{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:45:10Z","timestamp":1787755510644,"version":"build-2784847793"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,6,20]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Displaced transverse patellar fractures require open reduction and internal fixation. State-of-the-art stabilization techniques are tension band wiring (TBW) using Kirschner wires or cannulated screws. These techniques are associated with high rates of secondary fracture displacement, implant migration, implant prominence, wound-healing disturbances, and the need for implant removal. Recently, a locked intraosseous patellar nail prototype was developed. The aim of the present study was to investigate the biomechanical performance of this nail compared with TBW using cannulated screws.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Seven paired fresh-frozen human cadaveric knees were stripped of all soft tissues except the extensor apparatus. A transverse osteotomy was created to simulate an OTA\/AO type 34-C1 transverse patellar fracture. The specimen pairs were randomly assigned to be fixed with TBW using cannulated screws or with the new intraosseous nail. Each specimen was cyclically tested for 5,000 cycles by pulling on the quadriceps tendon and simulating active knee extension and passive knee flexion within the range from 90\u00b0 of flexion to full knee extension. Anterior and articular margin displacement of the fracture as well as interfragmentary rotation around the mediolateral axis were investigated with optical motion tracking after 100, 500, 1,000, 2,500, and 5,000 test cycles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Within the respective 5 testing-cycle time points evaluated, the articular margin displaced on average 68%, 60%, 72%, 76%, and 81% less after intraosseous nailing compared with TBW. Whereas the difference remained nonsignificant after 100 and 500 cycles (p \u2265 0.116), a trend toward significance was observed after 1,000 cycles (p = 0.063), which became significant after 2,500 and 5,000 cycles (p \u2264 0.043).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>From a biomechanical point of view, the locked intraosseous patellar nail may be an alternative to TBW using cannulated screws because of the higher interfragmentary stability provided at the articular fracture site.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>A locked patellar nail for transverse patellar fractures achieved a stable osteosynthetic construct that may reduce hardware-associated complications because of its intraosseous positioning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.00272","type":"journal-article","created":{"date-parts":[[2018,6,20]],"date-time":"2018-06-20T19:46:51Z","timestamp":1529524011000},"page":"e83","source":"Crossref","is-referenced-by-count":16,"title":["A Locked Intraosseous Nail for Transverse Patellar Fractures"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7168-3086","authenticated-orcid":false,"given":"Michael","family":"Nienhaus","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Zderic","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dieter","family":"Wahl","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pol Maria","family":"Rommens","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University Medical Center Mainz, Johannes Gutenberg-University, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"bib1-20230714","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3109\/ort.1972.43.suppl-143.01","article-title":"Fracture of the patella. A study of 422 patellar fractures","volume":"143","author":"Bostr\u00f6m","year":"1972","journal-title":"Acta Orthop Scand Suppl."},{"issue":"1","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1177\/0036933013518148","article-title":"Changing epidemiology of adult fractures in Scotland","volume":"59","author":"Court-Brown","year":"2014","journal-title":"Scott Med J."},{"issue":"6","key":"bib3-20230714","doi-asserted-by":"crossref","first-page":"e1154","DOI":"10.3928\/01477447-20160811-01","article-title":"Incidence and epidemiology of patellar fractures","volume":"39","author":"Larsen","year":"2016","journal-title":"Orthopedics."},{"key":"bib4-20230714","first-page":"81","article-title":"[Fundamentals and possibilities of traction osteosynthesis]","volume":"35","author":"Weber","year":"1964","journal-title":"Chirurg."},{"key":"bib5-20230714","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/BF02433616","article-title":"[Surprising success with the use of a traction binding in patellar fracture]","volume":"316","author":"Pauwels","year":"1966","journal-title":"Langenbecks Arch Chir."},{"issue":"5","key":"bib6-20230714","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/0020-1383(85)90144-5","article-title":"Fractured patella: operative treatment using the tension band principle","volume":"16","author":"Hung","year":"1985","journal-title":"Injury."},{"issue":"5","key":"bib7-20230714","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."},{"issue":"6","key":"bib8-20230714","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1097\/BOT.0b013e3181dd8f15","article-title":"Open reduction and internal fixation of displaced patella inferior pole fractures with anterior tension band wiring through cannulated screws","volume":"25","author":"Chang","year":"2011","journal-title":"J Orthop Trauma."},{"issue":"12","key":"bib9-20230714","doi-asserted-by":"crossref","first-page":"3429","DOI":"10.1007\/s11999-011-1913-z","article-title":"Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures","volume":"469","author":"Tian","year":"2011","journal-title":"Clin Orthop Relat Res."},{"issue":"6","key":"bib10-20230714","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1007\/s001040050245","article-title":"[Proper and improper tension band fixation exemplified by patellar fracture]","volume":"68","author":"Labitzke","year":"1997","journal-title":"Chirurg."},{"issue":"1","key":"bib11-20230714","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1007\/s10039-001-0533-3","article-title":"Frakturen der kniescheibe - eine h\u00e4ufig untersch\u00e4tzte verletzung","volume":"4","author":"Wendl","year":"2002","journal-title":"Trauma und Berufskrankheit."},{"issue":"5","key":"bib12-20230714","doi-asserted-by":"crossref","first-page":"831","DOI":"10.2106\/00004623-200305000-00010","article-title":"Cyclic loading of olecranon fracture fixation constructs","volume":"85","author":"Hutchinson","year":"2003","journal-title":"J Bone Joint Surg Am."},{"issue":"4","key":"bib13-20230714","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1016\/j.injury.2012.08.052","article-title":"Tension band wiring of the olecranon: is it really a dynamic principle of osteosynthesis?","volume":"44","author":"Brink","year":"2013","journal-title":"Injury."},{"issue":"3","key":"bib14-20230714","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1097\/00005373-199509000-00007","article-title":"Open fractures of the patella: long-term functional outcome","volume":"39","author":"Catalano","year":"1995","journal-title":"J Trauma."},{"issue":"3","key":"bib15-20230714","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/00005131-199704000-00008","article-title":"Early complications in the operative treatment of patella fractures","volume":"11","author":"Smith","year":"1997","journal-title":"J Orthop Trauma."},{"issue":"5","key":"bib16-20230714","doi-asserted-by":"crossref","DOI":"10.3928\/01477447-20100329-14","article-title":"Implant removal following surgical stabilization of patella fracture","volume":"33","author":"Kumar","year":"2010","journal-title":"Orthopedics."},{"issue":"7","key":"bib17-20230714","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1097\/BOT.0b013e318228c1a1","article-title":"Functional outcomes after operatively treated patella fractures","volume":"26","author":"LeBrun","year":"2012","journal-title":"J Orthop Trauma."},{"issue":"7","key":"bib18-20230714","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 Joint Surg Am."},{"issue":"11","key":"bib19-20230714","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1007\/s001040170037","article-title":"[Problems in osteosynthesis of patella fractures with the AO tension belt and consequences for new implants. The XS nail]","volume":"72","author":"Gehr","year":"2001","journal-title":"Chirurg."},{"issue":"12","key":"bib20-20230714","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1097\/BOT.0b013e31829950c0","article-title":"Defining the lateral and accessory views of the patella: an anatomic and radiographic study with implications for fracture treatment","volume":"27","author":"Berkes","year":"2013","journal-title":"J Orthop Trauma."},{"issue":"3","key":"bib21-20230714","doi-asserted-by":"crossref","first-page":"208","DOI":"10.55095\/achot2011\/033","article-title":"Cerclage handling for improved fracture treatment. A biomechanical study on the twisting procedure","volume":"78","author":"W\u00e4hnert","year":"2011","journal-title":"Acta Chir Orthop Traumatol Cech."},{"issue":"10","key":"bib22-20230714","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/j.clinbiomech.2009.08.002","article-title":"Biomechanical comparison of a new staple technique with tension band wiring for transverse patella fractures","volume":"24","author":"Schnabel","year":"2009","journal-title":"Clin Biomech (Bristol, Avon)."},{"issue":"5","key":"bib23-20230714","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/00005131-199806000-00011","article-title":"Biomechanical comparison of fixation methods in transverse patella fractures","volume":"12","author":"Scilaris","year":"1998","journal-title":"J Orthop Trauma."},{"issue":"8","key":"bib24-20230714","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1016\/j.injury.2012.04.020","article-title":"Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures","volume":"43","author":"Thelen","year":"2012","journal-title":"Injury."},{"issue":"1","key":"bib25-20230714","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.jbiomech.2005.11.007","article-title":"Accuracy and repeatability of an optical motion analysis system for measuring small deformations of biological tissues","volume":"40","author":"Liu","year":"2007","journal-title":"J Biomech."},{"issue":"5","key":"bib26-20230714","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1007\/s11999-008-0130-x","article-title":"The width:thickness ratio of the patella: an aid in knee arthroplasty","volume":"466","author":"Iranpour","year":"2008","journal-title":"Clin Orthop Relat Res."},{"issue":"2","key":"bib27-20230714","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1097\/00005131-199404000-00012","article-title":"Evaluation of methods of internal fixation of transverse patella fractures: a biomechanical study","volume":"8","author":"Burvant","year":"1994","journal-title":"J Orthop Trauma."},{"issue":"1","key":"bib28-20230714","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/S0020-1383(99)00190-4","article-title":"Fixation of patella fractures with braided polyester suture: a biomechanical study","volume":"31","author":"Patel","year":"2000","journal-title":"Injury."},{"issue":"4","key":"bib29-20230714","first-page":"162","article-title":"[Biomechanical study of various osteosynthesis procedures in transverse patella fractures]","volume":"90","author":"Brill","year":"1987","journal-title":"Unfallchirurg."},{"issue":"4","key":"bib30-20230714","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1007\/s00264-008-0602-3","article-title":"Anatomical and biomechanical evaluation of the tension band technique in patellar fractures","volume":"33","author":"Baran","year":"2009","journal-title":"Int Orthop."},{"issue":"8","key":"bib31-20230714","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1097\/01.bot.0000244994.67998.1b","article-title":"Comparison of a technique using a new percutaneous osteosynthesis device with conventional open surgery for displaced patella fractures in a randomized controlled trial","volume":"20","author":"Luna-Pizarro","year":"2006","journal-title":"J Orthop Trauma."},{"key":"bib32-20230714","first-page":"9","article-title":"Biomechanics of the patellofemoral joint","volume":"144","author":"Hungerford","year":"1979","journal-title":"Clin Orthop Relat Res."},{"issue":"8","key":"bib33-20230714","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.2106\/00004623-197153080-00007","article-title":"Mechanical function of the patella","volume":"53","author":"Kaufer","year":"1971","journal-title":"J Bone Joint Surg Am."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201806200-00009","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:43:25Z","timestamp":1787751805000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201806200-00009"}},"subtitle":["A Biomechanical Comparison with Tension Band Wiring Through Cannulated Screws"],"short-title":[],"issued":{"date-parts":[[2018,6,20]]},"references-count":33,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.17.00272","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,20]]}}}