Transosseous Suture With an All-FiberWire Technique in Patellar Fracture Fixation

Abstract

Background: Patellar fractures account for 0.5% to 1.5% of all bone fractures. Tension band wiring with heavy gauge steel wire and K-wires is traditionally procedure for treating patellar fractures. However, this method is associated with implant-related complications. Present study aimed to evaluate functional clinical outcomes of patellar fracture fixation with transosseous suture using an all-FiberWire technique.Methods: This was a retrospective study involving 16 patellar fractures patients were repaired by open reduction and internal fixation with FiberWire using a 3-transosseous tunnel technique. The functional outcomes were evaluated with Tegner-Lysholm and Bostman scoring. We also evaluated clinical and radiologic outcomes. Results:The mean time to bony union was 8.87 1.54 weeks (range, 7 to 12 wk). The mean Bostman score at final follow-up was 27.13 2.5 (range, 21 to 30), and mean Lysholm score at final followup was 90.69 5.75 (range, 83 to 100). Fractures healed in all patients, with no fixation failures. Minor loss of reduction (< 2 mm) were observed in 3 patients (18.75%). No patient has reoperation. One patient developed knee stiffness, with an infected hematoma 10 weeks postoperatively. None of patients developed anterior knee pain postoperatively. Two patients (12.5%) developed mild localized pain from prominent suture knots. There were no significant implant-related complications and no repeat surgery was necessary. Conclusions:The use of nonmetallic sutures with an all-FiberWire technique in patellar fracture fixation avoids implant-associated complications and possibility of a second surgery to remove metal implants. Nonmetallic high-resistance FiberWire matches traditional metallic fixation, with a reduced risk of postoperative complications.

Biomechanical evaluation of three fixation methods in a feline transverse patella fracture model

“…21 Several other clinical comparisons of suture repair vs wire fixation have reported satisfactory clinical outcomes but with fewer postoperative complications in suture methods. [23][24][25][26][27][28] The results of the present study show consistency with those of a previous study comparing the different wiring methods in a feline patella fracture cadaveric model, in that the CFEW group was stronger than the PTBW group. 10 In this previous study, the CFEW group showed a 1.31-fold greater mean maximum failure load than that of the PTBW group, while in the present study, it was approximately 1.19-fold greater.…”

“… 21 Several other clinical comparisons of suture repair vs wire fixation have reported satisfactory clinical outcomes but with fewer postoperative complications in suture methods. 23 – 28 …”