Treatment of inferior pole patellar fractures with suture anchors and headless compression screws_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Junsong ^1,2 , ZHANG Wei ² , TIAN Zhuan ¹ , JIANG Yu ² ,  YAO Qi ¹

1. Department of Joint Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038, P. R. China;
2. Department of Orthopedics, Chinese PLA General Hospital, Beijing, 100853, P. R. China;

Corresponding author：

YAO Qi, Email: yqjh2010@163.com

Keywords：

Inferior pole patellar fracture; headless compression screw; anchor; internal fixation; knee function

DOI：

10.7507/1002-1892.202506038

Video：

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Objective To evaluate the effectiveness of anchor suture combined with headless compression screw fixation in treating inferior pole patellar fractures. Methods A retrospective analysis was conducted on 36 patients with inferior patellar fractures, who were admitted between January 2018 and October 2024 and met the selective criteria. There were 15 males and 21 females with a mean age of 52.3 years (range, 23-81 years). The fracture were reduced and fixed using anchor suture combined with headless compression screws. The operation time, intraoperative blood loss, and the length of hospital stay were recorded. Functional recovery was assessed using knee range of motion (ROM), Hospital for Special Surgery (HSS) knee score, and Böstman patellar fracture score. Results The operation time ranged from 10 to 100 minutes, with an average of 57.6 minutes. The intraoperative blood loss was 10 to 120 mL, with an average of 73.3 mL. The length of hospital stay was 5 to 10 days, with an average of 6.3 days. All incisions healed by first intention. All 36 patients were followed up 18-24 months (mean, 20.6 months). Preoperative X-ray films indicated that the fractures had healed; no head compression screw breakage, anchor loosening, or implant foreign body rejection reactions occurred during follow-up. At last follow-up, the ROM of the affected knee joint was (136.0±2.3)°, and there was no significant difference compared with the healthy side (136.6±2.3)° (t=−1.944, P=0.060). The HSS score of the affected knee joint was 96-100 (mean, 99.1), and all cases were rated as excellent. The Böstman patellar fracture efficacy score was 27-30 (mean, 29.1), and 35 cases were rated as excellent and 1 as good. Conclusion The suture anchors combined with headless compression screws technique provides reliable fixation for inferior patellar fractures. This method combines surgical simplicity with excellent functional outcomes.

1.	Doig T, Fagan P, Frush T, et al. The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3606-3612.
2.	肖琦科, 张力鹏, 张永峰. 髌韧带编织缝合联合克氏针钢丝张力带内固定治疗髌骨下极骨折疗效观察. 中国骨与关节损伤杂志, 2021, 36(6): 605-607.
3.	Kadar A, Sherman H, Drexler M, et al. Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy. Int Orthop, 2016, 40(1): 149-154.
4.	Jang JH, Cho YJ, Choi YY, et al. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res, 2021, 107(3): 102866. doi: 10.1016/j.otsr.2021.102866.
5.	刘晨东, 胡孙君, 张世民. 髌骨下极骨折手术治疗进展. 中国修复重建外科杂志, 2023, 37(1): 115-119.
6.	Chang CH, Shih CA, Kuan FC, et al. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop, 2023, 10(1): 58. doi: 10.1186/s40634-023-00622-y.
7.	张建, 杨小勇. 经髌骨胫骨结节环形钛缆治疗髌骨下极骨折的效果分析. 中华骨与关节外科杂志, 2018, 11(2): 115-117,123.
8.	张如意, 唐佩福, 陶笙, 等. 锚钉技术治疗髌骨下极撕脱骨折11例近期疗效观察. 中国矫形外科杂志, 2013, 21(10): 1046-1048.
9.	孔嘉琛, 柳直, 王猛, 等. 带线锚钉穿骨张力带与高强线环扎双重固定治疗髌骨骨折的疗效观察. 中国骨与关节杂志, 2024, 13(2): 118-122.
10.	马翔宇, 项良碧, 刘兵, 等. 髌骨下极骨折部分切除治疗进展. 临床军医杂志, 2020, 48(4): 478-480.
11.	付尧, 瞿晓宏, 房小文, 等. 双排锚钉缝线桥技术治疗髌骨下极骨折疗效观察. 中国骨与关节损伤杂志, 2023, 38(6): 626-629.
12.	林学义, 林煜, 李平, 等. 改良张力带钢丝联合可吸收带线锚钉内固定治疗髌骨下极撕脱骨折疗效观察. 中国骨与关节损伤杂志, 2020, 35(8): 833-835.
13.	张如意, 唐佩福, 张立海, 等. 锚钉技术治疗髌骨下极撕脱骨折的疗效分析. 中国矫形外科杂志, 2017, 25(8): 700-703.
14.	朱少兵, 叶锋, 郑晓东, 等. 间断垂直钢丝结合Krackow缝合法治疗髌骨下极骨折. 临床骨科杂志, 2021, 24(5): 739-741.
15.	Dong Z, Liu F, Pan Y, et al. Clinical analysis of an anchor nail combined with a titanium cable in the treatment of lower patella fractures. J Int Med Res, 2020, 48(4): 300060519873505. doi: 10.1177/0300060519873505.
16.	周继辉, 李新志, 周游, 等. 髌骨骨折修复内植物选择的多重问题. 中国组织工程研究, 2021, 25(9): 1440-1445.
17.	Wang C, Zhu Y, Liu Z, et al. Causal associations of obesity related anthropometric indicators and body compositions with knee and hip arthritis: A large-scale genetic correlation study. Front Endocrinol (Lausanne), 2022, 13: 1011896. doi: 10.3389/fendo.2022.1011896.
18.	Rupp S, Seil R, Schneider A, et al. Ligament graft initial fixation strength using biodegradable interference screws. J Biomed Mater Res, 1999, 48(1): 70-74.
19.	陈松, 谢庆云, 刘金标, 等. 髌骨下极骨折治疗的现状分析. 中国骨与关节杂志, 2021, 10(12): 900-904.
20.	王培召, 韩旭, 王啸, 等. 不可吸收缝合线捆扎结合髌骨爪固定治疗髌骨下极骨折疗效观察. 中国修复重建外科杂志, 2020, 34(10): 1243-1247.
21.	李旭, 李石伦, 李升, 等. 全切术和部分切除术对髌骨粉碎性骨折的远期疗效比较. 河北医药, 2020, 42(12): 1809-1812.
22.	Hargett DI, Sanderson BR, Little MTM. Patella fractures: approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
23.	徐希斌, 何双建, 杨照耀, 等. 改良独立垂直钢丝联合钢丝环扎内固定治疗髌骨下极骨折疗效分析. 中国骨与关节损伤杂志, 2023, 38(2): 177-179.
24.	Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
25.	王强, 吕欣, 李兴业, 等. 带线锚钉+空心钉内固定治疗髌骨骨折的疗效. 临床骨科杂志, 2024, 27(2): 257-260.
26.	袁建敏, 陶周善, 杨民, 等. 带线锚钉联合髌骨横向钻孔修复股四头肌腱骨腱结合部断裂. 中国骨伤, 2020, 33(1): 71-75.
27.	王军, 王陶, 石波, 等. 空心拉力螺钉联合钢丝张力带治疗髌骨骨折. 华西医学, 2012, 27(2): 230-233.
28.	Thelen S, Schneppendahl J, Jopen E, et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury, 2012, 43(8): 1290-1295.
29.	杜军, 鲁成, 孔杨. 双结克氏针张力带固定治疗髌骨骨折. 临床骨科杂志, 2024, 27(6): 876-879.

1. Doig T, Fagan P, Frush T, et al. The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair. Knee Surg Sports Traumatol Arthrosc, 2020, 28(11): 3606-3612.
2. 肖琦科, 张力鹏, 张永峰. 髌韧带编织缝合联合克氏针钢丝张力带内固定治疗髌骨下极骨折疗效观察. 中国骨与关节损伤杂志, 2021, 36(6): 605-607.
3. Kadar A, Sherman H, Drexler M, et al. Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy. Int Orthop, 2016, 40(1): 149-154.
4. Jang JH, Cho YJ, Choi YY, et al. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res, 2021, 107(3): 102866. doi: 10.1016/j.otsr.2021.102866.
5. 刘晨东, 胡孙君, 张世民. 髌骨下极骨折手术治疗进展. 中国修复重建外科杂志, 2023, 37(1): 115-119.
6. Chang CH, Shih CA, Kuan FC, et al. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop, 2023, 10(1): 58. doi: 10.1186/s40634-023-00622-y.
7. 张建, 杨小勇. 经髌骨胫骨结节环形钛缆治疗髌骨下极骨折的效果分析. 中华骨与关节外科杂志, 2018, 11(2): 115-117,123.
8. 张如意, 唐佩福, 陶笙, 等. 锚钉技术治疗髌骨下极撕脱骨折11例近期疗效观察. 中国矫形外科杂志, 2013, 21(10): 1046-1048.
9. 孔嘉琛, 柳直, 王猛, 等. 带线锚钉穿骨张力带与高强线环扎双重固定治疗髌骨骨折的疗效观察. 中国骨与关节杂志, 2024, 13(2): 118-122.
10. 马翔宇, 项良碧, 刘兵, 等. 髌骨下极骨折部分切除治疗进展. 临床军医杂志, 2020, 48(4): 478-480.
11. 付尧, 瞿晓宏, 房小文, 等. 双排锚钉缝线桥技术治疗髌骨下极骨折疗效观察. 中国骨与关节损伤杂志, 2023, 38(6): 626-629.
12. 林学义, 林煜, 李平, 等. 改良张力带钢丝联合可吸收带线锚钉内固定治疗髌骨下极撕脱骨折疗效观察. 中国骨与关节损伤杂志, 2020, 35(8): 833-835.
13. 张如意, 唐佩福, 张立海, 等. 锚钉技术治疗髌骨下极撕脱骨折的疗效分析. 中国矫形外科杂志, 2017, 25(8): 700-703.
14. 朱少兵, 叶锋, 郑晓东, 等. 间断垂直钢丝结合Krackow缝合法治疗髌骨下极骨折. 临床骨科杂志, 2021, 24(5): 739-741.
15. Dong Z, Liu F, Pan Y, et al. Clinical analysis of an anchor nail combined with a titanium cable in the treatment of lower patella fractures. J Int Med Res, 2020, 48(4): 300060519873505. doi: 10.1177/0300060519873505.
16. 周继辉, 李新志, 周游, 等. 髌骨骨折修复内植物选择的多重问题. 中国组织工程研究, 2021, 25(9): 1440-1445.
17. Wang C, Zhu Y, Liu Z, et al. Causal associations of obesity related anthropometric indicators and body compositions with knee and hip arthritis: A large-scale genetic correlation study. Front Endocrinol (Lausanne), 2022, 13: 1011896. doi: 10.3389/fendo.2022.1011896.
18. Rupp S, Seil R, Schneider A, et al. Ligament graft initial fixation strength using biodegradable interference screws. J Biomed Mater Res, 1999, 48(1): 70-74.
19. 陈松, 谢庆云, 刘金标, 等. 髌骨下极骨折治疗的现状分析. 中国骨与关节杂志, 2021, 10(12): 900-904.
20. 王培召, 韩旭, 王啸, 等. 不可吸收缝合线捆扎结合髌骨爪固定治疗髌骨下极骨折疗效观察. 中国修复重建外科杂志, 2020, 34(10): 1243-1247.
21. 李旭, 李石伦, 李升, 等. 全切术和部分切除术对髌骨粉碎性骨折的远期疗效比较. 河北医药, 2020, 42(12): 1809-1812.
22. Hargett DI, Sanderson BR, Little MTM. Patella fractures: approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
23. 徐希斌, 何双建, 杨照耀, 等. 改良独立垂直钢丝联合钢丝环扎内固定治疗髌骨下极骨折疗效分析. 中国骨与关节损伤杂志, 2023, 38(2): 177-179.
24. Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
25. 王强, 吕欣, 李兴业, 等. 带线锚钉+空心钉内固定治疗髌骨骨折的疗效. 临床骨科杂志, 2024, 27(2): 257-260.
26. 袁建敏, 陶周善, 杨民, 等. 带线锚钉联合髌骨横向钻孔修复股四头肌腱骨腱结合部断裂. 中国骨伤, 2020, 33(1): 71-75.
27. 王军, 王陶, 石波, 等. 空心拉力螺钉联合钢丝张力带治疗髌骨骨折. 华西医学, 2012, 27(2): 230-233.
28. Thelen S, Schneppendahl J, Jopen E, et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury, 2012, 43(8): 1290-1295.
29. 杜军, 鲁成, 孔杨. 双结克氏针张力带固定治疗髌骨骨折. 临床骨科杂志, 2024, 27(6): 876-879.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesTreatment of inferior pole patellar fractures with suture anchors and headless compression screws

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