The application of internal fixation with tension band, multiple K-wire and annular steel-wire for the treatment of comminuted fractures of the patella

LU Yao; YUAN Jian-jun; FENG Da-jiang; LIU Jian-hua; LIANG Tao; Wang Yong-gang

doi:10.3969/j.issn.2095-252X.2013.07.008

Abstract： Objective To analyze and explore the surgical treatment methods and clinical outcomes of comminuted fractures of the patella. Methods The data of 18 patients with comminuted fractures of the patella who were treated in our department from February 2007 to March 2012 were retrospectively analyzed. Among them, there were 13 males and 5 females, whose average age was 41 years old ( range;20-61 years ). According to the classification of comminuted fractures of the patella made by Pengjian Wang and so on, 11 patients were at III A, 6 patients at III B and 1 patient at III C. All patients underwent open reduction and internal fixation with tension band, multiple K-wire and annular steel-wire. The X-rays of the patients were reviewed in the clinic monthly after the operation, and rehabilitation exercises were introduced to them. The treatment outcomes were measured by the operation time, flatness of the patellar articular surfaces, start time after the operation, loss of reduction during the follow-up postoperatively, surgical incision healing time, bone fracture healing time, function of the knee joints and so on. Results All the 18 patients were followed up for an average period of 16 months ( range;6-24 months ). The average operation time was 120 min ( range;100-150 min ). The intraoperative fluoroscopy and postoperative X-rays showed the flatness of the patellar articular surfaces was satisfactory. Gradual functional exercises were started 3 days postoperatively. Sutures were removed 12-14 days postoperatively, with no surgical site infection or poor healing. The X-rays showed no loss of reduction during the follow-up postoperatively. Bone healing of the fractures was obtained in all the 18 patients after an average period of 9 weeks ( range; 6-11 weeks ). According to Yupu Lu’s standard of knee joint function evaluation, there were 10 excellent cases, 6 good and 2 fair, and the excellence and good rate was 88.9%. Conclusions Tension band can maintain the stabilization of the fractures, so as to improve the early postoperative activities. Multiple K-wire can prop annular steel-wire and tension band up. Annular steel-wire can ensure good reduction and prevent its loss. Internal fixation with tension band, multiple K-wire and annular steel-wire is an effective treatment method for comminuted fractures of the patella, with the advantages of simple operation, reliable fixation, early functional exercises and exact effects.