Cable Pin System versus K-wire Tension Band Fixation for Patella Fractures in Chinese Han Population: A Meta-analysis

This meta-analysis compared the therapeutic effect of cable pin system（CPS） with K-wire tension band（KTB） in the treatment of patella fractures among Chinese Han population. The databases of PubM ed, Cochrane library, China National Knowledge Infrastructure（CNKI）, Chinese Wan Fang and Chinese VIP were searched for studies on CPS versus KTB in the treatment of patella fractures among Chinese Han population. Literatures were screened according to the inclusion and exclusion criteria. The quality of the studies was assessed, and meta-analysis was performed using the Cochrane Collaboration＇s REVMAN 5.3 software. A total of 932 patients from 15 studies were included in this meta-analysis（426 fractures treated with CPS and 506 fractures treated with KTB）. There were significant differences in duration of hospital stay [mean difference（MD）=–1.07; 95% confidence interval（CI）： –1.71 to –0.43], fracture healing time（MD=–1.23; 95% CI： –1.68 to –0.77）, flexion degree of knee joint at 6 th month after operation（MD=14.82; 95% CI： 10.93 to 18.71）, incidence of postoperative complication [risk ratio（RR）=0.16; 95% CI： 0.09 to 0.27] and excellent-good rate of B？stman score（RR=1.09; 95% CI： 1.03 to 1.16） between the CPS group and KTB group, while no significant difference was found in operative time between the two groups（MD=–4.52; 95% CI： –11.70 to 2.67）. For the treatment of patella fractures among Chinese Han population, limited evidence suggests that the CPS is more suitable than the KTB when considering the hospital stay, fracture healing time, flexion degree of knee at 6 th month after operation, incidence of postoperative complication and excellent-good rate of B？stman joint score. Due to the limitation of high quality evidence and sample size, more large-scale randomized controlled trials are needed to validate the findings in the future.

Open Patellar Fracture in a 2-Year-Old Child: A Rare Case Report

We present this unusual fracture in order to stress the importance of being aware of the existence of open fractures of patella in 2-year-old child. Fractures of the patella are rare in children, as the patella is largely cartilaginous and has great mobility. Normally in this age closed patellar fractures cannot be diagnosed radiologically as the ossification starts only after 3 years of age. Our case is an open transverse patellar fracture in a two-year-old girl which is treated with transcartilagenous absorbable sutures, which is not found reported in the literature.

A Double Tension Band Technique for Patellar Fractures—A New Concept

Amongst the many known techniques used for the management of fractures of the patella, the tension band wire fixation is a reliable treatment modality and has given consistently good results. In transverse patellar fractures, a combination of cerclage wiring and tension band fixation gives a good mechanical stability and an environment conducive to healing. The fracture described herein is classified as 45-C1 (based on Orthopaedic Trauma Association classification) of the right knee of a forty three years old male patient. It was fixed with three vertical 1.5 mm K wires and double cerclage wire looped proximally through the quadriceps tendon and distally through the patellar ligament in a double figure-of-eight configuration. The average follow-up period was 7 months. The Activity of Daily Living Scale (ADLS) of the Knee Outcome Survey was used to assess symptoms and functional capability of the knee. The fracture union was achieved at an average of 10 weeks. Full range of knee motion was achieved by end of the third postoperative month. No complications, such as infection and implant failure were noted. The technique aims to stress the advantage of giving a balanced fixation addressing the bony elements (the fractured ends) as well as the soft tissue (the extensor apparatus).

Biomechanical analysis of tension band wiring （TBW） of transverse fractures of patella

Purpose： Tension band wiring is commonly used for fixation of simple transverse fractures. The popular configuration is parallel Kirschner wires （K-wires） and a stainless steel wire loop placed in a vertically oriented figure-of-8. Methods： We used a wooden model of a patella with a midway transverse fracture and compared four different types of fixation. The first construct had a vertical figure-of-8 with one twist of wire. The second contained a vertical figure-of-8 with two twists of wire. The third was a vertical figure-of-8 with two twists of wire placed at adjacent corners while the last one had a horizontal figure-of-8 with two twists of wire placed at adjacent corners, lnterfragmentary compression at the point of wire breakage was measured for each construct as well as permanent displacement on cyclic loading. Results： Placement of the figure-of-eight in a horizontal orientation with two wire twists at the corner improved interfragmentary compression by 63% （p 〈 0.05, Tukey post ]hoc test）. On cyclic loading, all the constructs with vertical figure-of-eight but none with a horizontal construct failed （p = 0.01; Fisher＇s exact test）. Permanent fracture displacement after cyclic loading was ,57% lower with horizontal figure- of-eight constructs （p 〈 0.05; t test）. Conclusion： Placing wire twists at the corner and a horizontal placement of figure-of-8 improves stability of the construct.