J Knee Surg 2021; 34(09): 987-996
DOI: 10.1055/s-0039-3402802
Original Article

Comparison of the Kirschner Wire Tension Band with a Novel Nickel–Titanium Arched Shape–Memory Alloy Connector in Transverse Patellar Fractures: A Retrospective Study

Yang Wang*
1   Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
2   Department of Orthopedics, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
,
Demeng Xia*
1   Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
,
Xi Luo*
3   Department of Spine Surgery II, Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
,
Hongyue Zhang
1   Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
,
Jianghong Wu
1   Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
,
Panyu Zhou
1   Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
2   Department of Orthopedics, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
,
Shuogui Xu
1   Department of Emergency, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
2   Department of Orthopedics, Changhai Hospital, Naval Military Medical University, Shanghai, People's Republic of China
› Author Affiliations
Funding The study was funded by National Natural Science Foundation of China (grant/award number: “no. 81672134, no. 81571887, and no. 81601910”).

Abstract

This study aims to compare the clinical outcomes of the nickel–titanium arched shape–memory alloy connector (hereafter referred to as the ASC) and tension band fixation for the treatment of transverse patellar fractures. We retrospectively analyzed a total of 257 patients with transverse patellar fractures who were treated at our emergency orthopaedics department from March 2010 to March 2017. Either an ASC or the Kirschner wire (K-wire) tension band had been used to treat these fractures according to surgeons' experience and preference. We compared operative details, postoperative recovery, and postoperative knee function at 6 months. In terms of surgical duration, blood loss, incision length, length of hospital stay, and postoperative complications, patients in the ASC group showed significantly better results than patients in the K-wire group (p < 0.05). There were no significant differences between the two groups in terms of fracture healing time, knee mobility, and the Boström score at the postoperative 6-month evaluation (p > 0.05). Though, there were similar functional outcomes between two groups whose transverse patellar fractures were different methods, we found that the ASC method was a more reliable, more minimally invasive, and safer treatment option than the tension band wiring method using K-wires, resulting in less tissue damage, shorter surgical duration, shorter length of hospital stay, and fewer complications.

* Contributed equally to the article.




Publication History

Received: 08 November 2018

Accepted: 27 November 2019

Article published online:
02 January 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Mao N, Ni H, Ding W. et al. Surgical treatment of transverse patella fractures by the cable pin system with a minimally invasive technique. J Trauma Acute Care Surg 2012; 72 (04) 1056-1061
  • 2 Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl 1972; 143: 1-80
  • 3 Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg 2011; 19 (04) 198-207
  • 4 Uvaraj NR, Mayil Vahanan N, Sivaseelam A, Mohd Sameer M, Basha IM. Surgical management of neglected fractures of the patella. Injury 2007; 38 (08) 979-983
  • 5 Chang CW, Chen YN, Li CT, Chung YH, Chang CH, Peng YT. Role of screw proximity in the fixation of transverse patellar fractures with screws and a wire. J Orthop Surg (Hong Kong) 2018; 26 (03) 2309499018789705
  • 6 Gosal HS, Singh P, Field RE. Clinical experience of patellar fracture fixation using metal wire or non-absorbable polyester--a study of 37 cases. Injury 2001; 32 (02) 129-135
  • 7 Lue TH, Feng LW, Jun WM, Yin LW. Management of comminuted patellar fracture with non-absorbable suture cerclage and Nitinol patellar concentrator. Injury 2014; 45 (12) 1974-1979
  • 8 Navarro M, Michiardi A, Castaño O, Planell JA. Biomaterials in orthopaedics. J R Soc Interface 2008; 5 (27) 1137-1158
  • 9 Hoh DJ, Hoh BL, Amar AP, Wang MY. Shape memory alloys: metallurgy, biocompatibility, and biomechanics for neurosurgical applications. Neurosurgery 2009;64(05, Suppl 2):199–214, discussion 214–215
  • 10 Song K, Min T, Jung JY, Shin D, Nam Y. A superhydrophilic nitinol shape memory alloy with enhanced anti-biofouling and anti-corrosion properties. Biofouling 2016; 32 (05) 535-545
  • 11 Wardak MI, Siawash AR, Hayda R. Fixation of patella fractures with a minimally invasive tensioned wire method: compressive external fixation. J Trauma Acute Care Surg 2012; 72 (05) 1393-1398
  • 12 Kooistra BW, Sprague S, Bhandari M, Schemitsch EH. Outcomes assessment in fracture healing trials: a primer. J Orthop Trauma 2010; 24 (Suppl. 01) S71-S75
  • 13 Zhou PY, Jiang LQ, Xia DM, Wu JH, Ye Y, Xu SG. Nickel-titanium arched shape-memory alloy connector combined with bone grafting in the treatment of scaphoid nonunion. Eur J Med Res 2019; 24 (01) 27
  • 14 Tang X, Liu Y, Wu H. et al. Five-pointed star lattice sutures for fixation of patella transverse fractures: a clinical study. Eur J Orthop Surg Traumatol 2019; 29 (01) 163-168
  • 15 Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury 1981; 13 (03) 196-202
  • 16 Tian QX, Hai Y, Du XR. et al. Comparison of tension-band wiring with the cable pin system in patella fractures: a randomized prospective study. J Orthop Trauma 2015; 29 (12) e459-e463
  • 17 Gwinner C, Märdian S, Schwabe P, Schaser KD, Krapohl BD, Jung TM. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW 2016; 5: Doc01
  • 18 Larangeira JA, Bellenzier L, Rigo VdaS, Ramos Neto EJ, Krum FF, Ribeiro TA. Vertical open patella fracture, treatment, rehabilitation and the moment to fixation. J Clin Med Res 2015; 7 (02) 129-133
  • 19 Luna-Pizarro D, Amato D, Arellano F, Hernández A, López-Rojas P. Comparison of a technique using a new percutaneous osteosynthesis device with conventional open surgery for displaced patella fractures in a randomized controlled trial. J Orthop Trauma 2006; 20 (08) 529-535
  • 20 El-Sayed AMM, Ragab RKI. Arthroscopic-assisted reduction and stabilization of transverse fractures of the patella. Knee 2009; 16 (01) 54-57
  • 21 Nienhaus M, Zderic I, Wahl D, Gueorguiev B, Rommens PM. A locked intraosseous nail for transverse patellar fractures: a biomechanical comparison with tension band wiring through cannulated screws. J Bone Joint Surg Am 2018; 100 (12) e83
  • 22 Janes GC, Collopy DM, Price R, Sikorski JM. Bone density after rigid plate fixation of tibial fractures. A dual-energy X-ray absorptiometry study. J Bone Joint Surg Br 1993; 75 (06) 914-917
  • 23 Decker S, Krämer M, Marten AK. et al. A nickel-titanium shape memory alloy plate for contactless inverse dynamization after internal fixation in a sheep tibia fracture model: A pilot study. Technol Health Care 2015; 23 (04) 463-474
  • 24 Rubin J, Fan X, Biskobing DM, Taylor WR, Rubin CT. Osteoclastogenesis is repressed by mechanical strain in an in vitro model. J Orthop Res 1999; 17 (05) 639-645
  • 25 Tan H, Dai P, Yuan Y. Clinical results of treatment using a modified K-wire tension band versus a cannulated screw tension band in transverse patella fractures: A strobe-compliant retrospective observational study. Medicine (Baltimore) 2016; 95 (40) e4992
  • 26 Lin T, Liu J, Xiao B, Fu D, Yang S. Comparison of the outcomes of cannulated screws vs. modified tension band wiring fixation techniques in the management of mildly displaced patellar fractures. BMC Musculoskelet Disord 2015; 16: 282
  • 27 Chiang CC, Chen WM, Jeff Lin CF. et al. Comparison of a minimally invasive technique with open tension band wiring for displaced transverse patellar fractures. J Chin Med Assoc 2011; 74 (07) 316-321
  • 28 Hoshino CM, Tran W, Tiberi JV. et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg Am 2013; 95 (07) 653-659
  • 29 Smith ST, Cramer KE, Karges DE, Watson JT, Moed BR. Early complications in the operative treatment of patella fractures. J Orthop Trauma 1997; 11 (03) 183-187
  • 30 Hung LK, Chan KM, Chow YN, Leung PC. Fractured patella: operative treatment using the tension band principle. Injury 1985; 16 (05) 343-347
  • 31 Brink PRG, Windolf M, de Boer P, Brianza S, Braunstein V, Schwieger K. Tension band wiring of the olecranon: is it really a dynamic principle of osteosynthesis?. Injury 2013; 44 (04) 518-522
  • 32 Patel VR, Parks BG, Wang Y, Ebert FR, Jinnah RH. Fixation of patella fractures with braided polyester suture: a biomechanical study. Injury 2000; 31 (01) 1-6
  • 33 Tian Y, Zhou F, Ji H, Zhang Z, Guo Y. Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures. Clin Orthop Relat Res 2011; 469 (12) 3429-3435
  • 34 Nathan ST, Fisher BE, Roberts CS, Giannoudis PV. The management of nonunion and delayed union of patella fractures: a systematic review of the literature. Int Orthop 2011; 35 (06) 791-795
  • 35 Zderic I, Stoffel K, Sommer C, Höntzsch D, Gueorguiev B. Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation. Injury 2017; 48 (08) 1749-1757
  • 36 Bassani P, Panseri S, Ruffini A. et al. Porous NiTi shape memory alloys produced by SHS: microstructure and biocompatibility in comparison with Ti2Ni and TiNi3. J Mater Sci Mater Med 2014; 25 (10) 2277-2285
  • 37 Ryhänen J, Niemi E, Serlo W. et al. Biocompatibility of nickel-titanium shape memory metal and its corrosion behavior in human cell cultures. J Biomed Mater Res 1997; 35 (04) 451-457
  • 38 Su JC, Liu XW, Yu BQ, Li ZD, Li M, Zhang CC. Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion. Int Orthop 2010; 34 (03) 369-375