The application of the Nice knots as an auxiliary reduction technique in displaced comminuted patellar fractures. Issue 2 (February 2020)

• Record Type: Journal Article
• Authors: Chen, Mengcun; Jin, Xin; Fryhofer, George W.; Zhou, Wu; Yang, Shuhua; Liu, Guohui; Xia, Tian
• Is Part Of: Injury. Volume 51:Issue 2(2020)
• Page Start: 466
• Page End: 472
• Publication Date: 2020-02
• Subjects: Patella fractures -- Comminuted fractures -- Nice knots -- Treatment outcomes; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.12.005
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: To our knowledge, this study is the first to describe application of the Nice knot as an auxiliary reduction aid in the treatment of comminuted patellar fractures. The Nice knot is a sliding, double-stranded, self-stabilizing knot that allows for tightening to be stopped and resumed at any stage to facilitate optimal final knot position and anatomic reduction. Compared to traditional reduction techniques, use of the Nice knot as an auxiliary reduction aid was associated with reduced surgical time, decreased intraoperative blood loss, and satisfactory postoperative outcomes. Abstract: Purpose: To evaluate intraoperative and early postoperative clinical outcomes using the Nice knot as an auxiliary reduction technique in displaced comminuted patellar fractures. Methods: Thirty-nine patients with unilateral closed displaced comminuted patellar fractures received open reduction and internal fixation (ORIF), utilizing either Nice knot (the NK group, 24 patients) or traditional reduction (the TR group, 23 patients) techniques, were retrospectively reviewed in this study. Intra-operative surgical time and peri-operative hemoglobin were recorded. Post-operative clinical outcomes were measured using visual analgesic score, range of motion of the knee joint and the Böstman scales, and radiographic outcomes were used to evaluate fracture healing. Complications including infection, bone non-union, implant loosening, fragment displacement and painful hardware were also assessed. Results: In-hospital records indicated significantly shorter surgical duration (32.6 min) in the NK group than in the TR group (63.9 min). Intraoperative blood loss was also significantly decreased in the NK group (64.7 ml) compared to the TR group (189.1 ml). Patients in the NK and TR groups were followed for mean of 12.9 months and 12.5 months respectively. The union rate was 100% (24/24) in the NK group and 91.3% (21/23) in the TR group. In the TR group, there were two non-unions, including one infected non-union. There was no difference in the visual analgesic score, the range of motion of the knee joint or the Böstman scale at last follow-up between the two groups. Conclusion: The sliding, self-stabilizing Nice knot was associated with reduced surgical time, decreased intraoperative blood loss, and satisfactory postoperative outcomes in the treatment of displaced patellar fractures. Future studies are needed to ensure the generalizability of these findings to additional patient populations at other institutions.