Butala technique: polyglactin 910 suture repair of comminuted patellar fractures

Butala, Rajendaprasad R., Khedekar, Ravindra G., na Nagara, Michael P., Arora, Manit and Yadav, Siddhartha (2016) Butala technique: polyglactin 910 suture repair of comminuted patellar fractures. Current Orthopaedic Practice, 27 1: 113-116. doi:10.1097/BCO.0000000000000317

Author Butala, Rajendaprasad R.
Khedekar, Ravindra G.
na Nagara, Michael P.
Arora, Manit
Yadav, Siddhartha
Title Butala technique: polyglactin 910 suture repair of comminuted patellar fractures
Journal name Current Orthopaedic Practice   Check publisher's open access policy
ISSN 1941-7551
Publication date 2016-01
Year available 2016
Sub-type Article (original research)
DOI 10.1097/BCO.0000000000000317
Open Access Status Not Open Access
Volume 27
Issue 1
Start page 113
End page 116
Total pages 4
Place of publication Philadelphia, PA United States
Publisher Lippincott Williams & Wilkins
Collection year 2017
Language eng
Formatted abstract
The patella is made up of dense spongy bone covered by a thin lamina. It is divided into anterior and posterior surfaces. The anterior surface has upper, middle, and lower parts. The upper part serves as an attachment for the quadriceps tendon, the middle is made up of vascular canaliculi, and the lower serves as an origin for the patellar ligament. The posterior surface of the patella articulates with the femur at its upper part, and it contains vascular canaliculi filled with adipose tissue at its lower part.

The patella functions to protect the anterior border of the knee as well as to increase the lever arm of the quadriceps mechanism. Three important consequences of patellar function and position are: (1) the quadriceps is stronger with a correctly functioning and positioned patella; (2) there is a large compressive force at the patellofemoral joint, and (3) the patella is susceptible to high-tension forces.

Fractures of the patella can be from direct or indirect forces. The subcutaneous position of the patella makes it susceptible to injury from a direct blow, which is more likely to result in comminution than an indirect pull. The indication for internal fixation is a fracture with greater than 2 mm of articular displacement, 3 mm of fragment separation, or a comminuted fracture. A fracture is considered comminuted when there are fragments of 4 mm in diameter or more that are separated by at least 3 mm, or overriding by at least 2 mm. A heavily comminuted fracture or inability to obtain a precise reduction may require patellectomy. Quadriceps strength is reduced by as much as 49% if the fracture is treated by patellectomy. Thus, the patella provides an important role in extension of the knee, and patellar salvage is the rule.

Currently, circumferential cerclage stainless steel wiring is the most popular method for repairing comminuted patellar fractures, but we encountered many complications with this technique. Consequently, we developed a new technique of fixing patellar fractures using a braided absorbable suture instead of a traditional stainless steel wire.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

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Sub-type: Article (original research)
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