ObjectiveTo compare the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures.MethodsBetween January 2017 and January 2019, 26 patients with type C patellar fractures were treated with improved Kirschner wire tension band fixation (group A), and 24 patients were treated with traditional Kirschner wire tension band fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, and side and type of fracture between 2 groups (P>0.05). The operation time, intraoperative blood loss, the visual analogue scale (VAS) scores at 1 and 3 days after operation, the fracture healing time, and the occurrence of complications (skin irritation of Kirschner wires, failure of internal fixation, fracture reduction loss) were recorded, and the knee function was evaluated by Lysholm scoring standard in 2 groups.ResultsThe operation time in group A was significantly less than that in group B (t=−4.742, P=0.000). There was no significant difference in the intraoperative blood loss and VAS scores at 1 and 3 days after operation between 2 groups (P>0.05). All incisions healed by first intention. All patients were followed up 8-15 months, with an average of 11 months. The fracture healing time was (3.3±0.6) months in group A and (3.2±0.6) months in group B, showing no significant difference (t=0.589, P=0.559). At last follow-up, the knee joint function was evaluated according to Lysholm scoring standard. And there were 15 cases of excellent, 8 cases of good, and 3 cases of fair, with an excellent and good rate of 88.5% in group A; there were 8 cases of excellent, 7 cases of good, 7 cases of fair, and 2 cases of poor, with an excellent and good rate was 62.5%. The difference between 2 groups was significant (Z=2.828, P=0.005). The internal fixators were removed after the fracture healed in 2 groups. At last follow-up, no skin irritation of Kirschner wires occurred in group A, but 3 cases in group B. X-ray films reexamination showed that 5 cases of internal fixation failure and no fracture reduction loss were found in group A, while 9 cases of internal fixation failure and 1 case of fracture reduction loss in group B. The incidence of complications in group A was 19.2% (5/26), which was significantly lower than that in group B (54.2%, 13/24) (χ2=6.611, P=0.010).ConclusionCompared with the traditional Kirschner wire tension band fixation, the improved Kirschner wire tension band fixation in treatment of type C patellar fracture can shorten the operation time, reduce the incidence of complications, and benefit the functional recovery of knee joint.
Objective To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures. Methods Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by fall ing from height, 2 by tumbl ing, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of obl ique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days. Results One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture heal ing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension arc of the elbow averaged 92.8°(range, 23-130°), and the arc of forearm rotation averaged 124.4° (range, 42-175°). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1. Conclusion Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid compl ications.
Objective To explore the effectiveness of transverse double “8”-shaped tension band technique in the treatment of Lawrence zoneⅠfracture of the 5th metatarsal base. Methods Between February 2019 and October 2021, 15 patients with Lawrence zoneⅠfracture of the 5th metatarsal base were treated with transverse double “8”-shaped tension band technique. There were 8 males and 7 females, with a median age of 40 years (range, 23-59 years). The fractures were caused by sprains. The time from injury to operation was 3-7 days (mean, 4.1 days). X-ray films were taken to observe the fracture healing and the anchor looseness and detachment. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS) score, and the eversion angle of the calcaneal talus joint. Results The incisions healed by first intention after operation in 14 cases and the incision healed poorly in 1 case. All patients were followed up 8-12 months (median, 10 months). The imaging examination showed that all fractures healed well, with a healing time of 10-14 weeks (mean, 11.7 weeks). At last follow-up, AOFAS score was 82-100 (median, 98); 13 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. VAS score was 0-3 (median, 1). Three cases had mild limited ankle joint range of motion, while 12 cases had normal range of motion. The eversion angle of the calcaneal talus joint was 25°-32° (median, 30°). Conclusion The application of transverse double “8”-shaped tension band technique for Lawrence zone Ⅰ fracture of the 5th metatarsal base has advantages such as simple operation, avoidance of secondary operation, and reduction of foreign body sensation, with definite effectiveness.
Objective To compare the biomechanical stability of Kirschner wire and tension band wiring, reconstruction plate combined with tension band wiring, and olecranon anatomical plate in fixing proximal ulna combined with olecranon fracture, so as to provide the theoretical evidence for clinical selection of internal fixation. Methods Eight specimens of elbow joints and ligaments were taken from eight fresh male adult cadaveric elbows (aged 26-43 years, mean 34.8 years) donated voluntarily. The model of proximal ulna combined with olecranon fracture was made by an osteotomy in each specimen. Fracture end was fixed successively by Kirschner wire and tension band wiring (group A), reconstruction plate combined with tension band wiring (group B), and olecranon anatomical plate (group C), respectively. The biomechanical test was performed for monopodium compression experiments, and load-displacement curves were obtained. The stability of the fixation was evaluated according to the load value when the compression displacement of fracture segment was 2 mm. Results No Kirschner wire withdrawal, broken plate and screw, loosening and specimens destruction were observed. The load-displacement curves of 3 groups showed that the displacement increased gradually with increasing load, while the curve slope of groups B and C was significantly higher than that of group A. When the compression displacement was 2 mm, the load values of groups A, B, and C were (218.6 ± 66.9), (560.3 ± 116.1), and (577.2 ± 137.6) N, respectively; the load values of groups B and C were significantly higher than that of group A (P lt; 0.05), but no significant difference was observed between groups B and C (t=0.305, P=0.763). Conclusion The proximal ulna combined with olecranon fracture is unstable. Reconstruction plate combined with tension band wiring and olecranon anatomical plate can meet the requirement of fracture fixation, so they are favorable options for proximal ulna combined with olecranon fracture. Kirschner wire and tension band wiring is not a stable fixation, therefore, it should not be only used for proximal ulna combined with olecranon fracture.
ObjectiveTo estimate the outcome of cerclage followed by a figure-of-eight tension band with a single titanium wire for the treatment of patellar fracture.MethodsA retrospective analysis was made on the clinical data of 46 patients with patellar fractures treated between June 2012 and November 2014. There were 30 males and 16 females, aged 20-86 years (mean, 54 years). The fracture causes included falling in 27 cases, traffic accident in 16 cases, and knock in 3 cases. There were 41 cases of closed fractures and 5 cases of open fracture. The injury located at the left side in 24 cases and the right side in 22 cases. According to AO classification, fracture was rated as type 34-A in 3 cases, as type 34-B in 1 case, as type 34-C1 in 7 cases, as type 34-C2 in 13 cases, and as type 34-C3 in 22 cases. The time between injury and operation ranged 1-12 days (mean, 3.7 days). During operations, a single titanium wire was used to pass around the patellar, followed a figure-of-eight wrapping, to tight and fix at the tension of 35 kg.ResultsAll incisions healed primarily. The patients were followed up 20.6 months on average (range, 6-24 months). Partial wire loosening was found in 2 cases, irritation of skin or soft tissue in 1 case. The X-ray examination showed bony healing at 3 months after operation, without breakage of titanium wire. The internal fixation was removed in 38 cases at 12 months after operation. According to the Böstman rating score, the mean score was 28.34 (range, 24-30) at 12 months after ope-ration; the results were excellent in 42 cases and good in 4 cases, with an excellent and good rate of 100%.ConclusionFor patellar fracture, cerclage followed by a figure-of-eight tension band with a single titanium wire is able to achieve an effective stability and to allow early motion for patient with less complication.
Objective To analyze the effectiveness of three internal fixation methods, namely hollow screw combined with Kirschner wire tension band, hollow screw combined with anchor nail, and modified 1/3 tubular steel plate, in the treatment of avulsion fracture of tibial tubercle (AFTT) in adolescents. Methods Between January 2018 and September 2023, 19 adolescent AFTT patients who met the selection criteria were admitted. According to different internal fixation methods, patients were divided into group A (8 cases, hollow screw combined with Kirschner wire tension band), group B (6 cases, hollow screw combined with anchor nail), and group C (5 cases, modified 1/3 tubular steel plate). There was no significant difference in the baseline data of age, gender, side, cause of injury, Ogden classification, and time from injury to operation among the three groups (P>0.05). The range of motion (ROM), weight-bearing time, normal activity time of knee joint, and the hospital for special surgery (HSS) score at last follow-up were recorded and compared among the three groups. Recorded whether the fracture was displaced, whether the fracture line was blurred at 1 month after operation, whether there was epiphyseal dysplasia, and whether there was incision infection and other complications. Results There was no significant difference in hospital stay between the groups (P>0.05). All patients were followed up 10-24 months, with an average of 14.3 months; there was no significant difference between the groups (P>0.05). All the incisions healed well without soft tissue irritation or fracture nonunion, and no limb shortening deformity or epiphyseal dysplasia was found during follow-up. At 1 month after operation, the knee joint ROM and hospitalization expenses in group A were better than those in groups B and C, the fracture healing time, knee joint weight-bearing time, and normal activity time of knee joint were better than those in group C, and the hospitalization expenses in group C were better than those in group B, with significant differences (P<0.05); there was no significant difference in the other indicators between the groups (P>0.05). In group A, the fracture line was blurred 1 month postoperatively, the fracture ends were in close contact, and there was no fracture displacement; in groups B and C, the fracture line was clear in 2 cases, and 1 case in group C had slight fracture displacement; except for 1 case in group B, there was no fracture split in the other two groups. There was no significant difference in the incidences of blur of fracture line, fracture displacement, and intraoperative bone split between the groups at 1 month after operation (P>0.05). At last follow-up, the HSS scores of knee joints in the three groups were excellent and good, and there was no significant difference between the groups (P>0.05).ConclusionHollow screw combined with Kirschner wire tension band technique is effective in treating adolescent AFTT, which has the advantages of stabilizing fracture, accelerating fracture healing and rehabilitation, early feasible knee joint functional exercise, and reducing hospitalization expenses.