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

• Song HK
• Yoo JH
• Byun YS
• Yang KH

• KMID: 2068692
• DOI: http://doi.org/10.3349/ymj.2014.55.3.785

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

Figure

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  Fig. 1 Separate vertical wiring technique (lateral view of the patella). (A) A number one Steinmann pin with a small hole at its end was inserted vertically from the antero-superior aspect of the patella to the most posterior aspect of the transverse osteotomy; (B) a 0.75-mm diameter wire suture was passed through the hole in the Steinmann pin until the tip emerged from the osteotomy site and the Steinmann pin was then withdrawn with the wire; (C) the distal end of the wire was passed through the patellar tendon as close as possible to the bone from the posterior aspect of the two bone fragments; and (D) the distal end of the wire was then pulled anteriorly, twisted, and tightened with the proximal end at the anterosuperior aspect of the patella. This procedure successfully reduced the number of fragments.

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  Fig. 2 The ultimate load to failure and stiffness for the separate vertical wiring technique and for the combined technique.

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  Fig. 3 The augmentation effect of cerclage wiring is stronger the higher the age.

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  Fig. 4 Radiographs of a 70-year-old male patient. (A) Initial lateral radiograph showing displaced and comminuted fractures of the inferior pole of the patella. (B and C) Postoperative anteroposterior and lateral radiographs showing reduction of three comminuted fragments and fixation by three separate vertical wirings with cerclage wire. (D) Lateral radiograph at final check-up.

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