Transosseous suturing of patellar fractures with braided polyester – A prospective cohort with a matched historical control study Chun-ho Chen b , Hsing-yao Huang b , Tuoh Wu c , Jinn Lin a, * a Department of Orthopedics, National Taiwan University & Hospital, Taipei, Taiwan b Department of Orthopedics, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan c Department of Orthopedics, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan The incidence of patellar fractures accounts for 1% of all musculoskeletal system fractures [16]. Indications for surgical intervention include fractures with >2 mm of articular displace- ment, 3 mm of fragment separation, comminuted fractures with displacement of the articular surface, osteochondral fractures with displacement into the joint and marginal or longitudinal fractures with comminution or displacement [10]. The most popular operation method to fix the patellar fracture is the Arbeitsge- meinschaft fu ¨r Osteosynthesefragen (AO)-modified tension-band- wiring technique [2,22,23]. However, the implant-related compli- cation rate varies from 32.8% to 47% [12,14]. To reduce the metal- implant-related complications, several modified tension-band- wiring techniques have been studied [15,25]. Regardless of modification, metal implants seem to be palpable under the skin and implant removal is inevitable in symptomatic patients. Instead of using metal implants, some authors used non-absorbable sutures to fix the fracture with various techniques [6,10,11,20]. Each study showed that non-absorbable sutures have a compara- ble union rate but less complication and implant removal rate than a conventional fixation technique. Transosseous wire fixation of the patella has been reported by Lotke et al. [16] Their technique involves longitudinal drill holes through which a metal wire is pulled and looped over the anterior surface of the patella. It allows excellent inter-fragmentary compression, provides an anterior tension band and prevents a retropatellar step-off [16]. Tension- band fixation employing two parallel Kirschner’s wires and a braided polyester tightened by the modified Wagoner’s Hitch showed less fracture gap than other recognised tension-band suture and wire techniques in an in vitro biomechanical test [11]. However, to the best of our knowledge, there is no clinical series reporting a combination of Lotke’s technique and a braided polyester tightened by the modified Wagoner’s Hitch in the English literature. Patients and methods This prospective study was conducted in a 2500-bed teaching hospital from August 2010 to February 2011. We employed a Injury, Int. J. Care Injured 44 (2013) 1309–1313 A R T I C L E I N F O Article history: Accepted 21 June 2013 Keywords: Transosseous suturing Patellar fracture Tension-band wiring A B S T R A C T Background: Although tension-band wiring is the most widely used technique to fix patellar fractures, metal implant-related complications including implant failure and postoperative pain are very common and additional procedures are often necessary to treat the complications. The purpose of this study is to evaluate a totally metal-free technique using a transosseous suturing method and to compare it with the traditional fixation technique. Method: A total of 25 patients (mean age of 59.60 years) with displaced patellar fractures treated by a transosseous suturing technique were compared with a 1:1 matched historical control group that underwent modified tension-band-wire fixation. Union time, union rate, operation time, number of procedures, mean hospitalisation days and complications were compared between cases and controls. Results: Union time (8.43  2.92 vs. 8.64  2.82 weeks) and operation time (69.00  19.31 vs. 64.89  14.27 min) were not different between the two groups. Mean hospitalisation days (4.04  1.40 vs. 5.76  1.50 days; P < 0.001), number of procedures and the frequency of complications were significantly lower in the transosseous suturing group. Conclusion: The transosseous suturing technique is safe and effective in the transverse or comminuted fractures of the patella. The complication rate is significantly lower than with the tension-band-wiring technique. ß 2013 Elsevier Ltd. All rights reserved. * Corresponding author at: Department of Orthopedics, National Taiwan University & Hospital, No. 7, Chung-Shan South Road, Taipei, Taiwan. Tel.: +886 2 23123456x65278; fax: +886 2 2322 4112. E-mail address: jinn@ntu.edu.tw (J. Lin). Contents lists available at SciVerse ScienceDirect Injury jo ur n al ho m epag e: ww w.els evier .c om /lo cat e/inju r y 0020–1383/$ – see front matter ß 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.injury.2013.06.024