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. 2020 Jun;51(6):1281-1287.
doi: 10.1016/j.injury.2020.03.030. Epub 2020 Mar 17.

Biomechanical comparison of a 3.5 mm anterior locking plate to cannulated screws with anterior tension band wiring in comminuted patellar fractures

Ferdinand C Wagner  1 , Mirjam V Neumann  2 , Steffen Wolf  3 , Alexander Jonaszik  4 , Kaywan Izadpanah  2 , Stefan Piatek  5 , Norbert P Südkamp  2
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Biomechanical comparison of a 3.5 mm anterior locking plate to cannulated screws with anterior tension band wiring in comminuted patellar fractures

Ferdinand C Wagner et al. Injury. 2020 Jun.

Abstract

Purpose: To date, surgically treated multifragmentary patellar fractures are still associated with high rates of complications, such as i.e. secondary fracture displacement. Osteosynthesis is most frequently performed with screws and cerclages. To increase primary stability, locking plates have been introduced. However, there is still a lack of biomechanical data supporting the superiority of plate fixation compared to screw fixation with cerclages in these cases. The goal of the present study was to conduct biomechanical comparison of these two techniques under dynamic loading conditions.

Methods: A standardized 34-C3 fracture was created in eight pairs of human cadaveric knee joints. Following a randomization protocol, they were fixed with a 3.5 mm anterior locking plate (LP) or cannulated screws with anterior tension band wiring (hybrid osteosynthesis, HO).Subsequently, all constructs were tested for 100 cycles from 90° of knee-flexion to full extension by applying a pulling force to the quadriceps tendon. Outcome parameters were fracture displacement after one cycle, after 100 cycles and implant loosening. Failure was defined as fracture displacement > 2 mm.

Results: Biomechanical testing showed significantly less fracture displacement following LP compared to HO both after the first (p = 0.042) and after 100 cycles (p = 0.025). The difference in loosening was significant as well (p = 0.017). Following HO, 5/8 constructs failed during cyclic loading. There was no failure in the LP group. In the HO group, loosening correlated with bone mineral density (R = - 0.857) which was not observed in the LP group (R = - 0.429).

Conclusion: Anterior locking plate osteosynthesis of comminuted patellar fractures biomechanically provides better primary stability compared to cannulated screws with anterior tension band wiring.

Keywords: Anterior locking plate; Anterior tension band wiring; Basic science study; Biomechanics Level of evidence; Cannulated screws; Cyclic loading; Multifragmentary patella fracture.

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Conflict of interest statement

Declaration of Competing Interest Ferdinand C. Wagner: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. (Author's signature see individual PDF) Mirjam V. Neumann: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. (Author's signature see individual PDF) Steffen Wolf: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. (Author's signature see individual PDF) Alexander Jonaszik: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. (Author's signature see individual PDF) Kaywan Izadpanah: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. (Author's signature see individual PDF) Stefan Piatek: This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. (Author's signature see individual PDF) Norbert P. Südkamp: A family member of NP Südkamp is executive partner of the Synmedics KOMM. which is not related to this study. This author, their immediate family, and any research foundation with which they are affiliated did not receive any financial payments or other benefits from any commercial entity related to the subject of this article. (Author's signature see individual PDF)

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