Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation techn
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TRAUMA SURGERY
Suture anchor fixation of comminuted inferior pole patella fracture‑novel technique: suture bridge anchor fixation technique Kwang‑Sub Kim1 · Dong‑Whan Suh1 · Sang‑Eun Park1 · Jong‑Hun Ji1 · Young‑Hoon Han1 · Jae‑Hoon Kim1 Received: 20 June 2020 / Accepted: 15 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Comminuted inferior pole fractures of the patella are notorious fractures where it is difficult to obtain rigid internal fixation by conventional tension band wiring. The purpose of this study is to evaluate the clinical and radiological outcomes of the suture bridge anchor fixation for these comminuted inferior pole fractures of the patella. Methods From March 2012 to December 2018, suture bridge anchor fixation for the inferior pole comminuted fracture of the patella was performed in 22 patients. There were 21 patients of inferior pole comminuted fracture and 1 patient of lower periosteal sleeve avulsion fracture. Clinical outcomes including SF-36 score, Knee injury and osteoarthritis outcome score (KOOS) and post-operative range of motion were evaluated. In all patients, suture bridge anchor fixation was performed and, tension band wiring with K wire was added for large fragment fixation in two patients. We evaluated bony union, the patellar height using Insall–Salvati ratio and its complications. Results Mean age was 46 ± 20 (15–82) years. Mean follow-up period was 25 ± 18 (11–74) months. In all patients, bony union was achieved at postoperative 4 months. At final follow-up, mean SF-36 score was 72 ± 15 (30–91) points and KOOS score was 66.7 ± 16 (43–97). The average range of motion was 134 ± 5 (125–140) degrees. As a complication, one patient developed a wound infection and subsequent osteomyelitis of inferior pole fracture fragment. Compared to the normal knee, the Insall–Salvati ratio of the injured knee averages 0.73 and this smaller ratio less than 0.8 meant patella baja. Conclusions In the comminuted inferior pole fractures of the patella, suture bridge anchor fixation showed good bony union and satisfactory clinical outcomes at the short-term follow-up and could be a satisfactory alternative treatment option. Even though suture bridge anchor fixation in these fractures caused decreased Insall–Salvati ratio (patella height), any patellofemoral pain and limited range of motion was not developed. Level of evidence Level IV Keywords Patella · Comminuted inferior pole fracture · Suture bridge anchor fixation
Introduction The inferior pole comminuted fracture of the patella is rare and has been reported to occur in up to 11.5% in large clinical series of all patella fractures [1, 2]. It is difficult to obtain sufficient fixation strength by conventional methods such as tension band wiring with Kirschner-wires [3]. The surgical goal for patellar fracture is to re-establish the extensor * Jong‑Hun Ji [email protected] 1
Department of Orthopedic Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 64
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