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IntroductionTension band wire (TBW) and locking plate fixation (LPF) are widely used fixation methods for displaced fractures of the olecranon. The aim of our study was to review the current operative management of olecranon fractures and compare the complication and re-operation rates for patients undergoing TBW and LPF.Materials and methodsRetrospective data were collected for all patients who underwent acute fixation of olecranon fractures in 2016 across nine hospitals in the United Kingdom. We reviewed these cases to determine the incidence of complications and re-operations.ResultsOne hundred and forty patients were included in the study. Seventy-three (52%) had TBW, 67 (48%) had LPF. Males were more likely to have LPF (p = 0.01) as were patients with comminuted fractures (p < 0.01). The overall complication rate was 25%, including an infection rate of 3%, a prominent metalwork irritation rate of 12% and the overall re-operation rate was 17%. There was no significant difference in the complication rate (p = 0.38), infection rate (p = 0.92) or rate of prominent metalwork irritation (p = 0.10) between patients undergoing TBW and LPF. Sub group analysis of patients with comminuted fractures also demonstrated no significant difference in complication rates (p = 0.75) or re-operation rates (p = 0.26).ConclusionLPF has previously been advocated to be advantageous to TBW due to lower reported complication and re-operation rates despite there being no significant difference in functional outcomes. In this multicentre case series, which is the largest in the literature to date, we did not observe any significant differences in complication rates or re-operation rates between the two, even amongst comminuted fractures (which are traditionally treated with LPF), when decision making was left to surgeon preference. We, therefore, recommend that choice of fixation method should be left to individual surgeon’s preference.

PurposeA novel 3D reduction method combined with a modified Kirschner-wire tension band (3D MKTB) fixation method to treat comminuted patella fractures was introduced in this study. This study aims to evaluate the effectiveness and practicality of this novel technology.MethodsThis study is a retrospective case series study. Twenty-eight patients with closed comminuted patella fractures were treated with the novel 3D MKTB fixation method. Radiographs of the knee were obtained at the routine follow-up to assess fracture healing and widening of the articular step-off. Clinical outcomes including the degree of pain on a visual analogue scale (VAS), range of motion, Lysholm, and Bostman grading scales were measured at the last follow-up. The mean follow-up was 39.8 ± 10.5 (range 26–62) months.ResultsAll patients had bony union at a mean of 11.4 ± 1.4 (range 9–14 weeks) weeks based on X-ray. No patient had evidence of internal fixation failure. Only two patients suffered from surgical complication. One patient suffered from postoperative superficial infection, and one patient suffered from internal fixation irritation. Articular step-off larger than 2 mm was not seen in any cases. The average VAS-related pain score was 0.5 ± 0.5 (range 0–1) points. The average range of motion was 0–138.6° ± 11.9° (range 90°–155°), all patients had full knee extension. The mean Lysholm and Bostman scores were 92.9 ± 3.5 (range 86–100 points) points and 28.5 ± 1.3 (range 24–30 points) points, respectively.ConclusionThe novel 3D reduction technique combined with the modified Kirschner-wire tension band technique is an effective, safe, and simple treatment option for comminuted patella fractures.Level of evidenceIV.

Background Kirschner wire tension band (KWTB) and anatomical plate fixation are the most often used procedures for treating Mayo type II olecranon Fractures, each has its technological advantages. However, there are often some associated complications with single use, the combination of Kirschner-wire tension band reduction and locking plate fixation in treating Mayo type II olecranon fractures has been seldom recorded. This research aims to compare the efficacy of KWTB alone and KWTB combined with anatomical locking plate (ALP) in the treatment of Mayo type II olecranon fractures. Methods Clinical data from 72 individuals who had surgery for Mayo type II olecranon fractures between January 2020 and December 2022 were evaluated retrospectively. Patients were randomized to either KWTB ( n  = 37, 19 males and 18 females; range 36 to 75 years; mean age 49.12 ± 9.51 years) or KWTB + ALP ( n  = 35, 16 males and 19 females; range 37 to 75 years; mean age 50.07 ± 9.45 years). Data including operative duration, intraoperative bleeding, incision length, hospital stay, postoperative complications, and the time to return to work, fracture union time, and follow-up time were documented. Their Disabilities of the Arm, Shoulder and Hand (DASH), Mayo elbow performance score and elbow range of motion (ROM) measures were utilized for functional assessments. Results The mean follow-up time was 28.03 ± 8.14 months, there were no statistical differences in general characteristics, intraoperative blood loss and length of incision between the two groups ( P  > 0. 05).The operative duration of KWTB + ALP group was greater than that of KWTB group ( P  < 0. 05). The average stay in the hospital was 8. 80 ± 2. 62 in the KWTB group and 6. 94 ± 3. 82 in the KWTB + ALP group ( P  = 0.0181). Patients come back to work in 9.6 ± 3.4 weeks in the KWTB group and 7.8 ± 2.7 weeks in the KWTB + ALP group ( P  = 0.0156). The rate of complications was considerably greater in the KWTB group (24.3% compared with 5.8%; P  = 0.0283). The fracture union time was 15.36 ± 3.44 in the KWBT group and 12.28 ± 3.42 in the KWTB + ALP group ( P  = 0.003). The mean flexion-extension ROM values and pronation-supination ROM values showed no statistical difference between the two groups. The mean DASH score was 14.0 ± 2.8 in the KWTB group and 10.7 ± 3.2 in the KWTB + ALP group ( P  = 0.001). The average Mayo score was 84.0 ± 9.3 in the KWTB group and 88.3 ± 9.1 in the KWTB + ALP group ( P  = 0.0171). Mean Mayo score and mean DASH score were statistically different between the 02 groups. Conclusion Both operative procedures effectively treat Mayo type II olecranon fractures. Despite the fact that KWTB therapy is inexpensive and simple to administer, there is a high risk of complications associated with it. KWTB combined with ALP in the management of Mayo type II olecranon fracture, especially type IIB olecranon fracture has satisfactory medium and long-term outcome.

Objectives Surgical management of comminuted patella fractures remains a major challenge for the surgeon. We developed a suture reduction (SR) technique to better preserve the comminuted patella. The study aimed to compare the suture reduction technique with conventional reduction (CR) technique in the management of comminuted patellar fractures using the modified Kirschner-wire (K-wire) tension band. Methods From May 2016 to September 2020, a total of 75 patients with comminuted patellar fracture were reviewed retrospectively. Among these cases, 35 patients were in the suture reduction group with a mean age of 52 years, while 40 patients were in the conventional reduction group with a mean age of 53 years. All cases were closed fractures. Comminuted patellar fractures were classified as type 34-C3 according to the AO/OTA classification. Radiographs of the knee were obtained at routine follow-up to evaluate the reduction quality and fracture union. Clinical outcomes including range of motion (ROM), visual analog scale (VAS), Lysholm, and Böstman grading scales were measured at the last follow-up. Postoperative complications were also recorded. Results The average time from injury to surgery was 5.4 days in suture reduction group and 3.7 days in conventional reduction group (p < 0.05). The surgical time of suture reduction group was less than that of conventional reduction group, but there was no significant difference (p = 0.110) regarding surgical time between the two groups. The average blood loss in suture reduction group was 42.9 ml, while the average blood loss in conventional reduction group was 69.3 ml (p < 0.001). There was no difference regarding fracture union, ROM and knee function score (Lysholm score and Böstman scale) between the two groups. The complication rates were 17.1% in suture reduction group and 12.5% in conventional reduction group respectively (p > 0.05). Conclusions In the treatment of comminuted patellar fractures with modified K-wire tension band, the use of suture reduction technique can shorten the surgical time, reduce the surgical trauma, and obtain satisfactory results. This new surgical technique may be particularly effective in management of comminuted patellar fractures when patellectomy would otherwise be considered.

IntroductionTension band wiring of olecranon fractures has high reported rates of complications and reoperations. We aimed to compare classic tension band wiring to cerclage fixation without K-wires in the treatment of displaced olecranon fractures in elderly patients. The primary outcome was reoperation. Secondary outcomes included complications and patient reported outcomes. Outcomes following non-operative treatment were also studied.Materials and methodsPatients aged > 69 years presenting with Mayo class 2a and 2b olecranon fractures at our institution from 2004 through 2016 (n = 239) were eligible for study. Fracture type, treatment method, complications and reoperations were assessed from radiographs and hospital files. QuickDASH surveys were collected by mail.ResultsPatients operated with tension band wire technique had more reoperations (p value 0.03): relative risk (RR) 2.2 (CI 1.08–4.3), odds ratio (OR) 2.6 (CI 1.05–6.4), and complications (p value 0.001): RR 2.5 (CI 1.51–4.1), OR 3.7 (CI 1.67–8.2), compared with those operated with cerclage technique. Non-operative treatment yielded similar complication (p value 0.2) and reoperation rates (p value 0.06) as cerclage fixation. The answer rate was insufficient to compare QuickDASH scores between treatments methods.ConclusionsIn patients 70 years and older undergoing cerclage fixation for displaced stable olecranon fractures (Mayo class 2), the reoperation and complications rates were less than half of those in patients undergoing TBW fixation. Non-operative treatment yielded similar reoperation and complication rates to cerclage fixation, in selected cases.Level of evidenceIII—retrospective comparative cohort study.

Background Krackow suturing and suture bridge technique was compared with Kirschner-Wire (K-wire) tension band and patella cerclage for the fixation of inferior pole patella fracture. Methods This was a retrospective study of 47 patients with inferior pole patella fractures who underwent fixation procedures at our hospital between January 2019 and May 2022, of whom 25 had Krackow suturing combined with the suture-bridge technique (GROUP 1), and 22 received a K-wire tension band combined with patellar cerclage (GROUP 2). We compared the operative time, reoperation rate, Böstman score, knee range of motion (ROM), fracture-healing time, Insall–Salvati index, complications and hospital expenses between the two groups. Results The average follow-up period was 23.1 ± 5.8 months. The complication and reoperation rates in the GROUP 2 were significantly higher than those in the GROUP 1 ( P  = 0.023 and P  < 0.001). While the GROUP 1 has lower hospital expenses than GROUP 2 ( P  < 0.001). However, significant differences were not found regarding the Böstman score, knee ROM, Insall–Salvati index, fracture-healing time, and operation time between the two groups. Conclusions Both Krackow suturing combined with the suture-bridge technique and the K-wire tension band technique can achieve comparable clinical efficacy in stably fixing inferior patellar pole fractures, subsequently allowing an early commencement of rehabilitation exercise, while the suture-bridge technique can also reduce the incidence of complications, hospital expenses and the need for reoperation surgery. Trial registration This study was registered on https://www.chictr.org.cn (registration No. ChiCTR2300072069, 2023/06/01, retrospectively registered). Informed consent was obtained from all individual participants included in the study.

Background The optimal surgical technique for the fixation of inferior pole patellar fracture remains controversial. The aims of this study were (1) to compare clinical and radiological outcomes following fixation of inferior pole patellar fracture by using tension band wire (TBW) and transosseous reattachment (TOR) without excision of the bony fragment and (2) to determine the risk factors for postoperative radiological loss of reduction. Methods For this retrospective cohort study, consecutive patients with inferior pole patellar fracture between January 2010 and December 2017 were recruited. The patients were grouped according to their fixation method (TBW or TOR), and demographic data, clinical outcomes, and postoperative Insall–Salvati (IS) ratio were analyzed. Then, the patients were grouped according to radiological loss of reduction, the possible risk factors for loss of reduction were identified, and odds ratios were calculated. Result This study included 55 patients with inferior pole patellar fracture; 30 patients were treated using TBW and 25 were treated using TOR. Clinical failure occurred in two patients in the TBW group (7%) and three in the TOR group (12%). The rate of radiological loss of reduction was significant higher in the TOR group, whereas removal of implants was significantly more common in the TBW group. Patella baja was noted immediately after surgery in the TOR group, but the IS ratios of the two groups were similar after 3 months. Fracture displacement of more than 30 mm was the only independent risk factor for postoperative radiological loss of reduction. Conclusion For treating inferior pole patellar fracture, both TWB and TOR were effective and had a low clinical failure rate. In 60% of patients undergoing TBW fixation, however, additional surgery was required to remove the implants. Patella baja occurred immediately following TOR, but the patellar height was similar to that in the TBW group after 3 months. Surgeons should be aware of the high risk of postoperative radiological loss of reduction, especially when the fracture displacement is more than 30 mm.

Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of the knee, where large forces are transmitted, and its subcutaneous nature has made treatment of patella fractures a challenge. In this review article, we evaluate how the management of these fractures has evolved over time and the advantages associated with the various treatment techniques. There are few comparative studies looking at the different treatment types for fractures of the patella, with the goal of achieving a functional extensor mechanism with low rates of post-traumatic arthritis and metal-work irritation.

Purpose For olecranon fractures, the choice of tension band wire (TBW) or plate fixation has long been controversial. Therefore, this study aimed to evaluate the efficacy and safety of TBW and plate in the treatment of patients with Mayo II olecranon fractures by Meta-analysis. Methods PubMed, Embase, Cochrane, the Web of Science, China National Knowledge Infrastructure, Wanfang, and China Biomedical Database were searched for randomized controlled trials (RCTs) and cohort studies (CSs) where TBW was compared with plate for Mayo II olecranon fractures (OF). Subsequently, the data were extracted by two reviewers independently and were analysed via RevMan5.4.1. Besides, mean difference (MD), risk ratio (RR), and 95% confidence intervals (CIs) were calculated. Furthermore, Cochrane Risk of Bias Tool 2.0 and Newcastle–Ottawa Scale were adopted for assessing the risk of bias. Results A total of 1RCT and 10 CSs were included, when 449 cases were treated with TBW and 378 with plate. The plate has favourable postoperative long-term (≥ 1 year) functional score in MEPS (MD: − 3.06; 95% CI − 5.50 to 0.62; P  = 0.01; I 2  = 41%) and Dash score (MD: 2.32; 95% CI 1.91, 2.73; P  < 0.00001; I 2  = 0%), also carrying fewer complications (RR: 2.13; 95% CI 1.48, 3.08; P  < 0.0001; I 2  = 58%). Besides, there exists no significant difference in postoperative long-term (≥ 1 year) elbow flexion (MD: − 1.82°; 95% CI − 8.54, 4.90; P  = 0.60; I 2  = 71%) and extension deficits (MD: 1.52°; 95% CI − 0.38, 3.42; P  = 0.12; I 2  = 92%). Moreover, TBW is featured with a shorter operation time (MD = − 5.87 min; 95% CI − 7.93, − 3.82; P  < 0.00001; I 2  = 0) and less intraoperative bleeding (MD: − 5.33 ml; 95% CI − 8.15, − 2.52; P  = 0.0002; I 2  = 0). In terms of fracture healing time, it is still controversial. Furthermore, the subgroup analysis has revealed that for Mayo IIA OF, the plate has a better outcome in the long-term (≥ 1 year) postoperative MEPS, the Dash score, and the incidence of postoperative complications than TBW, while there is no significant difference in the long-term (≥ 1 year) postoperative elbow motion between two groups. Conclusions Plate has better efficacy and safety for Mayo II OF. Considering that few studies are included in the meta-analysis, more high-quality RCTs are still required to confirm these findings. PROSPERO registration number : CRD42022313855.

Background To compare the efficacy and safety of K-wire tension band fixation (KTB) with other alternative approaches (cannulated screws, cable pin, and ring pin) for treatment of patella fractures by performing a meta-analysis. Methods PubMed and EMBASE databases were searched for all relevant studies. Standardized mean difference (SMD) or relative risk (RR) and their corresponding 95% confidence intervals (CIs) were calculated for continuous or dichotomous outcomes via either a fixed- or random-effect model using Stata 13.0 software. Results Nine literatures involving 949 patients (581 in the KTB group and 368 in the control group) were included. Pooled analysis showed there were no differences in the success rate, operative time, healing time, and number of infections between patients undergoing KTB and others. However, the incidence of complications (RR = 8.04, 95% CI = 4.45–14.53; p  < 0.001) and VAS (SMD = 0.642, 95% CI = 0.22–1.06; p  = 0.003) were lower, while flexion degree (SMD = − 0.70 95% CI = − 1.04–− 0.36; p  < 0.001), Böstman joint function score (SMD = − 0.68, 95% CI = − 1.10–− 0.27; p  = 0.001), Iowa knee score (RR = 0.88, 95% CI = 0.81–0.96; p  = 0.004), and Lysholm score (SMD = − 0.71, 95% CI = − 1.10–− 0.32; p  < 0.001) were significantly higher in patients undergoing alternative approaches than the KTB. Subgroup analysis also demonstrated the cannulated screw fixation was superior to KTB in reducing the incidence of complications. Conclusions Alternative treatments may be effective for management of patella fractures and should be attempted to be popularized in clinic.