Multidirectional Kirschner Wires and Wiring Fixation for Displaced Comminuted Patellar Fracture: Cases Report
Nattawut Sastravaha MD1, Yantarat Sripanich MD1
Affiliation : 1 Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
Background : The modi(cid:976)ied anterior tension band [MATB] wiring proposed by the Arbeitsgemeinschaft für Osteosynthesefragen
[AO] has become the most prevalent technique for patellar fractures treatment in recent years. However, this technique is associated
with a well-known dif(cid:976)iculty when applied to the (cid:976)ixation of comminuted patellar fractures that is due primarily to the unidirectional
nature of conventional K-wires installation and the higher number of fractured bones involved.
Objective : To propose a novel (cid:976)ixation technique for displaced comminuted patellar fractures using multidirectional K-wires and
wiring.
Case Report: In the present prospective study, the authors enrolled six patients (average age of 41.7 years) with displaced
comminuted patellar fractures. All the patients were treated with an open reduction and internal (cid:976)ixation [ORIF] procedure using
multidirectional K-wires and wiring. The Lyshölm knee score (at 6 weeks, 12 weeks, 6 months and 12 months), the range of motion
of the knee (at 12 weeks and 12 months), and the time required for radiographic bone union were recorded postoperatively. Any
signs of other complications were also noted.
Results : The mean Lyshölm knee scores were 80.8±4.6, 86.5±3.1, 93.0±2.1 and 96.8±2.6, at 6 weeks, 12 weeks, 6 months and 12
months, respectively. The range of motion at 12 weeks and 12 months were 120.8±6.4 and 135.5±3.3 degrees. In all cases, the
mean duration of healing time was 11 weeks. Neither breakage nor migration of installed wires was observed. Nevertheless, some
hardware irritations, which limited the range of motion in extreme (cid:976)lexion, were reported by three patients.
Conclusion : The proposed (cid:976)ixation technique was based on the use of simple multidirectional K-wires and wiring. This method
served as a direct extension of the AO’s MATB technique. The preliminary successful clinical results suggest its applicability in
dealing with the troublesome treatment of displaced comminuted patellar fracture.
Keywords : Patellar fracture, Displaced fracture, Comminuted fracture, Fixation technique
