Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation

BACKGROUND: Cannulated screws with an anterior wire are currently used for managing transverse patellar fracture. However, the addition of anterior wiring with various types of screws via open surgery to increase the mechanical stability is yet to be determined. Hence, this study aimed to compare th...

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Autores principales: Chen, Chih-Hsien, Chen, Yen-Nien, Li, Chun-Ting, Chang, Chih-Wei, Chang, Chih-Han, Peng, Yao-Te
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399979/
https://www.ncbi.nlm.nih.gov/pubmed/30832645
http://dx.doi.org/10.1186/s12891-019-2474-7
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author Chen, Chih-Hsien
Chen, Yen-Nien
Li, Chun-Ting
Chang, Chih-Wei
Chang, Chih-Han
Peng, Yao-Te
author_facet Chen, Chih-Hsien
Chen, Yen-Nien
Li, Chun-Ting
Chang, Chih-Wei
Chang, Chih-Han
Peng, Yao-Te
author_sort Chen, Chih-Hsien
collection PubMed
description BACKGROUND: Cannulated screws with an anterior wire are currently used for managing transverse patellar fracture. However, the addition of anterior wiring with various types of screws via open surgery to increase the mechanical stability is yet to be determined. Hence, this study aimed to compare the mechanical behaviors of a fractured patella fixed with various screws types and at various screw locations with and without the anterior wire. The present study hypothesized that using the anterior wire reduces the fracture gap formation. METHODS: A finite element (FE) model containing a fractured patella fixed with various types of cannulated screws and anterior wiring was created in this study. Three types of screws, namely partial thread, full thread, and headless compression screws, and two screw depths, namely 5 and 10 mm away from the anterior surface of the patella, were included. The effect of the anterior wire was clarified by comparing the results of surgical fixation with and without the wire. Two magnitudes and two loading directions were used to simulate and examine the mechanical responses of the fractured patella with various fixation conditions during knee flexion/extension. RESULTS: Compared with partial thread and headless compression screws, the full thread screw increased the stability of the fractured patella by reducing fragment displacement, fracture gap formation, and contact pressure while increasing the contact area at the fracture site. Under 400-N in the direction 45°, the full thread screw with 5-mm placement reduced the gap formation by 86.7% (from 2.71 to 0.36 mm) and 55.6% (from 0. 81 to 0. 36 mm) compared with the partial thread screw with 10-mm placement, respectively without and with the anterior wire. CONCLUSION: The anterior wire along with the full thread screw is preferentially recommended for maintaining the surgical fixation of the fractured patella. Without the use of anterior wiring, the full thread screw with 5-mm placement may be considered as a less invasive alternative; however, simple screw fixation at a deeper placement (10 mm) is least recommended for the fixation of transverse patellar fracture.
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spelling pubmed-63999792019-03-14 Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation Chen, Chih-Hsien Chen, Yen-Nien Li, Chun-Ting Chang, Chih-Wei Chang, Chih-Han Peng, Yao-Te BMC Musculoskelet Disord Research Article BACKGROUND: Cannulated screws with an anterior wire are currently used for managing transverse patellar fracture. However, the addition of anterior wiring with various types of screws via open surgery to increase the mechanical stability is yet to be determined. Hence, this study aimed to compare the mechanical behaviors of a fractured patella fixed with various screws types and at various screw locations with and without the anterior wire. The present study hypothesized that using the anterior wire reduces the fracture gap formation. METHODS: A finite element (FE) model containing a fractured patella fixed with various types of cannulated screws and anterior wiring was created in this study. Three types of screws, namely partial thread, full thread, and headless compression screws, and two screw depths, namely 5 and 10 mm away from the anterior surface of the patella, were included. The effect of the anterior wire was clarified by comparing the results of surgical fixation with and without the wire. Two magnitudes and two loading directions were used to simulate and examine the mechanical responses of the fractured patella with various fixation conditions during knee flexion/extension. RESULTS: Compared with partial thread and headless compression screws, the full thread screw increased the stability of the fractured patella by reducing fragment displacement, fracture gap formation, and contact pressure while increasing the contact area at the fracture site. Under 400-N in the direction 45°, the full thread screw with 5-mm placement reduced the gap formation by 86.7% (from 2.71 to 0.36 mm) and 55.6% (from 0. 81 to 0. 36 mm) compared with the partial thread screw with 10-mm placement, respectively without and with the anterior wire. CONCLUSION: The anterior wire along with the full thread screw is preferentially recommended for maintaining the surgical fixation of the fractured patella. Without the use of anterior wiring, the full thread screw with 5-mm placement may be considered as a less invasive alternative; however, simple screw fixation at a deeper placement (10 mm) is least recommended for the fixation of transverse patellar fracture. BioMed Central 2019-03-04 /pmc/articles/PMC6399979/ /pubmed/30832645 http://dx.doi.org/10.1186/s12891-019-2474-7 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Chen, Chih-Hsien
Chen, Yen-Nien
Li, Chun-Ting
Chang, Chih-Wei
Chang, Chih-Han
Peng, Yao-Te
Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation
title Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation
title_full Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation
title_fullStr Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation
title_full_unstemmed Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation
title_short Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation
title_sort roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6399979/
https://www.ncbi.nlm.nih.gov/pubmed/30832645
http://dx.doi.org/10.1186/s12891-019-2474-7
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