Clin Orthop Surg.  2021 Sep;13(3):315-319. 10.4055/cios20253.

Biomechanical Analysis of the Kirschner-Wire Depth of the Modified Tension Band Wiring Technique in Transverse Patellar Fractures: An Experimental Study Using the Finite-Element Method

Affiliations
  • 1Department of Orthopaedic Surgery, Inje University Haeundae Paik Hospital, Busan, Korea
  • 2Department of Occupational and Environmental Medicine, Inje University Haeundae Paik Hospital, Busan, Korea

Abstract

Background
Modified tension band wiring is one of the most preferred surgical methods for transverse patellar fractures. However, the optimal depth or sagittal position of a Kirschner wire (K-wire) in modified tension band wiring has yet to be determined. The purpose of this study was to evaluate whether the depth of a K-wire affects the biomechanical characteristics of modified tension band wiring using the finite-element method.
Methods
A patella model was designed with a cuboid shape (length, 34.3 mm; width, 44.8 mm; and thickness, 22.4 mm) and divided into the cortical and cancellous bone parts. A transverse fracture line was formed on the midline of the cuboid shape model. The cuboidal model was applied to modified tension band wiring. The depth or sagittal position of the K-wire was divided into superficial, center, and deep. With the Abaqus v2017 program (Dassault System Inc.), the distal part of the model was fixed, and a tensile load of 850 N was applied to the proximal part of the model at an angle of 45°. The maximum pressures of the cortical and cancellous bones at the fracture plane were measured. The largest von Mises values of the K-wire and stainless steel wire were also measured. The fracture gap on the distracted or anterior side was measured.
Results
In deep K-wire placement, the highest peak von Mises values of the cortical and cancellous bones were observed. The Kwire and stainless steel wire showed the highest von Mises values in deep K-wire placement. The fracture gap was also largest in deep K-wire placement.
Conclusions
The depth of the K-wire affects the biomechanical characteristics of modified tension band wiring. Deep placement of the K-wire will be more favorable for bone union than the empirically known 5-mm anterior or center placement of the K-wire.

Keyword

Patella; Transverse fracture; Tension band wiring
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