title: Patellar Fractures: An Innovative Surgical Technique With Transosseous Suture to Avoid Implant Removal.
abstract: OBJECTIVE
  To describe a new surgical procedure and its outcomes: osteosynthesis with high-resistance sutures, avoiding metallic implants. Open sky osteosynthesis with Kirschner and cerclage wiring is the current gold standard for patella fractures. Favorable functional outcomes have been observed, although implant removal is required in many cases due to the prominent wires under the skin. New implants have been sought after to minimize the need for second surgeries.
  
  
  METHODS
  Eight patients, aged between 25 and 61 years, with a minimum follow-up of 24 months, were included in the present study. The surgical procedure consists of open reduction followed by internal fixation performing 3 longitudinal tunnels crossing double high-resistance sutures within these tunnels and suturing among them. Next, an anterior cerclage with parenchymal suture was performed.
  
  
  RESULTS
  During follow-up, no secondary fracture displacement was observed. No patient required or requested implant removal. Functional outcomes were equitable to other surgical techniques.
  
  
  CONCLUSIONS
  Despite the relatively small number of patients, osteosynthesis with high-resistance suture presents as an acceptable alternative within patella fracture treatment, being safe and with similar functional outcomes when compared with other techniques. Furthermore, no second surgeries for implant removal were required during the present study.
authors.affiliation: Mutua Montañesa, MATEPSS 7, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Buezo
authors.affiliation: Fundación García Cugat, Hospital Quirón, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Cuscó
authors.affiliation: Fundación García Cugat, Hospital Quirón, Barcelona, Spain roberto6jas@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Seijas
authors.affiliation: Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Andrea
authors.initials: A
authors.lastname: Sallent
authors.affiliation: Fundación García Cugat, Hospital Quirón, Barcelona, Spain.
authors.forename: Oscar
authors.initials: O
authors.lastname: Ares
authors.affiliation: Fundación García Cugat, Hospital Quirón, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Álvarez-Díaz
authors.affiliation: Fundación García Cugat, Hospital Quirón, Barcelona, Spain.
authors.forename: Ramón
authors.initials: R
authors.lastname: Cugat
mesh_terms: D000328:Adult; D020878:Device Removal / Q000706:statistics & numerical data*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data*; D050723:Fractures, Bone / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010329:Patella / Q000601:surgery*; D012189:Retrospective Studies; D013537:Sutures
keywords: high-resistance suture; implant removal; osteosynthesis; patellar cerclage; patellar fracture