• Jonas Adjal, Asger Haugaard, Liv Vesterby, Huda Muhudin Ibrahim, Kevser Sert, Morten Grove Thomsen, Peter Toft Tengberg, Ilija Ban, and Søren Ohrt-Nissen.
• Department of Orthopaedic Surgery and Traumatology, Hvidovre and Amager University Hospital, Kettegård Allé 30, Hvidovre DK-2650, Denmark. Electronic address: adjal.jonas@gmail.com.
• Injury. 2022 Aug 1; 53 (8): 2749-2753.

PurposeTraditional tension band fixation of patella fracture is associated with high reoperation rates. The purpose of the study was to assess strength of fixation in patella fractures treated with either a non-metallic all suture-based technique or traditional metallic tension band wiring.MethodsTen paired human cadaveric specimens were included. A transverse fracture was created, reduced and fixated with a non-metallic or metallic approach. Non-metallic fixation was done according to a previously published technique, metallic fixation was done according to AO description. Specimens were fixed in 90° of flexion and underwent 200 cycles of loading by pulling the Quadriceps tendon to 300 Newton. Fracture displacement was optically monitored. Primary outcome was fracture displacement after 200 cycles compared to the first cycle. Subsequently, load-to-failure was assessed by a monotonic pull to 1000 N.ResultsFor cyclic loading analysis, one specimen from each group was excluded due to machine synchronization, resulting in a total population of 18 specimens. Median (min-max) fracture displacement was 0.65 mm (0.06-1.3) in the non-metallic group and 0.68 mm (0-1.23), (p=0.931) in the metallic group. No difference in displacement was found between the two groups in the repeated measures analysis of variance (p=0.5524). For load-to-failure analysis one specimen was excluded due to machine synchronization, resulting a total population of 19 specimens. 2/9 specimens failed in the non-metallic group (at 979 and 635 N) and 2/10 failed in the metallic group (745 and 654 N).ConclusionNon-metallic technique is a biomechanically viable alternative to traditional tension band fixation and it can hopefully lead to fewer implant-related complications.Copyright © 2022. Published by Elsevier Ltd.

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