Effectiveness of three-needle and two-cable structure in treatment of inferior patellar pole avulsion fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

DUAN Cheng ¹ ,  CHENG Jie ²

1. Graduate School of Inner Mongolia Medical University, Hohhot Inner Mongolia Autonomous Region, 010030, P. R. China;
2. Department of Trauma Area C, the Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot Inner Mongolia Autonomous Region, 010030, P. R. China;

Corresponding?author：

CHENG Jie, Email: 48212903@qq.com

Keywords：

Inferior patellar pole avulsion fracture; internal fixation; three-needle and two-cable structure; tension band technique

DOI：

10.7507/1002-1892.202504011

Video：

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Objective To investigate the effectiveness of three-needle and two-cable structure in the treatment of inferior patellar pole avulsion fractures. Methods A clinical data of 62 patients with inferior patellar pole avulsion fractures who were admitted between January 2023 and December 2023 and met the selection criteria was retrospectively analyzed. Among them, the fractures were fixed with three-needle and two-cable structure in 32 patients (observation group) and traditional steel wire tension band in 30 cases (control group). There was no significant difference in the baseline data of age, gender, side of the affected limb, cause of injury, and disease duration between the two groups (P>0.05). The operation time, fracture healing and healing time, patellar height (Insall-Salvati index), occurrence of complications, knee range of motion, and B?stman score at last follow-up were compared between the two groups. Results The operation time of the observation group was significantly shorter than that of the control group (P<0.05). Patients in both groups were followed up 6-12 months (mean, 10.4 months). X-ray films re-examination showed that all fractures healed, and the fracture healing time was significantly shorter in observation group than in control group (P<0.05); no significant difference was found in Insall-Salvati index between the two groups (P>0.05). During follow-up, the complications occurred in 2 cases (6.25%) of observation group and in 9 cases (30.00%) of control group, and the difference in the incidences between the two groups was significant (P<0.05). At last follow-up, the range of motion and B?stman score of the knee joint in observation group were significantly superior to control group (P<0.05). Conclusion Compared with the traditional steel wire tension band fixation, the three-needle and two-cable structure fixation of the inferior patellar pole avulsion fractures is firm, which allows the knee joint to move early after operation and is conducive to the recovery of knee joint function.

Citation： DUAN Cheng, CHENG Jie. Effectiveness of three-needle and two-cable structure in treatment of inferior patellar pole avulsion fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(6): 686-691. doi: 10.7507/1002-1892.202504011 Copy

1.	Tsivelekas K, Pallis D, Lykos S, et al. Patella fracture after total knee arthroplasty: a review. Cureus, 2024, 16(1): e53281. doi: 10.7759/cureus.53281.
2.	Rajeev A, Krishnan S, Koshy G, et al. Stress avulsion fracture of the patellar tendon following open reduction and internal fixation of a transverse patella fracture with cannulated screws. Cureus, 2024, 16(8): e66590. doi: 10.7759/cureus.66590.
3.	湯俊峰, 孫良業, 鳳曉翔, 等. 髕骨下極粉碎性骨折兩種內固定的比較. 中國矯形外科雜志, 2024, 32(14): 1279-1284.
4.	Zhu W, Xu L, Xie K, et al. Design and validation of a smile-necklace plate for treating inferior patellar pole avulsion fractures: a review and hypothesis. Orthop Surg, 2022, 14(11): 2799-2808.
5.	向鋒, 張錫平, 陳俠甫, 等. 矩形鋼絲環扎聯合8字鋼絲張力帶與傳統克氏針鋼絲張力帶對治療髕骨橫形骨折的早中期療效比較. 中華損傷與修復雜志 (電子版), 2024, 19(3): 251-254.
6.	何宏慶, 李寧凱, 劉猛, 等. 帶線錨釘三維立體捆扎治療髕骨下極撕脫性骨折. 中國修復重建外科雜志, 2025, 39(1): 26-31.
7.	Yang KH, Cho H, Kim D, Park YC. Articular fragment detachment and separate fixation for the treatment of comminuted patellar fractures with coronal split articular fragments: articular detachment technique. Clin Orthop Surg, 2024, 16(3): 357-362.
8.	Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
9.	Oh HK, Choo SK, Kim JW, et al. Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing. Injury, 2015, 46(12): 2512-2515.
10.	Chang CH, Shih CA, Kuan FC, et al. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop, 2023, 10(1): 58. doi: 10.1186/s40634-023-00622-y.
11.	Henrichsen JL, Wilhem SK, Siljander MP, et al. Treatment of patella fractures. Orthopedics, 2018, 41(6): e747-e755.
12.	Alley MC, Kain M, Mitchell S, et al. Anterior hook plating of patella fractures: a biomechanical analysis and clinical series. J Orthop Trauma, 2023, 37(6): e258-e263.
13.	Steinmetz S, Brügger A, Chauveau J, et al. Practical guidelines for the treatment of patellar fractures in adults. Swiss Med Wkly, 2020, 150: w20165. doi: 10.4414/smw.2020.20165.
14.	Jang JH, Cho YJ, Choi YY, et al. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res, 2021, 107(3): 102866. doi: 10.1016/j.otsr.2021.102866.
15.	Fan W, Liu J, Tan X, et al. Candy box technique for the fixation of inferior pole patellar fractures: finite element analysis and biomechanical experiments. BMC Musculoskelet Disord, 2023, 24(1): 835. doi: 10.1186/s12891-023-06946-1.
16.	Cho JW, Kent WT, Cho WT, et al. Miniplate augmented tension-band wiring for comminuted patella fractures. J Orthop Trauma, 2019, 33(4): e143-e150.
17.	Zhu W, Xie K, Li X, et al. Combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures. Injury, 2020, 51(3): 764-768.
18.	謝美明, 廖冬發, 龔凱, 等. 多向三維鋼絲環套固定治療髕骨下極撕脫骨折療效分析. 中國修復重建外科雜志, 2021, 35(2): 183-187.
19.	高躍川, 王歆峰, 趙良春, 等. 改良錨釘置入角度和應用雙滑輪技術治療髕骨下極撕脫骨折. 中國骨傷, 2022, 35(7): 683-687.

1. Tsivelekas K, Pallis D, Lykos S, et al. Patella fracture after total knee arthroplasty: a review. Cureus, 2024, 16(1): e53281. doi: 10.7759/cureus.53281.
2. Rajeev A, Krishnan S, Koshy G, et al. Stress avulsion fracture of the patellar tendon following open reduction and internal fixation of a transverse patella fracture with cannulated screws. Cureus, 2024, 16(8): e66590. doi: 10.7759/cureus.66590.
3. 湯俊峰, 孫良業, 鳳曉翔, 等. 髕骨下極粉碎性骨折兩種內固定的比較. 中國矯形外科雜志, 2024, 32(14): 1279-1284.
4. Zhu W, Xu L, Xie K, et al. Design and validation of a smile-necklace plate for treating inferior patellar pole avulsion fractures: a review and hypothesis. Orthop Surg, 2022, 14(11): 2799-2808.
5. 向鋒, 張錫平, 陳俠甫, 等. 矩形鋼絲環扎聯合8字鋼絲張力帶與傳統克氏針鋼絲張力帶對治療髕骨橫形骨折的早中期療效比較. 中華損傷與修復雜志 (電子版), 2024, 19(3): 251-254.
6. 何宏慶, 李寧凱, 劉猛, 等. 帶線錨釘三維立體捆扎治療髕骨下極撕脫性骨折. 中國修復重建外科雜志, 2025, 39(1): 26-31.
7. Yang KH, Cho H, Kim D, Park YC. Articular fragment detachment and separate fixation for the treatment of comminuted patellar fractures with coronal split articular fragments: articular detachment technique. Clin Orthop Surg, 2024, 16(3): 357-362.
8. Kim KS, Suh DW, Park SE, et al. Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg, 2021, 141(11): 1889-1897.
9. Oh HK, Choo SK, Kim JW, et al. Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing. Injury, 2015, 46(12): 2512-2515.
10. Chang CH, Shih CA, Kuan FC, et al. Surgical treatment of inferior pole fractures of the patella: a systematic review. J Exp Orthop, 2023, 10(1): 58. doi: 10.1186/s40634-023-00622-y.
11. Henrichsen JL, Wilhem SK, Siljander MP, et al. Treatment of patella fractures. Orthopedics, 2018, 41(6): e747-e755.
12. Alley MC, Kain M, Mitchell S, et al. Anterior hook plating of patella fractures: a biomechanical analysis and clinical series. J Orthop Trauma, 2023, 37(6): e258-e263.
13. Steinmetz S, Brügger A, Chauveau J, et al. Practical guidelines for the treatment of patellar fractures in adults. Swiss Med Wkly, 2020, 150: w20165. doi: 10.4414/smw.2020.20165.
14. Jang JH, Cho YJ, Choi YY, et al. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthop Traumatol Surg Res, 2021, 107(3): 102866. doi: 10.1016/j.otsr.2021.102866.
15. Fan W, Liu J, Tan X, et al. Candy box technique for the fixation of inferior pole patellar fractures: finite element analysis and biomechanical experiments. BMC Musculoskelet Disord, 2023, 24(1): 835. doi: 10.1186/s12891-023-06946-1.
16. Cho JW, Kent WT, Cho WT, et al. Miniplate augmented tension-band wiring for comminuted patella fractures. J Orthop Trauma, 2019, 33(4): e143-e150.
17. Zhu W, Xie K, Li X, et al. Combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures. Injury, 2020, 51(3): 764-768.
18. 謝美明, 廖冬發, 龔凱, 等. 多向三維鋼絲環套固定治療髕骨下極撕脫骨折療效分析. 中國修復重建外科雜志, 2021, 35(2): 183-187.
19. 高躍川, 王歆峰, 趙良春, 等. 改良錨釘置入角度和應用雙滑輪技術治療髕骨下極撕脫骨折. 中國骨傷, 2022, 35(7): 683-687.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of three-needle and two-cable structure in treatment of inferior patellar pole avulsion fractures

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