Orthopedic journal club article presentation

orthopaedic jornal

1. Presenter : Dr Savankumar (JR) Moderator : Dr Sreedhar (SR) Impact Factor : 1.251

2. Introduction The incidence of patellar fractures is approximately 1%. Approximately 70–90% are transverse fractures. Tension band wiring (TBW) is probably the most commonly used and effective surgical method. Still, inevitably, it has the disadvantages of protruding discomfort, soft tissue irritation, and the need for secondary surgical removal. In this study a closed repositioning method combined with high-strength sutures to overcome the problem of protruding implants without affecting stable fixation was used.

3. Materials and Methods After obtaining approval from the institutional ethical review committee, 28 patients with patella fracture 34-C1 were included in the study. Patients treated between January 2019 to January 2020 were retrospectively analyzed. Among them, 16 cases were in the Tension band wiring group; and 12 were in the high-strength sutures (HS) group.

4. Materials and Methods Inclusion criteria: closed transverse patellar fracture (AO/ATO 34 C1) (2) normal knee function before injury (3) age≥18 years and≤70 years. (4) Signed informed consent. Exclusion criteria: comminuted patellar fracture. (2) multiple fractures or injuries. (3) combined peripheral neurovascular injury. (4) inability to cooperate with follow-up or missing relevant information.

5. Materials and Methods All patients provided written informed consent before the study. In addition, all patients were informed preoperatively about the minimally invasive treatment modality using closed reduction. Patients were duly informed about the possibility of using incisional reduction. Patients gave their informed consent and signed the informed consent form.

6. Surgical Techniques Preoperative Preparation: The patients were admitted to the hospital and externally immobilized with a plaster rest under extension on the same day. Preoperative prophylactic medication against VTE was routinely applied. Anesthesia and Position: Subarachnoid block anesthesia or combined epidural anesthesia was selected, and the patients were placed in the supine position on the surgical bed.

7. Postoperative Management Patients in both groups received the same postoperative rehabilitation program. Patients performed active quadriceps, ankle, toe flexion, and extension functional exercises two days postoperatively. Afterward, patients were instructed to perform passive knee flexion and extension exercises post surgery. Partial weight-bearing was acceptable starting on postoperative day 3. When the fracture was radiologically healed, full weight-bearing was allowed. Radiographs were reviewed 2, 4, 8, 12 weeks, and 6 months after surgery for fracture healing and to assess the function of the affected limb.

8. Result All 28 patients were healed till the last follow-up, with an average age of 56.32±7.77 years and a follow-up of 13.14±1.58 months. No significant difference was observed in patient demographic data between the two groups.

9. Statistical Analysis SPSS 24.0 statistical software was used to statistically analyze the data. The measurement data were expressed as mean ± standard deviation to compare the demographic data, surgical data, and postoperative-related clinical data. Categorical variables were expressed as frequencies or percentages. Continuous variables were expressed as mean ± SD. When the continuous variables were normally distributed, an independent sample t test was used to determine the differences between the two groups. Categorical variables were compared using the Pearson chi-square test or Fisher's exact probability method.

10. Comparison of Surgical Data, Complications, and Postoperative Function

11. Discussion High-strength sutures have been used as a substitute for metallic materials and have achieved good clinical results. We used the polyethylene braided material Ultrabraid NO.2 suture for internal fixation which has better results with knots than FiberWire. In our study, no significant difference was observed in healing time, final Böstman score, and knee mobility between the two groups compared to wire tension band wiring. While the differences in operation time, incision length, intraoperative bleeding, and secondary operation rate were statistically significant.

12. Conclusion Closed reduction high-strength sutures have good clinical efficacy in treating transverse patella fractures, with the advantages of > shorter duration of surgery > incision length > less intraoperative bleeding > no secondary removal.

13. Retrospective study, 48 This method showed some superiority to tradition tension band wiring in terms of safety and efficacy by reducing soft tissue stimulating complications and thus promoting functional recovery .

14. Observational study, 38 H as advantages of simple to operate, effective fixation, and less complication. It can avoid reoperation of removing the internal fixators.

15. Limitations 1. Retrospective study 2. Small sample size 3. Shorter duration of follow up

16. Take Home Message 1. High strength sutures in fracture patella has better results in terms of duration of surgery, incision length, intra-op bleed and need for secondary removal. 2. No significant difference in terms post-operative healing, Bostman score, Lysholm score or knee ROM post-operatively. 3. But this being retrospective study with small sample size and shorter follow up period, provides with an opportunity to further study regarding the above mentioned comparison with better study design and larger sample size.