Triangular configuration with headless compression screws in the fixation of transverse patellar fracture

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题名:	Triangular configuration with headless compression screws in the fixation of transverse patellar fracture
作者:	陳彥年;Nien, Chen Yen;張志偉;Chang, Chih-Wei;常閎志;Chang, Hung-Chih;楊岱樺;Yang, Tai-Hua;張嘉容;Chang, Chia-Jung;李俊廷;Li, Chun-Ting;城致軒;Chen, Chih-Hsien
贡献者:	醫學暨健康學院物理治療學系
关键词:	Patellar fracture；Triangular configuration；Finite element method
日期:	2022-02-01
上传时间:	2023-03-28 02:14:18 (UTC+0)
出版者:	亞洲大學
摘要:	A triangular configuration with three parallel cannulated screws is an established treatment for fixing transverse patellar fractures; however, the stability achieved with this approach is slightly lower than that attained with cannulated screws combined with anterior wiring. In the present study, triangular configurations were modified by partially or totally replacing the cannulated screws with headless compression screws (HCSs). Through finite element simulation involving a model of distal femoral, patellar, and proximal tibial fractures, the mechanical stability levels of the modified triangular configurations were compared with that of two cannulated screws combined with anterior wiring. Four triangular screw configurations were developed: three HCSs in a forward and backward triangular configuration, two deep cannulated screws along with one superficial HCS, and two superficial cannulated screws with one deep HCS. Also considered were two parallel cannulated screws (inserted superficially or deeply) combined with anterior wiring. The six approaches were all examined in full knee extension and 45° flexion under physiological loading. The highest stability was obtained with the three HCSs in a backward triangular configuration, as indicated by the least fragment displacement and the smallest fracture gap size. In extension and flexion, this size was smaller than that observed under the use of two deeply placed parallel cannulated screws with anterior wiring by 50.3% (1.53 vs. 0.76 mm) and 43.2% (1.48 vs. 0.84 mm), respectively. Thus, the use of three HCSs in a backward triangular configuration is recommended for the fixation of transverse patellar fractures, especially without the use of anterior wiring.
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