Platelet-Rich Plasma, Mesenchymal Stem Cell, and Non-metallic Suture-Based Fixation Technique in a Patellar Fracture Nonunion: A Technical Note and Systematic Review

Trinchese, Giovanni Felice; Cipollaro, Lucio; Calabrese, Emanuele; Maffulli, Nicola

doi:10.4055/cios20175

Cited by 12 publications

(7 citation statements)

References 27 publications

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“…The tension band technique converts the patellar surface tension generated by the extensor muscle during knee flexion into the axial compression force of the patellar fracture surface, thereby promoting bone healing and demonstrating good efficacy ( Jia et al, 2022 ). However, owing to the specific anatomic location of the patella, it is associated with a higher overall complication rate (approximately 52%) ( Li et al, 2022 ), including Kirschner needle displacement, tension band breakage, symptomatic hardware, and infection ( Lee et al, 2021 ; Trinchese et al, 2021 ). The modified regimen of titanium-cannulated screws may have better biomechanical characteristics and stability and can provide a direct compression force between the fracture fragments.…”

Section: Introductionmentioning

confidence: 99%

Tension band high-strength suture combined with absorbable cannulated screws for treating transverse patellar fractures: finite element analysis and clinical study

Xiang,

Xiao,

et al. 2024

Front. Bioeng. Biotechnol.

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Objective: Few reports exist on the treatment of transverse patellar fractures (TPFs) using absorbable cannulated screws and high-strength sutures, and most screws and sutures lack good biomechanics and clinical trials. Therefore, this study aimed to demonstrate the biomechanical stability and clinical efficacy of tension-band high-strength sutures combined with absorbable cannulated screws (TBSAS) in treating TPFs (AO/OTA 34 C1).Methods: Finite element models of five internal fixation schemes were established: tension-band wire with K-wire (TBW), TBW with cerclage wire (TBWC), TBW with headless pressure screws (TBWHS), TBW with full-thread screws (TBWFS), and TBSAS. We comprehensively compared the biomechanical characteristics of the TBSAS treatment scheme during knee flexion and extension. Forty-one patients with TPFs in our hospital between January 2020 and August 2022 were retrospectively enrolled and divided into the TBSAS (n = 22) and TBWC (n = 19) groups. Clinical and follow-up outcomes, including operative time, visual analog scale (VAS) pain score, postoperative complications, Bostman score, and final knee range of motion, were compared between both groups.Results: Finite element analysis (FEA) showed that TBWHS and TBWFS achieved the minimum mean fracture interface relative displacement during knee flexion (45°, 0–500 N bending load) and full extension (0°, 0–500 N axial load). There was no significant difference between TBSAS (0.136 mm) and TBWC (0.146 mm) during knee flexion (500 N); however, TBSAS displacement was smaller (0.075 mm) during full extension (500 N). Furthermore, the stress results for the internal fixation and the patella were generally lower when using TBSAS. Retrospective clinical studies showed that the TBSAS group had a shorter operative time, lower VAS pain score at 1 and 2 months postoperatively, better Bostman knee function score at 3 and 9 months postoperatively, and better final knee joint motion than the TBWC group (all p < 0.05). There were five cases (26.3%) of internal fixation stimulation complications in the TBWC group.Conclusion: TBSAS demonstrated excellent safety and effectiveness in treating TPFs. It is sufficient to meet the needs of TPF fixation and early functional exercise and effectively reduces metal internal fixation-induced complications and secondary surgery-induced trauma.

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Section: Introductionmentioning

confidence: 99%

Tension band high-strength suture combined with absorbable cannulated screws for treating transverse patellar fractures: finite element analysis and clinical study

Xiang,

Xiao,

et al. 2024

Front. Bioeng. Biotechnol.

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“…The comminution was thought to hinder the accurate reduction of the articular surface. Poor fracture reduction can often lead to many post-operative complications, including delayed union or nonunion, limited knee function, and post-traumatic osteoarthritis [ 4 , 7 ]. Prolonged operative time due to comminuted articular surfaces was also associated with post-operative infection and wound complications [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

A double-suture cerclage reduction technique with Nice knots for comminuted patella fractures (AO/OTA 34-C3)

et al. 2023

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Background Comminuted patella fractures place high demands on surgeons’ surgical skills. We used a double-suture cerclage reduction with Nice knots as an intra-operative reduction technique to displaced comminuted patella fractures. Methods Patients were divided into two groups by whether or not an intra-operative suture cerclage reduction technique was used. Fragments count, surgical time, quality of the reduction, and fracture healing time were recorded. The postoperative function was assessed by Böstman score and range of motion. Results With the inclusion and exclusion criteria, 48 patients we included in the cohort between Sept. 2016 and Oct. 2021. The double-suture cerclage reduction technique with a Nice knot achieved a satisfactory reduction. When the number of fragments was over 5, this technique showed significant advantages in saving surgery time. Conclusions In this study, the double-suture cerclage reduction technique combined with the Nice knot shows significant advantages for displaced highly comminuted patella fractures. This technique simplifies the operation and saves surgical time, which is helpful for clinical practice.

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“…Kirschner's wire ( K -wire) was the earliest instrument to be used with MTBW. However, MTBW with K -wire has notable disadvantages including fixation loosening, higher infection risk, non-union and hardware irritation [ 9 , 10 ]. Some researchers reported that screws provided stronger fixation than K -wire [ 11 – 13 ].…”

Section: Introductionmentioning

confidence: 99%

Novel screw-cable integrated system(SCIS) for minimally invasive treatment of patella transverse fractures: a finite element analysis

Liu,

et al. 2023

J Orthop Surg Res

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Background The most recommended method for treating transverse patella fractures is modified tension band wiring (MTBW). However, the optimal instrument for use with MTBW is still undetermined. Hence, we aimed to design a novel screw-cable integrated system (SCIS) and compare its biomechanical characteristics with Kirschner-wire, SCIS, and Cable-Pin systems in treating transverse patellar fracture. Methods A finite-element (FE) model of transverse patella fracture was created. The fracture model was fixed with either K-wire, SCIS, or Cable-pin. Different tension force loading (400 N and 800 N), direction(0° and 45°), and screw or K-wire depth(5 mm and 10 mm) were set. The maximum displacement of the fragment and maximum gap opening were measured by using FE analysis. Results Compared with the K-wire and Cable-pin system, SCIS increased the stability of the fractured patella by reducing fragment displacement and gap opening. Under 400 N loading in the direction 45°, SCIS with screw placing at 5-mm depth reduced the maximum fragment displacement (0.43 mm) by 49.62% and 26%, respectively, compared with the K-wire (0.22 mm) and Cable-pin (0. 22 mm) group. Meanwhile, the gap opening in SCIS (0.05 mm) was reduced by 83% and 59.8% (0.05 to 0.18) compared with the K-wire (0.30 mm) and Cable-pin (0.18 mm) group. Conclusion SCIS demonstrated improved biomechanical stability for treating transverse patellar fractures compared to MTBW with Kirschner wire and the Cable-Pin system. Finite element analysis showed SCIS substantially reduced fracture fragment displacement and gap opening under various loading conditions.

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Platelet-Rich Plasma, Mesenchymal Stem Cell, and Non-metallic Suture-Based Fixation Technique in a Patellar Fracture Nonunion: A Technical Note and Systematic Review

Cited by 12 publications

References 27 publications

Tension band high-strength suture combined with absorbable cannulated screws for treating transverse patellar fractures: finite element analysis and clinical study

Tension band high-strength suture combined with absorbable cannulated screws for treating transverse patellar fractures: finite element analysis and clinical study

A double-suture cerclage reduction technique with Nice knots for comminuted patella fractures (AO/OTA 34-C3)

Novel screw-cable integrated system(SCIS) for minimally invasive treatment of patella transverse fractures: a finite element analysis

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