Design and Validation of a Smile‐Necklace Plate for Treating Inferior Patellar Pole Avulsion Fractures: A Review and Hypothesis

• Published in: Orthopaedic surgery 2022-11, Vol.14 (11), p.2799-2808
• Main Authors: Zhu, Wanbo, Xu, Lei, Xie, Kai, Li, Xinyuan, Zhang, Xianlong, Fang, Shiyuan, Yang, Jiazhao
• Format: Article
• Language: English
• Subjects: Biomechanics; Cartilage; Fractures; Hypotheses; Inferior patellar pole avulsion fracture; Knee; Ligaments; Rehabilitation; Review; Smile‐necklace plate; Stress concentration; Surgeons; Trauma
• ISSN: 1757-7853; 1757-7861
• DOI: 10.1111/os.13490

The patella's inferior pole transmits force generated by contraction of the quadriceps muscle to the tibial tuberosity through the attached patellar ligament, thus completing knee extension. Therefore, fractures of the patella's inferior pole disrupt the coherence of mechanical transmission in the lower extremities. There appears to be no consensus among trauma centers regarding the treatment of infrapatellar pole fractures, primarily because there is no consistent design or application of internal fixation for this type of fracture. We designed a new internal implant similar to the smile necklace based on our previous study. This smile‐necklace plate (SNP) has the advantage of both plate fixation and tension‐band wiring fixation, permitting early rehabilitation, especially in osteoporotic comminuted infrapatellar pole fractures. Finite element analysis helped verify the biomechanical advantages of the SNP in comparison with existing studies. Hence, this novel implant is a promising treatment option for inferior pole patellar fractures. In this study, we reviewed previous surgical approaches used for fixation of inferior patellar pole fractures. Inspired by the famous smile necklace, we designed and validated an original smile necklace plate(SNP) to combine plate internal fixation with a wire tension band technique. The SNP permit early rehabilitation, especially in osteoporotic comminuted infrapatellar pole fractures. Finite element analysis helped verify the biomechanical advantages of the SNP in comparison with existing studies. Hence, this novel implant hold the promise as the best option for treating inferior pole patellar fractures.