The “invisible” wiring technique for displaced fracture patella

Abstract

Background: Operative treatment of displaced patella fracture dates back to Lister in 1877. Nowadays, steel wires remain the material of choice in tension band technique despite complications such as wire breakage, suboptimal placement, or skin impingement. We propose using a high-tensile strength braided tape-shaped polyblend suture (FiberTape®, Arthrex, Naples, Florida, USA) as an alternative that could minimize complications related to steel wires. Method: Between February 2014 and April 2018, 15 patients with displaced patella fractures (three distal pole, five transverse, and seven comminuted fractures) underwent our proposed method. Open fracture reduction was performed to optimize anatomy before figure-of-eight fixation with FiberTape®. An Ethibond-2 suture was also added as cerclage for stability. Postoperatively, an extension brace was given for wound resting, before progressing to mobilization exercises with a hinge-knee brace. At follow-ups, the knee’s range-of-motion (ROM), along with bone healing status from radiographs, was assessed. Results: The mean operation time was 84.5 min, and all surgeries were performed or supervised by the same senior surgeon. Eight patients were discharged from follow-up (mean follow-up of 9.9 months) after achieving good ROM and fracture healing. One patient defaulted, and the remaining is still being followed-up. There was no wound complication or knot impingement in all cases. One patient required manipulation under anesthesia due to stiffness, and one experienced malunion due to poor compliance to rehabilitation protocol. Conclusion: Fixation using a high-tensile strength braided suture may be an equally effective method in the management of displaced patella fracture. However, larger sample size is useful to provide a more definitive conclusion.

Patellar Fracture Fixation With Cannulated Compression Screws and FiberTape Cerclage

“… 11 Fracture fixation with suture tension bands have demonstrated high rates of fracture union and excellent outcomes. 18 , 19 , 20 Advantages of suture over metal wire include less hardware irritation with lower rates of revision surgery. 6 , 7 , 12 Furthermore, biomechanical studies have demonstrated that FiberWire (Arthrex) has greater failure strength and is superior to stainless steel in maintaining a tension band under force.…”

“… 21 Lastly, suture is easier to handle and tighten than metal wire, which can translate to a tighter construct and decreased tourniquet and operating time. 11 , 20 …”

“… 22 In comparison, technical errors during hand tying of suture can result in loose knots or knot slippage, which would compromise tension band function. 20 , 23 Correct tensioning and knot tightening thus may reduce the risk of subsequent fixation failure and poor outcomes. The FiberTape Cerclage System has been previously described in patella fracture fixation as part of a circumferential cerclage construct 22 ; however, use of this system has not been described as a technique to provide an anterior tension band while passing through cannulated screws.…”

“…21 Lastly, suture is easier to handle and tighten than metal wire, which can translate to a tighter construct and decreased tourniquet and operating time. 11,20 In addition, the FiberTape Cerclage System uses a pretied racking hitch knot and the accompanying tensioning system, allowing for precise and reproducible tensioning. 22 In comparison, technical errors during hand tying of suture can result in loose knots or knot slippage, which would compromise tension band function.…”

Surgical Management of Patella Fractures: A Review

“…Tension band technique through cannulated screws has continued to evolve, with the historic metal wires having been replaced by high strength non-absorbable sutures. Studies have demonstrated that facture fixation with suture tension bands result in excellent patient outcomes and high rates of fracture union [22][23][24]. In addition, suture tension bands cause less hardware irrigation and resultant revision surgery than metal wires [2,3,15].…”