Xinhui Du et al used a new surgical technique of Krackow suture combined with vertical Nice knot for the treatment of inferior patellar fractures and reported the clinical results. The study was published in ‘Indian Journal of Orthopaedics.’
Seventeen consecutive patients admitted with inferior patellar fractures were prospectively enrolled. The AO classification was 34-A1. All patients underwent open reduction and fixation with Krackow sutures in combination with vertical Nice knot. Postoperative follow-up was performed for at least 1 year to evaluate knee function.
The technique:
Three Kirschner wires (2.0 mm) were drilled through the posterior edge of the proximal fracture surface toward the anterior superior edge of the patella. Three non-absorbable sutures (2–0, Smith & Nephew) were passed through the drill tunnel by varus method, and then, the distal end of the non-absorbable suture was passed through the lower edge of the distal fragments and patellar tendon through the hollow puncture needle. Subsequently, make a reduction of the fracture in the knee-extension position, tightened the sutures separately and use Nice knots to fix the fracture vertically.The patellar tendon was sutured by double Krakow in parallel with non-absorbable suture (2–0, Smith & Nephew). A transverse tunnel was drilled in the proximal patella, and suture was pass through the tunnel and the knot was tightened.
Key results of the study were:
• The mean age of seventeen patients was 53.2±9.5 years (39–68 years), and all patients were followed up for more than 12 months.
• The operation time was 54.6±7.7 min (42–68 min).
• No patients had nonunion, joint stiffness, and joint pain.
• All cases achieved bony union at an average of 9.9±1.5 weeks (8–13 weeks) after surgery.
• At the last follow-up, there was no significant difference in range of motion between the injured knee (129.7±3.3°, range 125–135°) and the unaffected knee (130.8±3.8°, range 126–137°) (t=0.28, P>0.05).
• The mean Bostman score of the knee joint was 29.6±0.7, including 15 excellent cases (88.2%) and two good case (11.8%).
The authors concluded –
“Krackow sutures combined with vertical Nice knots are stable and reliable in the treatment of inferior patellar fractures. Knee rehabilitation can be performed immediately after surgery and satisfactory knee function can be achieved. It is a safe, simple, and reliable alternative surgical method, and patients do not need to bear the secondary surgical injury of removing the internal fixation material. Therefore, it is suitable for the application of clinical promotion.”
Further reading:
A New Method of Krackow Suture Combined with Nice Knot for the Treatment of Inferior Patellar Fractures Xinhui Du, Yansheng Huang et al Indian Journal of Orthopaedics (2024) 58:242–249 https://doi.org/10.1007/s43465-023-01093-0