{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T08:36:42Z","timestamp":1768984602093,"version":"3.49.0"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Summary:<\/jats:title>\n          <jats:p>Internal fixation of patella fractures remains technically challenging. Cannulated screws with an anterior tension band have been associated with high rates of implant prominence, and fracture comminution can make appropriate application of a tension band impractical. We present the results of a novel technique using a transtendinous\/transligamentous mini-fragment plate positioned peripherally around the patella with radially directed screws: termed the wagon-wheel (WW) construct. Compared with a cohort of fractures treated with cannulated screws with an anterior tension band, there was no difference in final range of motion and rate of nonunion. The WW construct had a significantly decreased incidence of symptomatic implants (5% vs. 32%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02), rate of reoperation (9% vs. 38%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.018), dependency on gait aids (10% vs. 38%, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.031), and a faster time to union (HR: 2.2; 95% CI, 1.28\u20133.95, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.005). In summary, the WW was designed with the goal of obtaining peripheral plate fixation to maximize fragment-specific fixation while minimizing implant prominence. Patients treated with the WW demonstrated reduced rates of implant prominence and reoperation.<\/jats:p>","DOI":"10.1097\/bot.0000000000002579","type":"journal-article","created":{"date-parts":[[2023,2,15]],"date-time":"2023-02-15T04:00:10Z","timestamp":1676433610000},"page":"e452-e458","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Patella Fracture Fixation With Novel Wagon Wheel Construct Versus Tension-Band Construct: A Technical Trick"],"prefix":"10.1097","volume":"37","author":[{"given":"Alexandra M.","family":"Cancio-Bello","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron R.","family":"Owen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0287-089X","authenticated-orcid":false,"given":"Nicolas P.","family":"Kuttner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krystin A.","family":"Hidden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William W.","family":"Cross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0175-1095","authenticated-orcid":false,"given":"Brandon J.","family":"Yuan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen A.","family":"Sems","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20250614","doi-asserted-by":"crossref","first-page":"244","DOI":"10.5435\/JAAOS-D-20-00591","article-title":"Patella fractures: approach to treatment","volume":"29","author":"Hargett","year":"2021","journal-title":"J Am Acad Orthop Surg."},{"key":"R2-20250614","doi-asserted-by":"crossref","first-page":"653","DOI":"10.2106\/JBJS.K.01549","article-title":"Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires","volume":"95","author":"Hoshino","year":"2013","journal-title":"J Bone Jt Surg"},{"key":"R3-20250614","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1097\/00005131-199707000-00009","article-title":"Biomechanical evaluation of current patella fracture fixation techniques","volume":"11","author":"Carpenter","year":"1997","journal-title":"J Orthop Trauma"},{"key":"R4-20250614","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/00005131-199711000-00005","article-title":"Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws","volume":"11","author":"Berg","year":"1997","journal-title":"J Orthop Trauma"},{"key":"R5-20250614","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s12891-020-03936-5","article-title":"A retrospective cohort study on prevalence of postoperative complications in comminuted patellar fractures: comparisons among stabilized with Cannulated-Screw, Kirschner-Wire, or Ring-Pin Tension Bands","volume":"22","author":"Zhu","year":"2021","journal-title":"BMC Musculoskelet Disord."},{"key":"R6-20250614","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1097\/BOT.0000000000000201","article-title":"Fix it or discard it? 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