Abstract
Introduction
We present a new surgical technique of Krackow suture combined with vertical Nice knot for the treatment of inferior patellar fractures and report the clinical results.
Patients and Methods
Seventeen consecutive patients admitted with inferior patellar fractures over a 2-year period from June 2019 to February 2022 were prospectively enrolled. The AO classification was 34-A1. All patients underwent open reduction and fixation with Krackow sutures in combination with vertical Nice knot. Postoperative follow-up was performed for at least 1 year to evaluate knee function.
Results
The mean age of seventeen patients was 53.2 ± 9.5 years (39–68 years), and all patients were followed up for more than 12 months. The operation time was 54.6 ± 7.7 min (42–68 min). No patients had nonunion, joint stiffness, and joint pain. All cases achieved bony union at an average of 9.9 ± 1.5 weeks (8–13 weeks) after surgery. At the last follow-up, there was no significant difference in range of motion between the injured knee (129.7 ± 3.3°, range 125–135°) and the unaffected knee (130.8 ± 3.8°, range 126–137°) (t = 0.28, P > 0.05). The mean Bostman score of the knee joint was 29.6 ± 0.7, including 15 excellent cases (88.2%) and two good case (11.8%).
Conclusion
Krackow sutures combined with vertical Nice knots are stable and reliable in the treatment of inferior patellar fractures. Knee rehabilitation can be performed immediately after surgery and satisfactory knee function can be achieved. It is a safe, simple, and reliable alternative surgical method, and patients do not need to bear the secondary surgical injury of removing the internal fixation material. Therefore, it is suitable for the application of clinical promotion.
Similar content being viewed by others
References
Anonymous. (2018). Patella. Journal of Orthopaedic Trauma, 32(Suppl 1), S45-s48.
Henrichsen, J. L., Wilhem, S. K., Siljander, M. P., Kalma, J. J., & Karadsheh, M. S. (2018). Treatment of patella fractures. Orthopedics, 41, e747–e755.
Jang, J. H., Rhee, S. J., & Kim, J. W. (2019). Hook plating in patella fractures. Injury, 50, 2084–2088.
Larsen, P., Court-Brown, C. M., Vedel, J. O., Vistrup, S., & Elsoe, R. (2016). Incidence and epidemiology of patellar fractures. Orthopedics, 39, e1154–e1158.
Li, J., Wang, D., He, Z., & Shi, H. (2019). Treatment of patellar lower pole fracture with modified titanium cable tension band plus patellar tibial tunnel steel “8” reduction band. Journal of Investigative Surgery, 32, 566–570.
Cho, J. W., Kim, J., Cho, W. T., Gujjar, P. H., Oh, C. W., & Oh, J. K. (2018). Comminuted inferior pole fracture of patella can be successfully treated with rim-plate-augmented separate vertical wiring. Archives of Orthopaedic and Trauma Surgery, 138, 195–202.
Song, H. K., Yoo, J. H., Byun, Y. S., & Yang, K. H. (2014). Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. Yonsei Medical Journal, 55, 785–791.
Yen, C. Y., Tsai, Y. J., Hsiao, C. K., Kao, F. C., & Tu, Y. K. (2019). Biomechanical evaluation of patellar tendon repair using Krackow suture technique. Biomedical Engineering Online, 18, 64.
Kim, K. S., Suh, D. W., Park, S. E., Ji, J. H., Han, Y. H., & Kim, J. H. (2020). Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: Suture bridge anchor fixation technique. Archives of Orthopaedic and Trauma Surgery. https://doi.org/10.1007/s00402-020-03671-5
He, Q. F., Pan, G. B., Yu, Z. F., Yao, W. X., Zhu, L. L., Luo, C. F., & Guo, X. S. (2021). Novel rim plating technique for treatment of the inferior pole fracture of the patella. Orthopaedic Surgery, 13, 651–658.
Fan, M., Wang, D., Sun, K., & Jiang, W. (2020). Study of double button plate fixation in treatment of inferior pole of patella fracture. Injury, 51, 774–778.
Misir, A., Kizkapan, T. B., Uzun, E., Oguzkaya, S., Cukurlu, M., & Golgelioglu, F. (2020). Fracture patterns and comminution zones in OTA/AO 34C type patellar fractures. Journal of Orthopaedic Trauma, 34, e159–e164.
He, S., Huang, X., Yan, B., Zhu, J., Bao, N., & Zhao, J. (2018). Modified technique of separate vertical wiring for the fixation of patellar inferior pole fracture. Journal of Orthopaedic Trauma, 32, e145–e150.
Böstman, O., Kiviluoto, O., & Nirhamo, J. (1981). Comminuted displaced fractures of the patella. Injury, 13, 196–202.
Oh, H. K., Choo, S. K., Kim, J. W., & Lee, M. (2015). Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing. Injury, 46, 2512–2515.
Yamaguchi, S., Endo, J., Yamamoto, Y., & Sasho, T. (2015). Double-row bridging suture fixation augmented with double Krackow suture for the repair of avulsion of the ossified achilles tendon: A technical tip. Foot and Ankle International, 36, 849–852.
Chen, M., Jin, X., Fryhofer, G. W., Zhou, W., Yang, S., Liu, G., & Xia, T. (2020). The application of the Nice knots as an auxiliary reduction technique in displaced comminuted patellar fractures. Injury, 51, 466–472.
Funding
This study was supported by the National Natural Science Foundation of China (Grant No. 31760270).
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of Interest
The authors declare that they have no competing interests.
Ethical Approval
This article does not contain any studies with human or animal subjects performed by the any of the authors.
Informed Consent
For this type of study, informed consent is not required.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Supplementary file1 (MOV 107888 KB)
Supplementary file2 (MOV 32732 KB)
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Du, X., Huang, Y., Duan, ·. et al. A New Method of Krackow Suture Combined with Nice Knot for the Treatment of Inferior Patellar Fractures. JOIO 58, 242–249 (2024). https://doi.org/10.1007/s43465-023-01093-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s43465-023-01093-0