ObjectiveTo estimate the outcome of cerclage followed by a figure-of-eight tension band with a single titanium wire for the treatment of patellar fracture.MethodsA retrospective analysis was made on the clinical data of 46 patients with patellar fractures treated between June 2012 and November 2014. There were 30 males and 16 females, aged 20-86 years (mean, 54 years). The fracture causes included falling in 27 cases, traffic accident in 16 cases, and knock in 3 cases. There were 41 cases of closed fractures and 5 cases of open fracture. The injury located at the left side in 24 cases and the right side in 22 cases. According to AO classification, fracture was rated as type 34-A in 3 cases, as type 34-B in 1 case, as type 34-C1 in 7 cases, as type 34-C2 in 13 cases, and as type 34-C3 in 22 cases. The time between injury and operation ranged 1-12 days (mean, 3.7 days). During operations, a single titanium wire was used to pass around the patellar, followed a figure-of-eight wrapping, to tight and fix at the tension of 35 kg.ResultsAll incisions healed primarily. The patients were followed up 20.6 months on average (range, 6-24 months). Partial wire loosening was found in 2 cases, irritation of skin or soft tissue in 1 case. The X-ray examination showed bony healing at 3 months after operation, without breakage of titanium wire. The internal fixation was removed in 38 cases at 12 months after operation. According to the Böstman rating score, the mean score was 28.34 (range, 24-30) at 12 months after ope-ration; the results were excellent in 42 cases and good in 4 cases, with an excellent and good rate of 100%.ConclusionFor patellar fracture, cerclage followed by a figure-of-eight tension band with a single titanium wire is able to achieve an effective stability and to allow early motion for patient with less complication.
目的 探讨空心拉力螺钉联合钢丝张力带治疗髌骨骨折的临床疗效。 方法 2005年6月－2010年9月采用空心拉力螺钉联合钢丝张力带治疗髌骨骨折38例，男29例，女9例；年龄32～69岁，平均42.2岁。其中髌骨中份横行骨折18例，斜行骨折15例，髌骨纵行骨折3例，髌骨下极骨折2例。骨折块移位0.6～3.2 cm，平均1.7 cm。受伤至手术时间1～7 d，平均2.1 d。末次随访时评估双侧膝关节主观感受、视觉模拟评分（VAS）、患侧膝关节活动度（ROM）、Lysholm评分及影像学变化。 结果 患者随访13～54个月，平均19.5个月。康复期内未出现皮肤刺痛、滑囊炎、切口延期愈合或不愈合等临床并发症。末次随访时疼痛VAS评分（1.5 ± 0.9）分，患侧膝ROM为健侧的85.2%。术后2.1～3.2个月，平均2.8个月达到临床骨性愈合。 患侧Lysholm评分优27例、良8例、可1例、差2例，优良率92.1%；健侧膝关节Lysholm评分优35例、良1例、可0例、差2例，两侧比较差异无统计学意义（P＞0.05）。 结论 空心拉力螺钉联合钢丝张力带治疗髌骨骨折可获得较好临床疗效，且术后循序渐进的康复锻炼是膝关节功能得到最大恢复的关键。
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 compare the biomechanical stability of Kirschner wire and tension band wiring, reconstruction plate combined with tension band wiring, and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture, so as to provide the theoretical evidence for clinical selection of internal fixation. Methods Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows (aged 26-43 years, mean 34.8 years) donated voluntarily. The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen. Fracture end was fixed successively by Kirschner wire and tension band wiring (group A), reconstruction plate combined with tension band wiring (group B), and olecranon anatomical plate (group C), respectively. The biomechanical test was performed for monopodium compression experiments, and load-displacement curves were obtained. The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm. Results No Kirschner wire withdrawal, broken plate and screw, loosening and specimens destruction were observed. The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load, while the curve slope of groups B and C was significantly higher than that of group A. When the compression displacement was 2 mm, the load values of groups A, B, and C were (218.6 ± 66.9), (560.3 ± 116.1), and (577.2 ± 137.6) N, respectively; the load values of groups B and C were significantly higher than that of group A (P lt; 0.05), but no significant difference was observed between groups B and C (t=0.305, P=0.763). Conclusion The proximal ulna combined with olecranon fracture is unstable. Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation, so they are favorable options for proximal ulna combined with olecranon fracture. Kirschner wire and tension band wiring is not a stable fixation, therefore, it should not be only used for proximal ulna combined with olecranon fracture.
Objective To investigate the surgical technique and effectiveness of tension band-assisted plate fixation combined with external fixator for volar marginal fractures of the distal radius. Methods A retrospective analysis was performed on the clinical data of 12 patients with volar marginal fractures of the distal radius treated by Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator between October 2018 and July 2023. The cohort included 9 males and 3 females, aged from 20 to 52 years (mean, 35.5 years). The injury causes included traffic accidents in 6 cases, falls from height in 3 cases, and fall in 3 cases. According to AO/Orthopaedic Trauma Association (AO/OTA), there were 1 case of type B2, 4 cases of type B3, 2 cases of type C1, 3 cases of type C2, and 2 cases of type C3. According to Fernandez classification, there were 2 cases of type Ⅲ, 5 cases of type Ⅳ, and 5 cases of type Ⅴ. Associated injuries included radiocarpal joint dislocation or subluxation in 7 cases and median nerve injury in 2 cases. The time from injury to operation was 2-7 days (mean, 3.2 days). Postoperatively, functional outcomes were evaluated using the modified Mayo wrist score and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. Grip strength was measured as the ratio to the unaffected side, and wrist range of motion (ROM) including dorsiflexion, palmar flexion, ulnar deviation, and radial deviation was assessed. Results All procedures were successfully completed, with an operation time of 55-110 minutes (mean, 65 minutes). All patients were followed up 6-36 months (mean, 13.7 months). Surgical incisions healed by first intention, without complications such as vascular-nerve injury or infection. Bony union and articular congruency were attained in all patients, with a healing time of 3-5 months (mean, 3.8 months). During follow-up, 1 case of Kirschner wire migration occurred with no instances of infections, radiocarpal dislocations, internal fixation failures, or extensor pollicis longus tendon ruptures. At last follow-up, the modified Mayo wrist score ranged from 65 to 92 (mean, 80.8), the DASH score ranged from 7 to 15 (mean, 11.6), the grip strength was 65%-90% (mean, 78.2%) of the unaffected side; and wrist ROM was palmar flexion 60°-85° (mean, 77.4°), dorsiflexion 55°-80° (mean, 74.8°), radial deviation 10°-25° (mean, 18.8°), and ulnar deviation 15°-30° (mean, 24.5°). Conclusion Kirschner wire tension band-assisted anatomical plate fixation combined with external fixator for volar marginal fractures of the distal radius is a simple method with reliable fixation, which can achieve satisfactory effectiveness.
Objective To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures. Methods Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by fall ing from height, 2 by tumbl ing, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of obl ique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days. Results One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture heal ing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension arc of the elbow averaged 92.8°(range, 23-130°), and the arc of forearm rotation averaged 124.4° (range, 42-175°). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1. Conclusion Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid compl ications.