees to 132.2degrees+/-6.5degrees at the last follow-up. The modified tension band combined with anti-gliding loop augmentation technique might be considered an alternative modification of modified tension band wiring for the treatment of comminuted patellar fracture.

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Heterotopic Ossification around Patellar Tendon Following Treatment of Patellar Fracture: A Case Report: Sang Jin Lee, Ji Wan Kim, Dong Hyun Lee, Jae Young Lim; J Korean Fract Soc 2013;26(1):73-76. Published online January 31, 2013; DOI: https://doi.org/10.12671/jkfs.2013.26.1.73

Abstract PDF: Heterotopic ossification around the patellar tendon is known to be extremely rare. A 42-year-old man had a transverse fracture of the left patella. Open reduction and tension band wiring were performed. At four weeks, plain radiographs showed an extensive ossification around the patellar tendon and the patient presented limitation of flexion and pain in kneeling position. We just encouraged active and passive ranges of motion exercises and performed one manipulation under anesthesia. At the final follow-up (10 months post-operatively), he was able to flex his knee by 140 degrees. We present a case of heterotopic ossification around the patellar tendon with limitation of knee flexion that was successfully treated with nonoperative treatment.

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Alteration of the Patella Tendon Length after Intramedullary Nail in Tibial Shaft Fractures: Dong Eun Shin, Ki Shik Nam, Jin Young Bang, Ji Hoon Chang; J Korean Fract Soc 2012;25(4):283-287. Published online October 31, 2012; DOI: https://doi.org/10.12671/jkfs.2012.25.4.283

Abstract PDF: PURPOSE
To compare and analyze length change of patella tendon after intramedullary nailing of tibial shaft fracture using transtendinous approach.
MATERIALS AND METHODS
Thirty-two cases were analyzed from December, 1999 to December, 2005. Insall Salvati ratios were estimated. Severity of initial trauma, duration of nail retension, knee function and pain on change of length of patellar tendon was evaluated.
RESULTS
Mean duration of nail retention was twenty-two months. The shortening of patella tendon was observed in 25 cases (p<0.001). The effect of AO type and the duration of nail retension on the decrease of Insall Salvati ratio was not significant (p>0.05, p=0.778). Lysholom score decrease to 89.5. There was no significant difference between the shortening of patellar tendon length and knee pain (p=0.058).
CONCLUSION
After intramedullary nailing for closed tibia fracture, shortening of patellar tendon length is observed. That is irrelevant to the fracture type and the duration of nail retension. The shortening of patella tendon length may contribute to decreasing of knee function, but it was no significance of knee pain after intramedullary nailing.

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Treatment of Transverse Patellar Fracture with Cannulated Screws: Jung Man Kim, Ju Seok Yoo, Yong Jin Kwon, Jang Ok Cheon; J Korean Fract Soc 2007;20(2):149-153. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.149

Abstract PDF

PURPOSE
To assess the indication and effect of screw fixation in the transverse patellar fractures.
MATERIALS AND METHODS
We analysed the results of 14 transverse patellar fractures fixed with screws from January 1991 to May 2005. Mean follow-up period was 47 months (range, 12~143 months). We analysed the radiologic union, operation time, ROM and postoperative Lysholm score.
RESULTS
All fractures healed uneventfully. The mean displacement was decreased from 2.2 mm preoperatively to 0.3 mm postoperatively (p=0.001, Wilcoxon signed rank test). The mean operation time was 34 minutes (range, 20 to 60 minutes). Normal range of motion was achieved in 13 knees (92.9%). Average Lysholm score was 95.9 at final follow-up.
CONCLUSION
Screw fixation seemed to be useful for treatment of transverse patellar fracture even in comminuted fractures with large fragments. The advantage of this technique was the preservation of extensor mechanism, simplicity, short operation time and good cosmesis.

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Surgery of patellar fractures using a medial parapatellar approach
Yong-Cheol Yoon, Jae-Ang Sim, Jin-Hun Hong
Journal of Orthopaedic Surgery.2017;[Epub] 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

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Transverse Fracture through Screw Site after Cannulated Screw Fixation in Vertical Patella Fracture: A Case Report: Suk Kang, Phil Hyun Chung, Chung Soo Hwang, Jong Pil Kim, Young Sung Kim, Chong Suck Parke; J Korean Fract Soc 2006;19(1):96-99. Published online January 31, 2006; DOI: https://doi.org/10.12671/jkfs.2006.19.1.96

Abstract

Many complications after operative treatment of patella including redisplacement of fracture, refracture, weakness of extensor muscles, patellofemoral joint arthritis, metal failure, malunion, infection, avascular necrosis were reported. We report a case of transverse fracture of patella through the cannulated screw fixation site used to fix previous vertical patella fracture with a review of the literatures.

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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 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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Operative Treatment of Patellar Fractures: Dong Hui Kim, Jung Man Kim, In Jun Koh; J Korean Fract Soc 2004;17(4):314-318. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.314

Abstract PDF

PURPOSE
To establish a general guide line in the treatment of the patellar fracture MATERIALS AND METHODS: Twenty three patellar fractures followed for 2.2 years in average, treated with internal fixation were evaluated retrospectively. The primary fixations were the metal screw fixation in 7, the Dall-Miles' cable circumferential fixation in 14 and combination of both methods in 2 cases. The additional fixations were the tension band wiring in 9, the load sharing cable fixation in 3 and combination of both methods in 5 cases. The initial postoperative immobilazation of the knee joint in flexion, preferably 90degrees, for 7 days was effective to gain full range of motion RESULTS: Complete union without displacement was achieved in all cases. Full ROM was achieved in all cases except one.
CONCLUSION
The choice of internal fixation need to be individualized according to the level of comminution, bone strength, fracture site and soft tissue damage. A strong internal fixation, initial immobilization in flexion followed by early ROM exercise were important factors to gain good result.

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Clinical Effectiveness of Korean Medical Rehabilitation Treatment after Patellar Fracture: A Report of 4 Cases
Ji-Hye Geum, Hyeon-Jun Woo, Jong-gyu Kim, Jung-Han Lee
Journal of Korean Medicine Rehabilitation.2020; 30(4): 203. 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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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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Arthroscopic-Assisted Reduction and Internal Fixation of Patella Fractures: Sang Hun Ko, Sung Do Cho, Hwa Yeop Na, Woo Suk Kim, You Young Jeong, Chang Yeul Kwag, Bum Soo Kim; J Korean Soc Fract 2003;16(4):482-489. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.482

Abstract PDF

PURPOSE
The aim of this study is to report the clinical effectiveness of arthroscopic-assisted reduction and internal fixation of patella fractures.
MATERIALS AND METHODS
We analyzed fifteen patella fractures, which had been operated by using an arthroscopic-assisted technique from January, 2000 to April, 2003 at our hospital. After clinical follow-ups for at least 1 year, clinical analyses had been done by using the Cincinnati Knee Rating System Score, Lysholm Score Scale, and radiological findings.
RESULTS
In our study group, the Cincinnati Knee Rating System scores were from 80 to 100, with a mean of 89.9. The Lysholm Scoring Scale scores ranged from 81 to 100 with a mean of 90.8 for the same group. Radiologically, we obtained complete anatomical reduction of articular surfaces in 80 percent of cases. Arthroscopic-assisted reduction for patella fractures brought clinically satisfactory results that are accurate articular surface reduction, early recovery of motion range, knee joint stability and minimal soft tissue damage, etc.
CONCLUSION
The operative treatment for patella fractures using arthroscopic-assisted reduction is an effective alternative method to open reduction.

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Clinical Effectiveness of Korean Medical Rehabilitation Treatment after Patellar Fracture: A Report of 4 Cases
Ji-Hye Geum, Hyeon-Jun Woo, Jong-gyu Kim, Jung-Han Lee
Journal of Korean Medicine Rehabilitation.2020; 30(4): 203. 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

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Arthroscopic Reduction and Percutaneous Cannulated Screw Fixation for Longitudinal Fractures of Patella: Jung Han Yoo, Yung Khee Chung, Yong Wook Park, Jin Sub Kim, Deuk Soo Jun, Ho Jin Lee; J Korean Soc Fract 2000;13(1):103-108. Published online January 31, 2000; DOI: https://doi.org/10.12671/jksf.2000.13.1.103

Abstract PDF: A variety of surgical modalities for fractures of patella have been described. We used arthroscopic reduction and percutaneous screw fixation for six cases of longitudinal fracture of patella. Ages of the patients ranged from 25 to 33 years. the postoperative regimen was one week long leg splint for reducing the pain, followed by continuous passive range of motion exercise of the knee including active one and quadriceps strengthening exercise until the full range of motion was gained, with progressive partial to full weight bearing with crutches. The follow-up period was from 12 to 54 monhts. Results were assessed subjectively and objectively with retrograde study. The full range of knee motion was recovered from 20 to 35 days postoperatively, The radiographic bone union was achieved from 31 to 42 days. And all patient had good results according to Lysholm and Gillquist scoring system. We had no experience of complication except one which is prominence of screw end. So, we believed that the arthroscopic reduction and percutaneous cannulated screw fixation for longitudinal fractures of patella is the useful surgical method.

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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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Treatment of the Long Term Neglected Patella Fracture Nonunion: 4 Cases Report: Duk Yong Lee, Jae Ik Shim, Taik Seon Kim, Sung Jong Lee, Suk Ha Lee, Dong Gi Lee, Yoen Sik Yu, Eun No Lee, Hong Man Cho; J Korean Soc Fract 1999;12(3):727-731. Published online July 31, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.3.727

Abstract PDF: Non-union of patella fracture was rare reported. We reported our experience with four cases of non-union of patella fracture treated by surgical intervention. Surgical management by skeletal traction and tension band wiring achieved union of the fracture in all four cases. The patients also recovered an excellent range of movement and strength in the affected knees.

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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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Osteochondral Avulsion Fracture in Patella after Treatment of Abscess around Knee: A Case report: Keun Soo Lee, Geon Woo Lee, Sang Ho Song, Hyun Seo; J Korean Soc Fract 1999;12(2):290-293. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.290

Abstract PDF: Osteochondral avulsion fracture of patella has been rarely reported. We experienced one case of osteochondral avulsion fracture which was developed after abscess around knee. The patient was a 16year old with the history of abscess. The presenting symptom was knee pain and loss of extension power. Radiologic and operative findings suggested that osteochondral avulsion fracture of the patella, was caused by minor trauma near the insertion site of quadriceps tendon. In usual case of quadriceps tendon rupture, the rupture occurred at the musculotendinous junction, caused by sudden contracture of the muscle without trauma history. This case was treated successfully with tension band wiring technique. Differential diagnosis between osteochondral avulsion fracture and osteomyelitis of patella was emphasized.

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Treatment of Patella Fracture Using Modified Transverse Tension Band Wiring Method: Jung Dae Oh, Cyeong Rim Lim, Yu Jin Joung, Gyu Sung Lee; J Korean Soc Fract 1998;11(4):858-864. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.858

Abstract PDF: Recently the fracture of patella has increasing tendency due to frequent traffic and industrial accidents. In this series, we treated fractures of patella by open reduction and internal fixation with modified transverse tension band wiring method. Early post operative continuous passive motion and early weight bearing exercise were followed. This method was excellent for treatment of the patella fractures. The surgical results were evaluted by Leveck scoring systems, 12 out of 14 cases had satisfactory results. This technique have some advantage in terms of decreasing pain and maintenance of circulation on the patella, because of the small incision and minimize dissection. It can prevent post operative complications such as limitation of motion and post traumatic arthritis of the knee joint.

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Availability of Supplementary Circumferential Wire Loop in Treatment of Complicated Patellar Fracture: Ju Hong Lee; J Korean Soc Fract 1998;11(4):811-816. Published online October 31, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.4.811

Abstract PDF: We have treated 22 patients of complicated patellar fracture with generally proposed fixation methods and supplementary circumferential wire loop as a checkrein or load sharing cable from Mar. 1995 to Feb. 1997 and then compared its surgical results with 15 patients of patellar fracture treated with modified tension band wiring alone in terms of functional recovery of the injured knee. The pattern of fracture was mostly comminuted(Bostman Type II), usually accompanying ipsilateral fractures with or without open wound, ligamentous injuries, or others. Although obtainning more satisfactory functional results in supplementary circumferential wire loop (68%) than control group(46.6%) in according to Lysholm and Gillquist scoring system and statistically significant difference in duration of regaining the functional arc of knee motion between two groups(p=0.007, Wilcoxon rank sum test) at 6 months postoperatively, we have found similar clinical results in two groups at 12 months follow-up(82% vs 80% in good results). Nevertheless, we thought that supplementary circumferential wire loop is one of the effective methods to improve the early surgical results of the complicated patellar fracture in respect of prompt regaining in knee motion.

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Severe Comminuted and Displaced Patellar Fracture Treated by Partial or Total Patellectomy: Kuen Tak Suh, Taek Geon Lee, Weon Wook Park, Chong Il Yoo, Kyu Yeol Lee, Bu Hwan Kim; J Korean Soc Fract 1997;10(4):851-859. Published online October 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.4.851

Abstract PDF: The results of partial and total patellectomy as a treatment for severe comminuted and displaced patellar fracture were assessed retrospectively with the use of clinical criteria and radiologic findings. Sixteen patients treated with patellectomy(four total and twelve partial patellectomies) were followed up for an average of 3 years 4 months and valuated. According to the Bostmans fracture classification, there were type I In 5 cases(31%), type II in 7 cases(44%), and type III in 4 cases(25%). The results of the patellectomy were relatively good since excellent result was shown in 11(69%) among 16 cases. The comparison between partial and total patellectomy was difficult because the fracture patterns treated by these techniques were different. In this study, the result of the partial patellectomy was better than that of the total patellectomy, but their difference was not statisticaliy significant(P>0.05). The results of the study indicated that partial or total patellectomy could be one of the effective treatment methods for severe comminuted and displaced patellar fracture. However total patellectomy should be recommended only when the entire patella was too severely comminuted to function as a part of the extensor mechanism of the knee.

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The Clinical Result of Operative Treatment of the Comminuted Patellar Fractures : A Comparison of Clinical Results According to the Operative Methods and the Postoperative Cares: Byeong Yoen Seong, Jong Hoon Lee, Seung Jun Park; J Korean Soc Fract 1997;10(3):604-613. Published online July 31, 1997; DOI: https://doi.org/10.12671/jksf.1997.10.3.604

Abstract PDF: Approximately one third of patellar fractures require surgery and stellate and comminuted frachres of the patella has been increased. Operative treatment of the patella should be achieved to ensure continuity of the extensor mechanism, to preserve patellar function and reduce the incidence of complications related to articular fracture. Various techniques of internal fixation have been recommended for comminuted fracture of De patella, but there are some complications including loss of fragment position, reoperation, nonunion, loss of range of motion and loss of extensor mechanism strength. The evaluation of the clinical results in rigid fixation group which was made postoperative excercise from postoperative 2 weeks without cylinder cast application, was needed for the purpose whether or not to decrease those complications. We reported 46 cases of comminuted patellar fracture who were operated various methods with or without cylinder cast as postoperative care, from Jun 1990 to Dec 1995 at the department of orthopaedic surgery, Dongrae Bongsaeng hospital. In conculsions, rigid fixation as using Kirschner wires with modified anterior tension band and a circumferential wiring and early motion without cylinder cast for the comminuted patellar could be increased the fusion rate and range of motion and recovered function of the knee joint.

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Clinical Study of Prognostic Factors in Patellar Fractures: Duck Yun Cho, Hee Chun Kim, Chung Hwan Kim; J Korean Soc Fract 1996;9(4):977-983. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.977

Abstract PDF: Most authors report 70% to 80% good to excellent results following open reduction and internal fixation of fractures of the patella. As with most intraarticular fractures, the prognosis for healing and restoration of function in fractures of the patella is dependent on the amount of articular cartilage damage and exact reduction of fracture. In order to document clinical results and describe any prognostic factors, we evaluated the results of 69 patellar fractures treated in 66 patients who had been treated with open reduction and internal fixation at the Department of Orthopaedic Surgery, Nationanl Medical Center, from January 1990 to December 1994. The average age at the time of surgery was 41.2 years(16 years-75 years) and the average follow-up time was 38.7 months(14 months-74 months). The results were as fellows: 1. The mechanism of injury(traffic accident), concomittant inury of ipsilateral lower extremity, fracture morphology, immgbilization period less than two weeks and accuracy of reduction were significant prognostic factors. 2. Age and method of fixation were not significant prognostic factors. 3. The brisement of knee under general anesthesia was helpful, that had been performed following bony union.

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Operative Treatment of Comminuted Fraeture of the Patella: Yung Khee Chung, Jung Han Yoo, Yong Wook Park, Gyu Cheol Roh; J Korean Soc Fract 1996;9(4):970-976. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.970

Abstract PDF

The patella, lying within the quadriceps tendon mechanism and subcutaneous in position, is susceptible to the effects of both direct and indirect trauma. Patella fractures are intra-articular injuries and have a significant effect on knee function. The tension band wiring technique is widely used for treating fractures of the patella and is often the treatment of choice. We reviewed tweenty nine cases of cemminuted fracture of the patella treated with surgical methods from Jan. 1989 to Mar. 1995 and fellowed up more than one year, from the department of of hopedic surgiry, Kangnam Sacred Heart Hospital, Hallym University. The results were as follows: 1. According to the classincation of Bostman, there were 6 cases(20.7%) of type 1.16(55.2%) of II A, 5(17.2%) of II B and 2(6.9%) of III. 2. Of tweenty nine cases, tweenty six(89.7%) were treated by modified tension band wiring with cerclage wiring (MTBW with CW) and three(10.3%) by partial patellectomy with cerclage wiring(PP with CW). 3. Among tweenty six cases treated with MTBW with CW. tweenty one cases(76.9%) revealed a good or exellent result according to the Cincinnati rating system. 4. Especially, among 5 cases of type II B & 2 cases of type III comminuted fracture treated with MTBW with CW, 5 cases(73.4%) revealed good result. We concluded that the use of modified tension band wiring with cerclage wiring for the comminuted fracture of patella has been shown to be a satisfactory method.

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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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Patellar Fracture: Duck Yun Cho; J Korean Soc Fract 1996;9(4):835-840. Published online October 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.4.835

Abstract PDF: Patellar fractures constitute approximately 1 percent of skeletal injuries in the literature and 3.4 percent in the authors institution. The goals of treatment are restoration of the entensor mechanism and perfect restoration of the articulating surface. In contrast to most other intraarticular fractures, the selection of treatment must take into consitleration tensile suess of the bone, as were as compressive stress. The basic schema for treatment of patellar fracture is as follows: 1. To determine therapy, patellar fractures must be classified in 3 models;The mechanism of injury. amount of displacement, and configuration of fracture. 2. Nonoperative treatment is indicated if the extensor retinaculum is intact and if displacement of fragment is minimal. 3. The success of operative treatment depends on the exact reduction of fracture, secure fixation, and the amount of articular cartilage damage. 4. Recent biomechanical studies on the efficiency of various forms of fixation for patellar fractures showed that fixation with modified tension band wiring with or without circumferentiat wiring was superior to tension band wiring or circumferential wiring. 5. Partial patellectomy should be selected in preference to total patellectomy if at all possible because partial patellectomy offers better function.

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Operative Treatment of Patellar Fracutres: Eun Kyoo Song, Dae Ik Kim, Hyung Seog Kim; J Korean Soc Fract 1996;9(3):640-646. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.640

Abstract PDF: Patella has important roles to enhance extensor mechanism of knee, therefore patellar fractures should be treated correctly according to the type and displacement of fractures for the preservation of patellar function. The purpose of study is to analyse the clinical results of operative treatment for patellar fractures. 77 cases of patellar fracture which were treated at Chonnam University Hospital between June 1985 and March 1995 were reveiwed. Among them, 32 cases with open reduction and internal fixation were included in this study. The mean follow-up period was 21.5 months(range twelve to eighty two months). Oircurnferential wiring, modified tension band wiring, malleolar screws and combination of circlage and tension band wiring were used as a fixatives. The clinical results were compared according to Reileys clinical evaluation criteria mainly by range of motions, mid-thigh circumferential difference. The most favorable results could be obtained with the combination of circlage and tension band wiring.

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