A Comparative Study on the Efficacy of Kirschner Wire Tension Band Combined with Anchor Cross-Suture Internal Fixation versus Partial Patellectomy in the Treatment of Comminuted Inferior Pole Patellar Fractures

doi:10.21203/rs.3.rs-5297158/v1

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Research Article

A Comparative Study on the Efficacy of Kirschner Wire Tension Band Combined with Anchor Cross-Suture Internal Fixation versus Partial Patellectomy in the Treatment of Comminuted Inferior Pole Patellar Fractures

https://doi.org/10.21203/rs.3.rs-5297158/v1

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Objective

The treatment of comminuted inferior pole patellar fractures has long posed a challenge for orthopedic surgeons. This study aims to compare the biomechanical stability and clinical efficacy of Kirschner wire tension band combined with anchor cross-suture fixation versus traditional partial patellectomy in the treatment of comminuted inferior pole patellar fractures.

Methods

A retrospective analysis was conducted on 14 patients who underwent Kirschner wire tension band combined with anchor cross-suture fixation (Group A) in our department of orthopedics from September 2020 to April 2022. Additionally, we matched 14 patients with similar baseline characteristics who received inferior pole patellectomy combined with patellar ligament repair (Group B). The two groups were compared in terms of operative time, intraoperative blood loss, postoperative complications, and at the final follow-up, knee range of motion (ROM), visual analogue scale (VAS) score, Bostman knee function score, peak knee torque, and Insall-Salvati (IS) ratio.

Results

All patients were followed up for more than 12 months. At the final follow-up, Group A showed significantly better outcomes than Group B in terms of knee range of motion (ROM), Bostman knee function score, knee VAS score, and average peak knee torque, with statistically significant differences (P < 0.05), indicating faster postoperative recovery and better clinical results in Group A. The IS ratio of the injured knee in Group B was 0.71 ± 0.66, less than 0.8, suggesting a decrease in patellar height. There were no significant differences between the two groups in terms of operative time, intraoperative blood loss, or incision length (P > 0.05). In Group A, one patient experienced complications from hardware irritation, while in Group B, one patient had postoperative knee pain, and two patients experienced knee extension weakness after cast removal and rehabilitation.

Conclusion

Kirschner wire tension band combined with anchor cross-suture fixation for the treatment of inferior pole patellar fractures yields satisfactory results. This technique provides reliable fixation, restores the original extensor mechanism, promotes early postoperative rehabilitation, and reduces the incidence of complications, making it suitable for clinical application and widespread use.

inferior pole patellar fracture

tension band

suture anchor

internal fixation

partial patellectomy

The patella is the largest sesamoid bone in the human body, located between the quadriceps femoris and the patellar tendon. As a key component of the knee's extensor mechanism, its function is essential for normal knee joint movement. Patellar fractures account for approximately 1% of all fractures in the body [1, 2]. The inferior pole of the patella refers to the distal one-fourth of the patella, primarily composed of cancellous bone. Although this area does not directly participate in the formation of the patellofemoral joint, it plays an important role as the attachment point for the patellar ligament during knee extension [3, 4]. Therefore, the anatomical structure and functional integrity of the patella directly affect the function of the knee joint.

Comminuted fractures of the inferior pole of the patella are relatively rare, accounting for approximately 9.3–22.4% of patellar fractures, and are commonly seen in cases of direct trauma or in patients with osteoporosis [5, 6]. Clinical studies have shown that when the knee joint is flexed at angles between 45° and 60°, the stress on the patella can reach 4 to 5 times the body weight. As the attachment point for the patellar ligament, the inferior pole bears the greatest tensile stress, making it particularly susceptible to fractures [7, 8]. Fractures of the inferior pole of the patella can lead to loss of patellar height and disruption of the extensor mechanism. Conservative treatment typically requires prolonged immobilization, and due to poor fracture reduction and lack of early rehabilitation exercises, knee joint function often does not recover satisfactorily. Early surgical intervention is generally recommended in clinical practice. Due to the anatomical and biomechanical characteristics of the inferior pole, fractures in this area are often comminuted with small fragments, making anatomical reduction and stable fixation challenging during surgical procedures [9].

The traditional surgical methods for comminuted fractures of the inferior pole of the patella primarily include partial patellectomy and Kirschner wire tension band fixation [10, 11]. Although these methods can provide a certain degree of fixation strength, some patients experience issues such as fixation failure or recurrence postoperatively, which limits the ability to engage in early rehabilitation. In recent years, with the development of new internal fixation techniques, the surgical methods for inferior pole patellar fractures have gradually diversified, including cerclage wire fixation, screw fixation, anchor fixation, suture fixation, and double-button plate fixation [6, 7, 12–16]. However, these techniques have not been widely adopted in all hospitals, and each surgical method has its limitations. Currently, there is still no consensus on the optimal treatment strategy for comminuted inferior pole patellar fractures in clinical practice [17]. In clinical practice, we have found that the clinical efficacy of treating comminuted inferior pole patellar fractures with Kirschner wire tension band combined with anchor cross-suture fixation is superior to that of partial patellectomy. This method not only provides reliable physical stability for fracture healing but also ensures early rehabilitation for patients, with a relatively straightforward and easy surgical process. To validate the effectiveness of this approach, we conducted a retrospective analysis of patients with comminuted inferior pole patellar fractures admitted to our hospital from September 2020 to April 2022. This article aims to provide a detailed analysis of the clinical outcomes of Kirschner wire tension band combined with anchor cross-suture fixation in the treatment of comminuted inferior pole patellar fractures, with the hope of providing more evidence for clinical treatment and promoting further optimization of treatment methods.

1.1 General Information

Inclusion Criteria:

Normal knee function prior to injury, with a unilateral closed patellar fracture.

Fracture located in the inferior pole of the patella, with comminuted fragments ≥ 3.

Surgery performed within 7 days of injury.

No obvious contraindications for surgery upon preoperative assessment.

Exclusion Criteria:

Other fractures in the same limb.

Severe osteoporosis or other conditions affecting normal knee joint function.

Open fractures.

Lost to follow-up.

According to the inclusion and exclusion criteria, from September 2020 to April 2022, 28 patients with closed fractures were included in this clinical study at the Central Hospital Affiliated to Shenyang Medical College. All fractures were classified as AO type 34-A1. The surgeries were performed 2 to 7 days after the injury. This study was approved by the Ethics Committee of the Central Hospital Affiliated to Shenyang Medical College, and all patients provided written informed consent. The study adheres to the principles of the Declaration of Helsinki.

1.2 Preoperative Preparation

After admission, all patients underwent preoperative X-ray and 3D CT examinations. The injured lower limb was temporarily immobilized with a plaster cast at 0° extension to alleviate pain, and the affected limb was elevated. Preoperative medications included routine pain relief and anticoagulants. After excluding contraindications for surgery, the procedure was carried out. All patients received a single dose of antibiotics 30 minutes before surgery. The surgeries were performed by the same team of experienced surgeons, and the suture anchors used were provided by Smith & Nephew.

1.3 Surgical Procedure

After the patient is under general or lumbar anesthesia, they are placed in the supine position. A pneumatic tourniquet is applied to the upper thigh of the affected limb. The limb is then disinfected with iodine. After completing the hemostasis, a straight incision is made anterior to the knee joint. The incision is carried out layer by layer through the skin, subcutaneous tissue, and fascia. The edges of the incision are retracted to expose the comminuted bone fragments of the inferior pole of the patella. The area is irrigated with saline, and the soft tissue and blood clots at the fracture site are cleaned. The joint cavity is also irrigated.

(Group A) (Kirschner Wire Tension Band Combined with Anchor Cross-Suture Internal Fixation): Reduction is assessed using X-rays, the fracture is realigned, and joint surface integrity is restored. The patella is stabilized with a patella reduction clamp or towel clamp. During the procedure, care is taken to avoid detaching the prepatellar fascia and periosteum to prevent separation of the fracture fragments. Two parallel Kirschner wires (2.0 mm in diameter) are drilled from the superior pole to the inferior pole of the patella. Steel wire is threaded through the ends of the Kirschner wires, forming a longitudinal figure-eight tension band on the anterior side of the patella. The Kirschner wire is then tightened using a Kirschner wire clamp, and the upper ends of the Kirschner wires are bent over the patella to prevent loosening or displacement. Under C-arm fluoroscopy, after confirming satisfactory reduction of the fracture fragments, a single anchor is inserted perpendicular to the cross-section of the proximal patellar fracture fragment (Fig. 1a). The anchor is embedded into the patellar body. The tail-suture cross-suture method is then used to secure the comminuted fragments of the inferior pole patellar fracture and the patellar ligament (Figs. 1b, d). The knee joint is flexed and extended to ensure fracture stability and proper tension of the patellar ligament. A final C-arm fluoroscopy is performed to confirm good alignment of the fracture ends (Fig. 1c). The surgical area is irrigated with saline, and the incision is closed layer by layer. (Fig. 1)

(Group B) (Partial Patellectomy): Partial patellectomy and patellar ligament repair (PP) were performed using standard techniques [11]. During the surgery, the comminuted bone fragments of the inferior pole of the patella were first excised, taking care to avoid excessive damage to the prepatellar fascia. Next, we reshaped the ends of the patella. Then, using Kirschner wires, we drilled parallel holes at equal intervals approximately 1.5 centimeters from the edge of the patellar fracture or right next to the cartilage surface of the fracture site (Fig. 2a). Subsequently, high-strength, non-absorbable sutures were passed through the patellar tendon, and the sutures were tightened and secured through the bone holes in the patella to ensure firm contact between the patellar tendon and the bone surface (Fig. 2b, c). Postoperatively, we mobilized the joint to check the stability of the fixation, then sutured the prepatellar fascia and joint capsule, closing the incision layer by layer. This technique ensures the precision and consistency of the surgery. A plaster cast was applied for 6 weeks, during which active quadriceps muscle strengthening exercises were conducted. After 6 weeks, the plaster cast was removed, and external fixation was discontinued. (Fig. 2)

1.4 Postoperative Management

All patients receive a single dose of antibiotics within 24 hours postoperatively to prevent infection. Routine pain management and anticoagulant therapy are provided. On the first postoperative day, knee joint X-rays in the anteroposterior and lateral views are reviewed. The surgical incision is dressed every 2–3 days to monitor healing, and the sutures are removed at 2 weeks postoperatively. For patients in Group A, the plaster cast is removed after surgery. On the first postoperative day, following a review of the knee joint X-rays in the anteroposterior and lateral views, exercises are started, including isometric quadriceps contractions, straight leg raises, knee flexion, and ankle joint functional exercises. Light weight-bearing with crutches is permitted on postoperative day 3, along with progressive knee flexion exercises. After 4 weeks, full range of motion exercises and full weight-bearing without walking aids are initiated, allowing complete knee flexion. For patients in Group B, a long leg cast is applied to maintain the knee joint in full extension for approximately 6 weeks. During this period, patients are instructed to strengthen their quadriceps muscle training and are allowed to use crutches for partial weight-bearing. After the cast is removed, based on follow-up X-ray results, progressive knee flexion exercises are started to guide patients in regaining full range of motion. From the 7th week onwards, patients are encouraged to achieve full weight-bearing while walking on flat surfaces without the use of supports. In both groups of patients, those who are older, have severely comminuted fractures, or are at risk of developing significant osteoporosis in the future should have their crutch use extended appropriately.

1.5 Observational Indicators and Statistical Methods

In this study, data analysis was conducted using SPSS 27.0 statistical software to ensure the scientific validity and reliability of the statistical analyses. To compare the two groups of patients regarding operative time, intraoperative blood loss, length of hospital stay, incidence of complications, and visual analog scale (VAS) scores, range of motion (ROM), and Böstman scores at the last follow-up, the Böstman score—a widely used clinical tool for assessing functional prognosis after patellar fractures—includes parameters such as pain level, walking ability, range of motion, squatting ability, quadriceps atrophy, and complications (such as infection or loss of reduction). The total score ranges from 0 to 30, with higher scores indicating better functional outcomes. Count data were expressed as frequencies or percentages, and chi-square tests were used for intergroup comparisons.

For continuous data, all values were expressed as means ± standard deviations. The Shapiro-Wilk test was used to assess whether the continuous data followed a normal distribution. For continuous variables that met the normal distribution, independent samples t-tests were used for analysis; for continuous variables that did not meet the normal distribution, the Mann-Whitney U test was employed. In all statistical analyses, a p-value of less than 0.05 was considered statistically significant.

To further assess quadriceps strength, we measured peak torque using an isokinetic dynamometer. Additionally, the Insall-Salvati (IS) ratio from the lateral knee X-ray was used to evaluate patellar height, with an IS ratio of less than 0.8 indicating patellar inferiority and greater than 1.2 indicating patellar superiority. Group A underwent weekly anteroposterior and lateral X-ray imaging of the knee on the first day postoperatively, and at one month and two months postoperatively, to assess bone healing until the fracture was healed. Patients in Group B had monthly X-ray follow-ups to observe changes in patellar height and position. These methods ensured a comprehensive evaluation of all indicators and provided solid data support for subsequent research.

A total of 28 patients were included in this study, all of whom completed follow-up, with follow-up durations ranging from 12 to 18 months. The surgical incisions in both groups healed primarily. All fractures in Group A healed, allowing for full knee extension. In Group B, one patient reported knee pain during daily activities, and two patients experienced knee extension weakness. X-ray examinations in Group B showed reduced patellar height and decreased patellofemoral contact area after partial patellectomy.

2.1 Comparison of General Data

Both groups of patients (Group A and Group B) had comminuted inferior pole patellar fractures. There were no significant differences in terms of age, gender, side of fracture, length of hospital stay, time from injury to surgery, and follow-up duration (P > 0.05), indicating that the two groups are comparable. See Table 1 for details.

Table 1
	Group A(n = 14)	Group B(n = 14)	P
Age, years	43.29 ± 11.10	46.00 ± 13.00	0.557
Gender, n			0.704
Male	5	7
Female	9	7
Fracture side, n			0.706
Left	6	8
Right	8	6
Length of hospital stay, days	5.64 ± 1.15	5,57 ± 1.16	0.868
Time from injury to surgery, days	3.71 ± 1.20	4.07 ± 1.49	0.492
Follow-up time, months	16.14 ± 1.66	17.21 ± 1.63	0.096

2.2 Clinical Effectiveness Analysis

2.2.1 Comparison of Surgical-Related Indicators

There were no significant differences between the two groups of patients in terms of operative time, intraoperative blood loss, and incision length (P > 0.05). Specifically, the average operative time for Group A was 37.86 ± 5.32 minutes, and the average intraoperative blood loss was 33.29 ± 8.15 ml. In Group B, the average operative time was 41.21 ± 5.58 minutes, and the average intraoperative blood loss was 36.71 ± 10.55 ml. Regarding incision length, Group A measured 8.86 ± 1.46 cm, while Group B measured 9.07 ± 1.54 cm, with no statistically significant difference (P > 0.05). The two groups showed similarity in these surgical-related indicators, indicating no significant differences in the difficulty of the surgical procedures between the groups.

2.2.2 Comparison of Functional Assessment

At the final follow-up, Group A demonstrated significantly better knee function recovery compared to Group B. The range of motion (ROM) in Group A was significantly greater than that in Group B, with an average knee flexion range of 131.07 ± 4.88° for Group A and 116.43 ± 11.84° for Group B (P < 0.05). Additionally, the Bostman score for knee function in Group A was significantly higher (28.29 ± 0.83) than that in Group B (25.79 ± 1.93) (P < 0.05), indicating better knee function recovery for Group A patients. In terms of pain scores, the VAS score for Group A (0.36 ± 0.63) was lower than that for Group B (1.64 ± 1.82), indicating that patients in Group A experienced less postoperative pain.

2.2.3 Biomechanical Analysis

The results of the peak torque measurement at the knee joint showed that the average peak torque for Group A was 107.86 ± 10.51 Nm, significantly higher than that of Group B, which was 93.71 ± 16.14 Nm (P < 0.05). This indicates that the recovery of knee strength in Group A patients was better than that in Group B, reflecting superior clinical outcomes.

In the analysis of patellar height, patients in Group B exhibited a significant decrease in patellar height. X-ray examinations revealed that after the partial resection of the inferior pole of the patella in Group B, the patellar height decreased, and the patellofemoral contact area was reduced, with an IS ratio of 0.71 ± 0.66, which is below the normal patellar height ratio (> 0.8). In contrast, the IS ratio for Group A was 1.01 ± 0.13, within the normal range, and the difference compared to Group B was statistically significant (P < 0.05). This further supports the advantages of the surgical method used in Group A in preserving the anatomical structure and function of the patella.

2.2.4 Fracture Healing and Complications Analysis

The average fracture healing time for patients in Group A was 10.79 ± 1.53 weeks, with all patients achieving fracture healing and being able to fully extend their knees. Although one patient in Group A experienced mild discomfort due to hardware irritation postoperatively, no serious complications such as hardware loosening or re-displacement of the fracture were observed. In contrast, Group B had three patients with complications: one patient reported knee pain postoperatively, and two patients experienced knee extension weakness during rehabilitation training after the removal of the cast. The complication rate in Group B was significantly higher than that in Group A, indicating that the combination of Kirschner wire tension band and anchor cross-suture fixation has certain advantages in reducing complications.

In summary, patients in Group A demonstrated superior outcomes in knee range of motion, pain relief, strength recovery, patellar height maintenance, and complication control compared to Group B. This indicates that the combination of Kirschner wire tension band and anchor cross-suture fixation has better clinical efficacy. See Table 2 for details.

Table 2
	Group A	Group B	P
Operative time, minutes	37.86 ± 5.32	41.21 ± 5.58	0.115
Intraoperative blood loss, mL	33.29 ± 8.15	36.71 ± 10.55	0.595
Incision length, cm	8.86 ± 1.46	9.07 ± 1.54	0.709
Fracture healing time, weeks	10.79 ± 1.53
Range of motion, °	131.07 ± 4.88	116.43 ± 11.84	<0.001
Bostman score	28.29 ± 0.83	25.79 ± 1.93	<0.001
Average peak torque of the knee joint, Nm	107.86 ± 10.51	93.71 ± 16.14	0.011
Salvati Index	1.01 ± 0.13	0.71 ± 0.66	<0.001
VAS score	0.36 ± 0.63	1.64 ± 1.82	0.541
Complications, n	1	3	0.596

The inferior pole patellar fracture occurs in the non-cartilaginous distal part of the patella and is a special type of patellar fracture classified as a non-articular fracture [18]. The inferior pole of the patella is an important component of the knee extension mechanism. Clinical intervention is usually required when patellar surface collapse exceeds 3 millimeters or separation is greater than 4 millimeters [5, 8]. The main goals of surgery are to restore the integrity and stability of the knee extension mechanism, achieve anatomical reduction as much as possible, facilitate early and effective rehabilitation, maximize knee joint function, and reduce the occurrence of fracture complications [9]. Currently, despite the variety of surgical methods available for treating inferior pole patellar fractures, there are still many challenges in restoring anatomical structure, achieving effective fixation, and facilitating early postoperative rehabilitation [19, 20]. Optimizing surgical techniques to improve fracture healing quality and functional recovery remains a key focus in clinical research and practice.

In cases of comminuted fractures of the patellar inferior pole that are difficult to fix, some clinical experts prefer to perform partial excision of the non-articular fragments of the patellar inferior pole and reattach the patellar tendon to the remaining part of the patella using transosseous sutures [21, 22]. Research has shown that after excision of non-articular fractures of the patellar inferior pole and reconstruction of the patellar tendon, with about 6 weeks of plaster external fixation, the rate of excellent joint scores can reach 73.5% [23]. Marder et al. [24] demonstrated that after excision of the patellar inferior pole and reconstruction of the patellar tendon, there is no significant difference in the patellofemoral contact area and patellofemoral joint pressure compared to normal conditions. Scapinelli et al. [25] hold a similar view. However, some scholars argue that excision of the patellar inferior pole can lead to patellar displacement, disrupt the original anatomical relationships, alter the mechanical structure of the patellar joint surface, and increase the load on the quadriceps during knee movement. This could potentially result in long-term adverse effects such as knee pain, knee extension dysfunction, and traumatic patellofemoral arthritis [23, 26–29].

In addition, healing after excision of the patellar inferior pole often relies on tendon-to-bone healing, which is typically unreliable. A study by Veselko et al. [23] found that patients who underwent surgery preserving the patellar inferior pole had significantly better recovery in terms of knee function and pain compared to those who had the patellar inferior pole excised. Similar results were reported by Matejčić et al. [28]. The patella, as the pivot for knee flexion and extension, reduces the tension in the quadriceps and increases the range of motion of the knee joint. Without the patella, the lever arm of the quadriceps shortens, requiring 30% more force to perform the same knee extension movement. Although the lower pole of the patella does not involve the joint surface, its removal leads to patellar displacement. This displacement can cause misalignment of the patellofemoral contact area, resulting in knee joint dysfunction and increasing the risk of complications such as traumatic arthritis [30]. Deng et al. [31] found that long-term follow-up after partial resection of the patellar lower pole showed satisfactory outcomes for knee joint function in patients. However, due to the wide age range of patients with lower pole patellar fractures, some have higher expectations for short-term recovery of knee function. Prolonged plaster immobilization postoperatively may lead to muscle atrophy, which can hinder recovery [25]. Furthermore, postoperative rehabilitation exercises for patients who have undergone lower pole patellar resection should be performed under the guidance of a professional. Based on this study, we believe that patellar partial resection should only be performed when it is difficult to achieve and maintain stable fixation of the comminuted lower pole patellar fracture. Clinically, more experts prefer to preserve the lower pole of the patella, aiming to restore the local extensor mechanism and anatomical structure as much as possible, in order to improve postoperative functional recovery and quality of life for patients [32–34].

The Kirschner wire tension band is the most commonly used and classic method for open reduction and internal fixation of patellar fractures. It can effectively and simply fix patellar fractures by converting the tensile force of the wire into axial pressure at the fracture site, thereby increasing the stability of the fracture ends. The postoperative excellent rate is relatively high [25]. However, this method requires relatively intact bone support. When dealing with comminuted fractures of the lower pole of the patella, the Kirschner wires are prone to loosening, resulting in incomplete reduction and ineffective fixation [35, 36]. Studies have indicated that for comminuted fractures of the lower pole of the patella, the probability of requiring a secondary surgical fixation after using only the Kirschner wire tension band for treatment is approximately 21–58% [37, 38]. In our clinical practice, we have also found that the stability of using only the Kirschner wire tension band for fixing comminuted patellar fractures is poor, especially when the bone quality of the lower pole of the patella is relatively porous. The internal fixation Kirschner wires and wires tend to cut through the porous bone, leading to loosening and failure of the internal fixation.

In recent years, we have employed the method of Kirschner wire tension band combined with anchor cross-suture internal fixation for treating comminuted fractures of the inferior pole of the patella [39]. This combined fixation method has shown excellent performance in improving fracture stability and reducing internal fixation loosening. It overcomes the limitations of the single method and provides a more reliable solution for the treatment of comminuted fractures of the lower pole of the patella. The lower pole of the patella does not directly participate in forming the patellofemoral joint surface. Therefore, in the reduction of fractures of the lower pole of the patella, the requirements are relatively lower compared to other types of fractures. The main goal of surgical treatment is to restore the extension function of the knee joint rather than achieving anatomical alignment of the fracture. Hence, during reduction, it is unnecessary to strive for perfect fracture alignment, as repeated manipulations may aggravate knee joint damage and prolong the surgical time. This study utilized the Kirschner wire tension band combined with anchor cross-suture internal fixation technique and achieved good results in clinical practice. This treatment method has the following advantages: (1) The Kirschner wire tension band, as the most classic treatment for patellar fractures, can convert the tension on the cortical bone surface into pressure, promoting bone healing while preserving the fracture fragments of the lower pole of the patella;(2) Screwing the anchors vertically into the transverse section of the proximal patellar fracture fragments can effectively ensure the stability of the anchors; (3) Using the anchor suture technique to wrap the comminuted fracture fragments of the lower pole of the patella provides strong and effective internal fixation. This method can restore the extensor mechanism of the knee and promote bone-to-bone healing at the fracture site, laying the foundation for early rehabilitation exercises of the knee joint and helping to prevent joint stiffness. In this study, Group B had one patient with knee pain and two patients with postoperative weakness in knee extension. Although these patients were able to meet their daily activity needs after rehabilitation exercises, their knee joint function and Bostman scores were worse compared to Group A. Additionally, all patients in Group A were able to begin early knee flexion and extension exercises without experiencing internal fixation loosening or fracture redisplacement, further demonstrating that the technique provides sufficient stability.

However, this study also has certain limitations. Due to the limited number of cases, as it only included patients with comminuted fractures of the lower pole of the patella, and because long-term follow-up was not conducted, future research should involve a larger sample size and longer follow-up observations to further validate the long-term effectiveness and safety of the technique.

Overall, this study provides strong clinical evidence for the application of Kirschner wire tension band combined with anchor cross-suture fixation technology in the treatment of comminuted inferior pole patellar fractures. It demonstrates that this technique has significant advantages in restoring knee function and promoting postoperative rehabilitation. This method effectively stabilizes inferior pole patellar fractures, especially in cases with small fracture fragments. Compared to traditional partial patellectomy, patients can initiate functional exercises earlier postoperatively, achieving good knee function and avoiding complications such as nonunion, fixation failure, and patellar height loss. With its notable clinical efficacy and lower incidence of complications, the combination of Kirschner wire tension band and anchor cross-suture fixation has become a valuable surgical option in clinical practice, providing an excellent treatment strategy for patellar fractures.

Author Contributions

Z-CC designed the study and interpreted the data. H-RL collected the data. MS analyzed the data. S-YD，H-FL and R-DX wrote the paper. All authors have read and agreed to the published version of the manuscript.

Funding: This study was supported by the Natural Science Foundation of Liaoning Province (2024-MS-222), the Liaoning Provincial Department of Education Fund Project (JYTMS20231396), and the Science and Technology Plan Project of Shenyang City (Grant no. 22-321-32-13).

Data availability

The datasets generated and/or analyzed during the current study are not publicly available due to limitations of ethical approval involving the patient data and anonymity but are available from the corresponding author on reasonable request.

Ethics approval and consent to participate

This study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of the Affiliated Central Hospital of Shenyang Medical College (Ethics No. 2020020). All procedures were carried out in accordance with relevant guidelines and regulations. Written informed consent was obtained from all patients.

Consent for publication

Informed consent for publication has been obtained from all participants.

Data Availability Statement

All data generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Clinical trial number

Not applicable.

Acknowledgements

We wish to thank all patients and medical staff for their co-operation.

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No competing interests reported.

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A Comparative Study on the Efficacy of Kirschner Wire Tension Band Combined with Anchor Cross-Suture Internal Fixation versus Partial Patellectomy in the Treatment of Comminuted Inferior Pole Patellar Fractures

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Abstract

Objective

Methods

Results

Conclusion

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Introduction

Clinical Data and Methods

1.1 General Information

1.2 Preoperative Preparation

1.3 Surgical Procedure

1.4 Postoperative Management

1.5 Observational Indicators and Statistical Methods

Results

2.1 Comparison of General Data

2.2 Clinical Effectiveness Analysis

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1