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      Treatment of inferior pole fracture of the patella with tension-free external immobilization

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          Abstract

          Background

          Inferior pole fracture of the patella (IPFP) has small and comminuted fracture blocks that are hard to immobilize, and early mobilization may lead to loss of fracture reduction and immobilization failure. Therefore, a difficulty of treatment is to achieve rigid immobilization with early functional exercise. Here, a new treatment method of tension-free external immobilization is put forward.

          Methods

          The clinical data of 11 IPFP patients treated with tension-free external immobilization from May 2016 to June 2019 were retrospectively analyzed. There were six males and five females aged 39.0 ± 12.8 years (range 18–53 years). IPFP was caused by traffic accidents in five cases and falls in six cases. All cases had unilateral closed injuries, including four in the left knee and seven in the right knee. The preoperative range of motion of the knee was 22.0 ± 7.5° (10–30°). The time from injury to operation was 4.5 ± 1.3 d (3–7 d). The operation-related indices were recorded, and the function of the affected knee was assessed by the Böstman score.

          Results

          All operations were successful. The operation time was 56.4 ± 8.4 mi (45–70 min), the intraoperative blood loss was 54.1 ± 14.6 mL (40–80 mL), and the length of hospital stay was 7.5 ± 1.9 d (5–11 d). The mean follow-up time was 20.4 ± 7.6 months (12–36 months), the duration of fracture healing was 8.9 ± 1.5 weeks (7–12 weeks), and the removal time of the external immobilization device was 10.4 ± 0.9 weeks (9–12 weeks). At the last follow-up, the range of motion had no significant difference between the affected knee (129.7 ± 3.3°, range 125–135°) and the unaffected knee (130.8 ± 3.8°, range 126–137°) ( t = 0.718, p < 0.05). The Böstman score of the knee was 29.2 ± 1.0 points (27–30 points), including 10 excellent cases (90.9%) and one good case (9.1%).

          Conclusion

          Tension-free external immobilization is a feasible treatment for IPFP. It can help with early functional exercise and achieve a satisfactory clinical effect.

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          Most cited references21

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          Early complications in the operative treatment of patella fractures.

          To identify and review early complications in the operative treatment of patella fractures. Retrospective review. Single tertiary care institution with multiple surgeons, including generalists and fellowship trained subspecialists. A consecutive series of eighty-seven patella fractures over a five year period was reviewed. Patients treated nonoperatively or with partial or total patellectomy were excluded. Minimum follow-up to fracture healing (four months) was available in fifty-one fractures. Modified tension band wire fixation was used in forty-nine fractures, whereas two fractures were treated with tension band wires threaded through cannulated screws. Early complications such as loss of reduction or fixation, infection, or soft-tissue problems were evaluated. Displacement of > or = 2 mm before healing was noted in eleven fractures. The displacement could be attributed to technical errors in five cases, and to patient noncompliance with postoperative activity restrictions in another five cases. Two cases of superficial infection were documented. Nine patients with symptomatic hardware required hardware removal. Twenty-two percent of fractures treated with tension band wiring and early motion displaced > or = 2 mm within the early postoperative period. Technical errors or patient noncompliance were identified as factors. The incidence of early complications in operatively treated patella fractures is higher than previously reported.
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            Functional outcomes after operatively treated patella fractures.

            To evaluate the midterm functional outcomes of patients with isolated operatively treated patella fractures.
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              Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy.

              Partial patellectomy (PP) and reattachment of the patellar ligament with transosseous suturing is the mainstay of surgical treatment for distal pole patellar fractures. An anchor suturing (AS) technique has recently been reported as an alternative to PP in such fractures and allows for bone-to-bone interface and possibly superior fracture healing than bone-to-tendon interface with PP. We present our experience with AS and compare it to PP.
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                Author and article information

                Contributors
                xuyongqingkm@163.net
                zyhchina@yeah.net
                Journal
                BMC Surg
                BMC Surg
                BMC Surgery
                BioMed Central (London )
                1471-2482
                12 September 2022
                12 September 2022
                2022
                : 22
                : 337
                Affiliations
                [1 ]Department of Orthopedics, 920 Hospital of the Joint Logistic Support Force, 650032 Kunming, China
                [2 ]GRID grid.414918.1, Department of Orthopedics, , The First People’s Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, ; 650032 Kunming, China
                Article
                1790
                10.1186/s12893-022-01790-x
                9465923
                36096769
                2562319b-bc1c-456d-b77d-fbc6ca84a270
                © The Author(s) 2022

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 7 June 2022
                : 6 September 2022
                Categories
                Research
                Custom metadata
                © The Author(s) 2022

                Surgery
                external immobilization,inferior pole fracture of patella,knee
                Surgery
                external immobilization, inferior pole fracture of patella, knee

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