A Novel Technique for Supplementing Transosseous Suture Repair of Inferior Pole Patella Fractures with a Tension Band
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SURGICAL TECHNIQUE
A Novel Technique for Supplementing Transosseous Suture Repair of Inferior Pole Patella Fractures with a Tension Band Shaam Achudan1 · Ernest Beng Kee Kwek1 Received: 7 December 2019 / Accepted: 22 May 2020 © Indian Orthopaedics Association 2020
Abstract Introduction The transosseous suture fixation is a recognised surgical technique for inferior pole patella fractures. However, post-operative range of motion (ROM) is typically restricted to reduce complications of fracture displacement. We present a novel modified surgical technique using a supplemental Ethibond figure-of-eight stitch to reinforce the transosseous suture repair and studied its outcomes. We performed a retrospective study looking at outcomes of patients with displaced inferior pole patella fractures who underwent modified suture fixation from 2010 to 2018. Operative Technique In the modified suture fixation technique, after the standard transosseous repair was performed, the remnant Ethibond suture was placed in a figure-of-eight tension band fashion anteriorly across the patella. Immediate postoperative ROM was allowed if the fixation was stable. The patients were assessed up to 6 months post-surgery to monitor for fracture displacement/gap and for bony union. Case Series We analysed the results of 14 patients who underwent modified suture repair. All patients were allowed immediate post-operative ROM. Only 1 fixation failure (7%) was noted at 6 months. Conclusion Complication rates were low with the modified technique even when patients were allowed immediate postoperative mobilisation. This shows greater confidence in the stability of the fixation and represents a viable technique for early mobilisation post-fixation of inferior pole patella fractures. Keywords Patella fracture · Inferior pole · Suture repair · Transosseous repair · Tension band
Background Patella fractures comprise about 1% of all skeletal fractures [1]. Of these fractures that undergo surgical fixation, approximately 9.3–22% involve the avulsion of the inferior pole with the patellar tendon [2]. The indication for fixation is the restoration of the knee’s extensor mechanism, failing which the patient would experience complications of loss of knee movement and stiffness. These inferior pole fractures are classified as extra-articular fractures under the AO classification, and the transosseous suture repair technique is one of several fixations of choice [3, 4]. A typical post-operative regimen requires the patient’s knee to be kept in extension
with a knee brace for a minimum of 6 weeks, thereby affecting the early functional recovery of the patient. To confer greater stability to the transosseous repair and allow earlier range of motion (ROM), we modified the standard transosseous repair technique to incorporate a tension band. Our primary outcome measure was to assess for post-operative fracture gap formation from our modified repair technique and our secondary outcome was to evaluate the overall union rates when allowed early ROM after the modif
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