Yonsei Med J.  2014 May;55(3):785-791. 10.3349/ymj.2014.55.3.785.

Separate Vertical Wiring for the Fixation of Comminuted Fractures of the Inferior Pole of the Patella

Affiliations
  • 1Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea.
  • 2Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
  • 3Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea.
  • 4Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. kyang@yuhs.ac

Abstract

PURPOSE
Among patients over 50 years of age, separate vertical wiring alone may be insufficient for fixation of fractures of the inferior pole of the patella. Therefore, mechanical and clinical studies were performed in patients over the age of 50 to test the strength of augmentation of separate vertical wiring with cerclage wire (i.e., combined technique).
MATERIALS AND METHODS
Multiple osteotomies were performed to create four-part fractures in the inferior poles of eight pairs of cadaveric patellae. One patella from each pair was fixed with the separate wiring technique, while the other patella was fixed with a combined technique. The ultimate load to failure and stiffness of the fixation were subsequently measured. In a clinical study of 21 patients (average age of 64 years), comminuted fractures of the inferior pole of the patellae were treated using the combined technique. Operative parameters were recorded from which post-operative outcomes were evaluated.
RESULTS
For cadaveric patellae, whose mean age was 69 years, the mean ultimate loads to failure for the separate vertical wiring technique and the combined technique were 216.4+/-72.4 N and 324.9+/-50.6 N, respectively (p=0.012). The mean stiffness for the separate vertical wiring technique and the combined technique was 241.1+/-68.5 N/mm and 340.8+/-45.3 N/mm, respectively (p=0.012). In the clinical study, the mean clinical score at final follow-up was 28.1 points.
CONCLUSION
Augmentation of separate vertical wiring with cerclage wire provides enough strength for protected early exercise of the knee joint and uneventful healing.

Keyword

Patella; inferior pole; vertical wiring; cerclage wiring

MeSH Terms

Aged
Aged, 80 and over
*Bone Wires
Female
Fracture Fixation, Internal/methods
Fractures, Comminuted/*surgery
Humans
Male
Middle Aged
Osteotomy
Patella/*injuries/*surgery
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