ABSTRACT
Objective:
Few
reports exist on the
treatment of transverse patellar fractures (TPFs) using absorbable cannulated screws and high-strength
sutures, and most screws and
sutures lack good
biomechanics and clinical trials. Therefore, this study aimed to demonstrate the biomechanical stability and
clinical efficacy of tension-band high-strength
sutures combined with absorbable cannulated screws (TBSAS) in treating TPFs (AO/OTA 34 C1).
Methods:
Finite
element models of five internal fixation schemes were established tension-band wire with K-wire (TBW), TBW with cerclage wire (TBWC), TBW with headless
pressure screws (TBWHS), TBW with full-thread screws (TBWFS), and TBSAS. We comprehensively compared the biomechanical characteristics of the TBSAS
treatment scheme during
knee flexion and extension. Forty-one
patients with TPFs in our
hospital between January 2020 and August 2022 were retrospectively enrolled and divided into the TBSAS (n = 22) and TBWC (n = 19) groups. Clinical and follow-up outcomes, including
operative time,
visual analog scale (VAS)
pain score,
postoperative complications, Bostman score, and final
knee range of motion, were compared between both groups.
Results:
Finite element analysis (FEA) showed that TBWHS and TBWFS achieved the minimum mean fracture interface relative displacement during
knee flexion (45°, 0-500 N bending load) and full extension (0°, 0-500 N axial load). There was no significant difference between TBSAS (0.136 mm) and TBWC (0.146 mm) during
knee flexion (500 N); however, TBSAS displacement was smaller (0.075 mm) during full extension (500 N). Furthermore, the stress results for the internal fixation and the
patella were generally lower when using TBSAS. Retrospective clinical studies showed that the TBSAS group had a shorter
operative time, lower VAS
pain score at 1 and 2 months postoperatively, better Bostman
knee function score at 3 and 9 months postoperatively, and better final
knee joint motion than the TBWC group (all p < 0.05). There were five cases (26.3%) of internal fixation stimulation
complications in the TBWC group.
Conclusion:
TBSAS demonstrated excellent
safety and
effectiveness in treating TPFs. It is sufficient to meet the
needs of TPF fixation and early functional
exercise and effectively reduces
metal internal fixation-induced
complications and
secondary surgery-induced
trauma.