ObjectiveTo compare the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures.MethodsBetween January 2017 and January 2019, 26 patients with type C patellar fractures were treated with improved Kirschner wire tension band fixation (group A), and 24 patients were treated with traditional Kirschner wire tension band fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, and side and type of fracture between 2 groups (P>0.05). The operation time, intraoperative blood loss, the visual analogue scale (VAS) scores at 1 and 3 days after operation, the fracture healing time, and the occurrence of complications (skin irritation of Kirschner wires, failure of internal fixation, fracture reduction loss) were recorded, and the knee function was evaluated by Lysholm scoring standard in 2 groups.ResultsThe operation time in group A was significantly less than that in group B (t=?4.742, P=0.000). There was no significant difference in the intraoperative blood loss and VAS scores at 1 and 3 days after operation between 2 groups (P>0.05). All incisions healed by first intention. All patients were followed up 8-15 months, with an average of 11 months. The fracture healing time was (3.3±0.6) months in group A and (3.2±0.6) months in group B, showing no significant difference (t=0.589, P=0.559). At last follow-up, the knee joint function was evaluated according to Lysholm scoring standard. And there were 15 cases of excellent, 8 cases of good, and 3 cases of fair, with an excellent and good rate of 88.5% in group A; there were 8 cases of excellent, 7 cases of good, 7 cases of fair, and 2 cases of poor, with an excellent and good rate was 62.5%. The difference between 2 groups was significant (Z=2.828, P=0.005). The internal fixators were removed after the fracture healed in 2 groups. At last follow-up, no skin irritation of Kirschner wires occurred in group A, but 3 cases in group B. X-ray films reexamination showed that 5 cases of internal fixation failure and no fracture reduction loss were found in group A, while 9 cases of internal fixation failure and 1 case of fracture reduction loss in group B. The incidence of complications in group A was 19.2% (5/26), which was significantly lower than that in group B (54.2%, 13/24) (χ2=6.611, P=0.010).ConclusionCompared with the traditional Kirschner wire tension band fixation, the improved Kirschner wire tension band fixation in treatment of type C patellar fracture can shorten the operation time, reduce the incidence of complications, and benefit the functional recovery of knee joint.
Objective To analyze the effectiveness of three internal fixation methods, namely hollow screw combined with Kirschner wire tension band, hollow screw combined with anchor nail, and modified 1/3 tubular steel plate, in the treatment of avulsion fracture of tibial tubercle (AFTT) in adolescents. Methods Between January 2018 and September 2023, 19 adolescent AFTT patients who met the selection criteria were admitted. According to different internal fixation methods, patients were divided into group A (8 cases, hollow screw combined with Kirschner wire tension band), group B (6 cases, hollow screw combined with anchor nail), and group C (5 cases, modified 1/3 tubular steel plate). There was no significant difference in the baseline data of age, gender, side, cause of injury, Ogden classification, and time from injury to operation among the three groups (P>0.05). The range of motion (ROM), weight-bearing time, normal activity time of knee joint, and the hospital for special surgery (HSS) score at last follow-up were recorded and compared among the three groups. Recorded whether the fracture was displaced, whether the fracture line was blurred at 1 month after operation, whether there was epiphyseal dysplasia, and whether there was incision infection and other complications. Results There was no significant difference in hospital stay between the groups (P>0.05). All patients were followed up 10-24 months, with an average of 14.3 months; there was no significant difference between the groups (P>0.05). All the incisions healed well without soft tissue irritation or fracture nonunion, and no limb shortening deformity or epiphyseal dysplasia was found during follow-up. At 1 month after operation, the knee joint ROM and hospitalization expenses in group A were better than those in groups B and C, the fracture healing time, knee joint weight-bearing time, and normal activity time of knee joint were better than those in group C, and the hospitalization expenses in group C were better than those in group B, with significant differences (P<0.05); there was no significant difference in the other indicators between the groups (P>0.05). In group A, the fracture line was blurred 1 month postoperatively, the fracture ends were in close contact, and there was no fracture displacement; in groups B and C, the fracture line was clear in 2 cases, and 1 case in group C had slight fracture displacement; except for 1 case in group B, there was no fracture split in the other two groups. There was no significant difference in the incidences of blur of fracture line, fracture displacement, and intraoperative bone split between the groups at 1 month after operation (P>0.05). At last follow-up, the HSS scores of knee joints in the three groups were excellent and good, and there was no significant difference between the groups (P>0.05).ConclusionHollow screw combined with Kirschner wire tension band technique is effective in treating adolescent AFTT, which has the advantages of stabilizing fracture, accelerating fracture healing and rehabilitation, early feasible knee joint functional exercise, and reducing hospitalization expenses.
ObjectiveTo investigate the effectiveness of the Krackow suture of patellar tendon with vertical fixation through bone tunnels combined with Kirschner wire tension band in the treatment of comminuted fractures of the inferior pole of the patella. Methods The clinical data of 62 patients with unilateral comminuted fractures of the inferior pole of the patella who were admitted between January 2023 and July 2024 and met the selection criteria were retrospectively analyzed. Of these patients, 31 were treated with Krackow suture of patellar tendon with vertical fixation through bone tunnels combined with Kirschner wire tension band fixation (group A), whereas the remaining 31 were treated with conventional Kirschner-wire tension-band fixation (group B). There was no significant difference between the two groups in baseline characteristics, including gender, age, side of injury, body mass index, interval from injury to surgery, preoperative visual analogue scale (VAS) score for anterior knee pain, and preoperative knee range of motion (P>0.05). The operation time, intraoperative blood loss, incision length, time to postoperative full weight-bearing, fracture healing time, and postoperative complications were recorded and compared between the two groups. Anterior knee pain was assessed using the VAS before surgery, at 1 week and 1 month after surgery, and at last follow-up. Knee range of motion was measured before surgery, at 1 and 3 months after surgery, and at last follow-up. At last follow-up, the Insall-Salvati index was measured to assess patellar height, and knee function was evaluated using the Bostman score for patellar fractures. ResultsAll patients underwent surgery successfully. Group A had a shorter incision, a shorter operation time, and less intraoperative blood loss than group B, with significant differences between the two groups (P<0.05). All patients were followed up with the follow-up time (15.35±1.87) months in group A and (15.81±2.30) months in group B, showing no significant difference in follow-up time between the two groups (P>0.05). No complication, such as internal fixation failure or infection, occurred in group A. In group B, disengagement and failure of the internal fixation occurred in 1 patient, and implant irritation and activity-related pain caused by late posterior migration of the Kirschner wires occurred in 2 patients. The time to postoperative full weight-bearing and fracture healing time were significantly shorter in group A than in group B (P<0.05). In both groups, knee range of motion and VAS scores for anterior knee pain at all postoperative time points significantly improved when compared with the corresponding preoperative values (P<0.05). At each postoperative time point, group A had a greater knee range of motion and a lower VAS score for anterior knee pain than group B, with significant differences between the two groups (P<0.05). At last follow-up, both the Bostman score and the Insall-Salvati index were significantly higher in group A than in group B (P<0.05). ConclusionCompared with conventional Kirschner wire tension band fixation, Krackow suture of patellar tendon with vertical fixation through bone tunnels combined with Kirschner wire tension band fixation provides satisfactory fracture reduction and reliable fixation, facilitates early functional rehabilitation, and is associated with a lower risk of internal fixation failure. It may therefore serve as a safe and reliable fixation option for comminuted fractures of the inferior pole of the patella.