Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy.

PURPOSE: 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. METHODS: Between 2006 and 2011, 60 patients with distal pole patellar fracture underwent either AS (n = 27) or PP (n = 33). We retrospectively gathered their demographic data and information on fracture type, fixation technique, operation time, postoperative complications and knee range of motion. A telephone survey was performed to grade functional outcomes with standard questionnaires (the SF-12 for quality of life, the Kujala score for patellofemoral function and a visual analog scale [VAS] pain score). RESULTS: AS was equivalent to PP in terms of residual pain and functional outcomes (VAS: 2.45 vs. 2.26, p = 0.83 and Kujala score: 74.3 vs. 69, p = 0.351, respectively) as well as for knee range of motion. Complications included three cases of infection in each group, two cases of early hardware failure and one case of non-union in the AS group. Operation time was significantly shorter for AS compared to PP (68.5 vs. 79.1 min, p = 0.03). CONCLUSIONS: AS is non-inferior to PP for function and pain after distal pole patellar fractures and is superior to PP with regard to operative time. Common complications of this technique are hardware failure and infections. LEVEL OF EVIDENCE: Therapeutic Level III.

Comparative analysis of the benefits of autotransfusion of blood by a shed blood collector after total knee replacement.

INTRODUCTION: Joint replacement is associated with massive blood loss. Various techniques have been used to avoid the use of allogeneic blood. One of the techniques used is postoperative salvage and reinfusion of shed blood that was found to reduce the use of banked blood with its potential risk. MATERIALS AND METHODS: We prospectively studied 365 patients who underwent knee joint replacement (TKR) and were divided in two groups. Group A's shed blood (SureTrans System) was collected ( n=194) and reinfused and group B's was not ( n=171, "controls"). Hemoglobin levels before and after the operation were recorded. RESULTS: Allogeneic blood requirement for TKR decreased by 65% in group A compared to group B. The packed cell/patient index dropped from 0.91 to 0.29 in group 2A. Statistical analysis yielded the odds ratio for blood replacement, a "predicting formula" for blood replacement depending on hemoglobin levels, and a cutoff point for a patient's receiving blood replacement. CONCLUSION: We recommend using this system in TKR for decreasing allogeneic blood replacement and potential associated risks. The predicting formula for blood replacement may be a helpful tool when making a decision of whether or not to use the collector system and for whom.