Candy box technique for the fixation of inferior pole patellar fractures: finite element analysis and biomechanical experiments.
Biomechanical experiments
Candy box technique
Finite element analysis
Fracture
Inferior Pole of the patella
Knee
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
23 Oct 2023
23 Oct 2023
Historique:
received:
01
08
2023
accepted:
07
10
2023
medline:
27
10
2023
pubmed:
24
10
2023
entrez:
23
10
2023
Statut:
epublish
Résumé
Maintaining effective reduction and firm fixation in inferior pole patellar fractures is a highly challenging task. There are various treatment methods available; although tension-band wiring combined with cerclage wiring (TBWC) is the mainstream approach, its effectiveness is limited. Herein, we propose and evaluate a new technique called candy box (CB), based on separate vertical wiring (SVW), for the treatment of inferior pole patellar fractures. Specifically, we provide biomechanical evidence for its clinical application. Five fixation models were built: SVW combined with cerclage wiring (SVWC); TBWC; modified SVW with the middle (MSVW-A) or upper (MSVW-B) 1/3 of the steel wire reserved, and CB. A finite element analysis was performed to compare the displacement and stress under 100-N, 200-N, 300-N, 400-N and 500-N force loads. Three-dimensional printing technology was utilized to create fracture models, and the average displacement of each model group was compared under a 500-N force. The results of the finite element analysis indicate that CB technology exhibits significantly lower maximum displacement, bone stress, and wire stress compared to that with other technologies under different loads. Additionally, in biomechanical experiments, the average force displacement in the CB group was significantly smaller than that with other methods under a 500-N force (P < 0.05). CB technology has the potential to overcome the limitations of current techniques due to its superior biomechanical characteristics. By incorporating early functional exercise and ensuring strong internal fixation, patient prognosis could be enhanced. However, further clinical trials are needed to fully evaluate the therapeutic effects of CB technology.
Sections du résumé
BACKGROUND
BACKGROUND
Maintaining effective reduction and firm fixation in inferior pole patellar fractures is a highly challenging task. There are various treatment methods available; although tension-band wiring combined with cerclage wiring (TBWC) is the mainstream approach, its effectiveness is limited. Herein, we propose and evaluate a new technique called candy box (CB), based on separate vertical wiring (SVW), for the treatment of inferior pole patellar fractures. Specifically, we provide biomechanical evidence for its clinical application.
METHODS
METHODS
Five fixation models were built: SVW combined with cerclage wiring (SVWC); TBWC; modified SVW with the middle (MSVW-A) or upper (MSVW-B) 1/3 of the steel wire reserved, and CB. A finite element analysis was performed to compare the displacement and stress under 100-N, 200-N, 300-N, 400-N and 500-N force loads. Three-dimensional printing technology was utilized to create fracture models, and the average displacement of each model group was compared under a 500-N force.
RESULTS
RESULTS
The results of the finite element analysis indicate that CB technology exhibits significantly lower maximum displacement, bone stress, and wire stress compared to that with other technologies under different loads. Additionally, in biomechanical experiments, the average force displacement in the CB group was significantly smaller than that with other methods under a 500-N force (P < 0.05).
CONCLUSIONS
CONCLUSIONS
CB technology has the potential to overcome the limitations of current techniques due to its superior biomechanical characteristics. By incorporating early functional exercise and ensuring strong internal fixation, patient prognosis could be enhanced. However, further clinical trials are needed to fully evaluate the therapeutic effects of CB technology.
Identifiants
pubmed: 37872511
doi: 10.1186/s12891-023-06946-1
pii: 10.1186/s12891-023-06946-1
pmc: PMC10594795
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
835Subventions
Organisme : the Natural Science Foundation of Sichuan Province
ID : 2022NSFSC1534
Organisme : Shang'antong Special Fund of Sichuan Medical Association
ID : 2022SAT12
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Arch Orthop Trauma Surg. 2023 Jun;143(6):2973-2980
pubmed: 35767037
J Orthop Surg (Hong Kong). 2018 May-Aug;26(3):2309499018789705
pubmed: 30037293
BMC Musculoskelet Disord. 2019 Mar 4;20(1):99
pubmed: 30832645
J Orthop Surg Res. 2019 Jan 11;14(1):14
pubmed: 30634995
Orthop Surg. 2023 Jan;15(1):266-275
pubmed: 36331126
J Orthop Surg Res. 2022 Feb 21;17(1):117
pubmed: 35189926
Orthop Surg. 2022 Nov;14(11):2799-2808
pubmed: 36125193
Orthop Surg. 2021 Apr;13(2):651-658
pubmed: 33619908
BMC Surg. 2022 Sep 12;22(1):337
pubmed: 36096769
Am J Sports Med. 2015 Jun;43(6):1422-9
pubmed: 25794869
Int Orthop. 2017 Aug;41(8):1527-1533
pubmed: 28012048
Materials (Basel). 2020 Apr 03;13(7):
pubmed: 32260138
J Bone Joint Surg Am. 2005 Mar;87 Suppl 1(Pt 1):113-21
pubmed: 15743853
Injury. 2010 Feb;41(2):156-60
pubmed: 19665707
Orthop J Sports Med. 2020 Oct 02;8(10):2325967120954808
pubmed: 33062760
J Orthop Trauma. 2018 Apr;32(4):e145-e150
pubmed: 29557940
Geriatr Orthop Surg Rehabil. 2017 Sep;8(3):135-144
pubmed: 28835869
J Orthop Trauma. 2015 Feb;29(2):80-4
pubmed: 25050749
Clin Biomech (Bristol, Avon). 2009 Feb;24(2):196-202
pubmed: 19103468
Injury. 2015 Dec;46(12):2512-5
pubmed: 26482481
Sports Med Arthrosc Rev. 2007 Jun;15(2):48-56
pubmed: 17505317
Knee Surg Sports Traumatol Arthrosc. 2022 May;30(5):1620-1628
pubmed: 34333671
Orthop Traumatol Surg Res. 2021 May;107(3):102866
pubmed: 33677129
Injury. 2020 Mar;51(3):764-768
pubmed: 32005322
Yonsei Med J. 2014 May;55(3):785-91
pubmed: 24719149
J Mech Behav Biomed Mater. 2014 May;33:99-108
pubmed: 23972564
Asian J Surg. 2023 Jun;46(6):2450-2451
pubmed: 36577583
Clin Oral Investig. 2020 Feb;24(2):701-710
pubmed: 31127429
Arch Orthop Trauma Surg. 2021 Nov;141(11):1889-1897
pubmed: 33125547
J Orthop Surg Res. 2021 Jun 8;16(1):365
pubmed: 34103048
Arch Orthop Trauma Surg. 2008 Apr;128(4):403-8
pubmed: 18270723
Arch Orthop Trauma Surg. 2018 Feb;138(2):195-202
pubmed: 29058078
Orthop Surg. 2023 Feb;15(2):628-638
pubmed: 36597674
Arch Orthop Trauma Surg. 2023 Aug;143(8):5105-5115
pubmed: 37233796
Eur J Orthop Surg Traumatol. 2021 Jan;31(1):121-130
pubmed: 32725431
Anat Rec (Hoboken). 2019 Nov;302(11):2030-2039
pubmed: 31496035
Injury. 2020 Mar;51(3):774-778
pubmed: 32008817
Br Med Bull. 2013;107:69-85
pubmed: 23620578
J Pediatr Orthop. 2019 Mar;39(3):e210-e215
pubmed: 30300279
J Knee Surg. 2017 Feb;30(2):166-173
pubmed: 27206070
J Orthop. 2022 Sep 16;34:276-281
pubmed: 36158038
J Bone Joint Surg Br. 2003 Nov;85(8):1155-60
pubmed: 14653599
Front Bioeng Biotechnol. 2022 Oct 17;10:1010508
pubmed: 36324895
Arthroscopy. 2018 Feb;34(2):513-518
pubmed: 29100765
J Orthop Sci. 2021 May;26(3):409-414
pubmed: 32354577
Orthop Clin North Am. 2016 Jan;47(1):77-83
pubmed: 26614923