Treatment of patellar fractures using bioresorbable forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide cannulated screws and nonabsorbable sutures

• Published in: Injury 2021-06, Vol.52 (6), p.1587-1591
• Main Authors: Usami, Takuya, Takada, Naoya, Sakai, Hiroaki, Endo, Shinichiro, Sekiya, Isato, Ueki, Yoshino, Murakami, Hideki, Kuroyanagi, Gen
• Format: Article
• Language: English
• Subjects: Bioresorbable implant; F-u-HA/PLLA screw; Hydroxyapatite; Nonabsorbable sutures; Open reduction and internal fixation; Patella fractures; Poly-L-lactide
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2020.12.015

•F-u-HA/PLLA implants have properties of high mechanical strength, bioactivity, and radio-opacity.•Fifteen patients with transverse patellar fractures were treated with F-u-HA/PLLA cannulated screws and FiberLoop®.•Treatment with F-u-HA/PLLA cannulated screws and FiberLoop® provides good clinical results without any complications. Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) implants are widely used in surgeries because they possess high mechanical strength, bioactivity, and radio-opacity. We previously reported that F-u-HA/PLLA implants were useful for treating lateral tibial condylar, lateral humeral condylar, and ankle fractures. The study aim was to investigate the efficacy of F-u-HA/PLLA cannulated screws and FiberLoop® for treating transverse patellar fractures. From April 2013 to February 2019, 15 patients with transverse patellar fractures were treated with F-u-HA/PLLA cannulated screws and FiberLoop® as follows: Open reduction and internal fixation (ORIF) were performed with two F-u-HA/PLLA cannulated screws and a temporary fixation Kirshner wire (K-wire). Three No. 2 FiberLoops® were inserted into these two screw holes and the K-wire hole for temporary fixation. All patients were allowed to full weight-bearing gaits using a knee brace. Knee range of motion exercise was initiated on postoperative day 1. Knee flexion was restricted to ≤90° for 1 month postoperatively. Radiograph was performed to evaluate fracture healing, screw breakage, reduction loss, and screw radio-opacity. Clinical outcomes and postoperative complications were assessed. The average follow-up was 16.0 months. All fractures were successfully united. Screw breakage, reduction loss, osteolysis, and radiolucent zones around the screws were not observed at the final radiographic follow-up. All F-u-HA/PLLA screw shadows were observed during the follow-up. The average range of flexion and extension were 132.0° and −2.7°, respectively. No patients experienced deep infection episodes, late aseptic tissue reactions, or foreign body reactions postoperatively. No patients complained of pain at the final follow-up. All patients returned to their pre-injury work level and activities of daily living. Our results strongly suggest that ORIF with F-u-HA/PLLA screws and FiberLoop® could be an alternative treatment option for transverse patellar fractures.