Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella.
OBJECTIVE
Among patients over 50 years of age, separate vertical wiring alone may be insufficient for fixation of fractures of the inferior pole of the patella. Therefore, mechanical and clinical studies were performed in patients over the age of 50 to test the strength of augmentation of separate vertical wiring with cerclage wire (i.e., combined technique).


METHODS
Multiple osteotomies were performed to create four-part fractures in the inferior poles of eight pairs of cadaveric patellae. One patella from each pair was fixed with the separate wiring technique, while the other patella was fixed with a combined technique. The ultimate load to failure and stiffness of the fixation were subsequently measured. In a clinical study of 21 patients (average age of 64 years), comminuted fractures of the inferior pole of the patellae were treated using the combined technique. Operative parameters were recorded from which post-operative outcomes were evaluated.


RESULTS
For cadaveric patellae, whose mean age was 69 years, the mean ultimate loads to failure for the separate vertical wiring technique and the combined technique were 216.4±72.4 N and 324.9±50.6 N, respectively (p=0.012). The mean stiffness for the separate vertical wiring technique and the combined technique was 241.1±68.5 N/mm and 340.8±45.3 N/mm, respectively (p=0.012). In the clinical study, the mean clinical score at final follow-up was 28.1 points.


CONCLUSIONS
Augmentation of separate vertical wiring with cerclage wire provides enough strength for protected early exercise of the knee joint and uneventful healing.
Department of Orthopaedic Surgery, Ajou University School of Medicine, Suwon, Korea.
Hyung Keun
HK
Song
Department of Orthopaedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.
Je Hyun
JH
Yoo
Department of Orthopaedic Surgery, Daegu Fatima Hospital, Daegu, Korea.
Young Soo
YS
Byun
Department of Orthopaedic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Kyu Hyun
KH
Yang
D000368:Aged; D000369:Aged, 80 and over; D001864:Bone Wires; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D010329:Patella / Q000293:injuries* / Q000601:surgery*
Patella; cerclage wiring; inferior pole; vertical wiring