{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T13:40:59Z","timestamp":1790775659785,"version":"4.1.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T00:00:00Z","timestamp":1709769600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> Few reports exist on the treatment of transverse patellar fractures (TPFs) using absorbable cannulated screws and high-strength sutures, and most screws and sutures lack good biomechanics and clinical trials. Therefore, this study aimed to demonstrate the biomechanical stability and clinical efficacy of tension-band high-strength sutures combined with absorbable cannulated screws (TBSAS) in treating TPFs (AO\/OTA 34 C1).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> Finite element models of five internal fixation schemes were established: tension-band wire with K-wire (TBW), TBW with cerclage wire (TBWC), TBW with headless pressure screws (TBWHS), TBW with full-thread screws (TBWFS), and TBSAS. We comprehensively compared the biomechanical characteristics of the TBSAS treatment scheme during knee flexion and extension. Forty-one patients with TPFs in our hospital between January 2020 and August 2022 were retrospectively enrolled and divided into the TBSAS (<jats:italic>n<\/jats:italic> = 22) and TBWC (<jats:italic>n<\/jats:italic> = 19) groups. Clinical and follow-up outcomes, including operative time, visual analog scale (VAS) pain score, postoperative complications, Bostman score, and final knee range of motion, were compared between both groups.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Finite element analysis (FEA) showed that TBWHS and TBWFS achieved the minimum mean fracture interface relative displacement during knee flexion (45\u00b0, 0\u2013500\u00a0N bending load) and full extension (0\u00b0, 0\u2013500\u00a0N axial load). There was no significant difference between TBSAS (0.136\u00a0mm) and TBWC (0.146\u00a0mm) during knee flexion (500\u00a0N); however, TBSAS displacement was smaller (0.075\u00a0mm) during full extension (500\u00a0N). Furthermore, the stress results for the internal fixation and the patella were generally lower when using TBSAS. Retrospective clinical studies showed that the TBSAS group had a shorter operative time, lower VAS pain score at 1 and 2\u00a0months postoperatively, better Bostman knee function score at 3 and 9\u00a0months postoperatively, and better final knee joint motion than the TBWC group (all <jats:italic>p<\/jats:italic> &amp;lt; 0.05). There were five cases (26.3%) of internal fixation stimulation complications in the TBWC group.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> TBSAS demonstrated excellent safety and effectiveness in treating TPFs. It is sufficient to meet the needs of TPF fixation and early functional exercise and effectively reduces metal internal fixation-induced complications and secondary surgery-induced trauma.<\/jats:p>","DOI":"10.3389\/fbioe.2024.1340482","type":"journal-article","created":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T05:04:50Z","timestamp":1709787890000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Tension band high-strength suture combined with absorbable cannulated screws for treating transverse patellar fractures: finite element analysis and clinical study"],"prefix":"10.3389","volume":"12","author":[{"given":"Feifan","family":"Xiang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukun","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dige","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenzhe","family":"Ma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunkang","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,3,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2749","DOI":"10.1016\/j.injury.2022.05.015","article-title":"Suture tension band fixation vs. metallic tension band wiring for patella fractures \u2013 a biomechanical study on 19 human cadaveric patellae","volume":"53","author":"Adjal","year":"2022","journal-title":"Injury"},{"key":"B2","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1016\/j.cjtee.2021.02.009","article-title":"Comparison of the clinical efficacy of different fixation systems for the treatment of transverse patellar fractures","volume":"24","author":"Bai","year":"2021","journal-title":"Chin. J. Traumatology"},{"key":"B3","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.medengphy.2021.07.013","article-title":"Experimental testing and finite element method analysis of the anterior cruciate ligament primary repair with internal brace augmentation","volume":"95","author":"Bartolin","year":"2021","journal-title":"Med. Eng. Phys."},{"key":"B4","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s13018-022-03482-x","article-title":"Biomechanical comparison of different screw-included angles in crossing screw fixation for transverse patellar fracture in level walking: a quasi-dynamic finite element study","volume":"18","author":"Chang","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"B5","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1186\/s12891-019-2474-7","article-title":"Roles of the screw types, proximity and anterior band wiring in the surgical fixation of transverse patellar fractures: a finite element investigation","volume":"20","author":"Chen","year":"2019","journal-title":"BMC Musculoskelet. Disord."},{"key":"B6","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1016\/j.injury.2021.11.048","article-title":"Triangular configuration with headless compression screws in the fixation of transverse patellar fracture","volume":"53","author":"Chen","year":"2022","journal-title":"Injury"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1010508","DOI":"10.3389\/fbioe.2022.1010508","article-title":"Efficacy comparison of Kirschner-wire tension band combined with patellar cerclage and anchor-loop plate in treatment of inferior patellar pole fracture","volume":"10","author":"Du","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"2927","DOI":"10.1007\/s00264-022-05565-0","article-title":"Fixation of patella fractures with metallic implants is associated with a significantly higher risk of complications and re-operations than non-metallic implants: a systematic review and meta-analysis","volume":"46","author":"Edoardo","year":"2022","journal-title":"Int. Orthop."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e747","DOI":"10.3928\/01477447-20181010-08","article-title":"Treatment of patella fractures","volume":"41","author":"Henrichsen","year":"2018","journal-title":"Orthopedics"},{"key":"B10","doi-asserted-by":"publisher","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":"B11","doi-asserted-by":"publisher","first-page":"1116976","DOI":"10.3389\/fbioe.2023.1116976","article-title":"Biomechanical evaluation of two modified intramedullary fixation system for treating unstable femoral neck fractures: a finite element analysis","volume":"11","author":"Huang","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.21037\/apm-22-208","article-title":"Percutaneous minimally invasive treatment of transverse patellar fracture using cannulated screws combined with high-strength sutures and Nice knots: a retrospective study","volume":"11","author":"Jia","year":"2022","journal-title":"Ann. Palliat. Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1186\/s13018-021-02494-3","article-title":"Abstaining from symptomatic implants of modified tension band wiring by nonabsorbable suture fixation for transverse patella fractures","volume":"16","author":"Jirangkul","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"B14","doi-asserted-by":"publisher","first-page":"179","DOI":"10.37190\/abb-01532-2019-02","article-title":"Laser-modified PLGA for implants: in vitro degradation and mechanical properties","volume":"22","author":"Kobielarz","year":"2020","journal-title":"Acta Bioeng. Biomechanics"},{"key":"B15","doi-asserted-by":"publisher","first-page":"4727","DOI":"10.1007\/s00068-022-01993-0","article-title":"Epidemiology, classification and treatment of patella fractures: an observational study of 3194 fractures from the Swedish Fracture Register","volume":"48","author":"Kruse","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"B16","doi-asserted-by":"publisher","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":"B17","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1186\/s43019-021-00116-0","article-title":"Open reduction and internal fixation using multiple nonabsorbable suture materials in acute patella fracture: comparison of clinical and radiological outcome with tension band wiring","volume":"33","author":"Lee","year":"2021","journal-title":"Knee Surg. Relat. Res."},{"key":"B18","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1186\/s12893-022-01788-5","article-title":"The clinical outcomes and complications of combined fixation with cannulated screws and the modified Pyrford technique for the treatment of transverse patellar fractures: a case series study","volume":"22","author":"Li","year":"2022","journal-title":"BMC Surg."},{"key":"B19","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s13018-019-1060-x","article-title":"Where should Kirschner wires be placed when fixing patella fracture with modified tension-band wiring? A finite element analysis","volume":"14","author":"Ling","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1155\/2022\/5610627","article-title":"Clinical outcomes of cannulated screws versus ring pin versus K-wire with tension band fixation techniques in the treatment of transverse patellar fractures: a case-control study with minimum 2-year follow-up","volume":"2022","author":"Liu","year":"2022","journal-title":"BioMed Res. Int."},{"key":"B21","doi-asserted-by":"publisher","first-page":"105139","DOI":"10.1016\/j.clinbiomech.2020.105139","article-title":"Optimization of the knot configuration for early accelerated rehabilitation after Achilles tendon rupture","volume":"80","author":"Liu","year":"2020","journal-title":"Clin. Biomech."},{"key":"B22","doi-asserted-by":"publisher","first-page":"192","DOI":"10.3892\/etm.2022.11115","article-title":"Treatment for transverse patella fractures with minimally invasive techniques (Review)","volume":"23","author":"Ma","year":"2022","journal-title":"Exp. Ther. Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"107502","DOI":"10.1016\/j.cmpb.2023.107502","article-title":"Positive medial cortical support versus anatomical reduction for trochanteric hip fractures: finite element analysis and biomechanical testing","volume":"234","author":"Mao","year":"2023","journal-title":"Comput. Methods Programs Biomed."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e240","DOI":"10.1097\/bot.0000000000001447","article-title":"Biomechanical comparison of tension band fixation of patella transverse fracture: headless screws versus headed screws","volume":"33","author":"Martin","year":"2019","journal-title":"J. Orthop. Trauma"},{"key":"B25","doi-asserted-by":"publisher","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"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1116","DOI":"10.1016\/j.injury.2011.01.025","article-title":"Double fixation of displaced patella fractures using bioabsorbable cannulated lag screws and braided polyester suture tension bands","volume":"42","author":"Qi","year":"2011","journal-title":"Injury"},{"key":"B27","doi-asserted-by":"publisher","first-page":"2034","DOI":"10.3390\/ijms23042034","article-title":"PLGA-based composites for various biomedical applications","volume":"23","author":"Rocha","year":"2022","journal-title":"Int. J. Mol. Sci."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD009651.pub3","article-title":"Interventions for treating fractures of the patella in adults","volume":"2021","author":"Sayum Filho","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"B29","doi-asserted-by":"publisher","first-page":"785","DOI":"10.3349\/ymj.2014.55.3.785","article-title":"Separate vertical wiring for the fixation of comminuted fractures of the inferior Pole of the patella","volume":"55","author":"Song","year":"2014","journal-title":"Yonsei Med. J."},{"key":"B30","doi-asserted-by":"publisher","first-page":"w20165","DOI":"10.4414\/smw.2020.20165","article-title":"Practical guidelines for the treatment of patellar fractures in adults","volume":"150","author":"Steinmetz","year":"2020","journal-title":"Swiss Med. Wkly."},{"key":"B31","doi-asserted-by":"publisher","first-page":"708","DOI":"10.1016\/j.arthro.2019.08.048","article-title":"A biomechanical comparison of different suture materials used for arthroscopic shoulder procedures","volume":"36","author":"Taha","year":"2020","journal-title":"Arthroscopy"},{"key":"B32","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1007\/s00590-018-2272-1","article-title":"Five-pointed star lattice sutures for fixation of patella transverse fractures: a clinical study","volume":"29","author":"Tang","year":"2018","journal-title":"Eur. J. Orthop. Surg. Traumatology"},{"key":"B33","doi-asserted-by":"publisher","first-page":"344","DOI":"10.4055\/cios20175","article-title":"Platelet-rich plasma, mesenchymal stem cell, and non-metallic suture-based fixation technique in a patellar fracture nonunion: a technical note and systematic review","volume":"13","author":"Trinchese","year":"2021","journal-title":"Clin. Orthop. Surg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"1587","DOI":"10.1016\/j.injury.2020.12.015","article-title":"Treatment of patellar fractures using bioresorbable forged composites of raw particulate unsintered hydroxyapatite\/poly-L-lactide cannulated screws and nonabsorbable sutures","volume":"52","author":"Usami","year":"2021","journal-title":"Injury"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1143575","DOI":"10.3389\/fbioe.2023.1143575","article-title":"Biomechanical study of internal fixation methods for femoral neck fractures based on Pauwels angle","volume":"11","author":"Wang","year":"2023","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1016\/j.injury.2009.04.011","article-title":"FiberWire\u00ae is superior in strength to stainless steel wire for tension band fixation of transverse patellar fractures","volume":"40","author":"Wright","year":"2009","journal-title":"Injury"},{"key":"B37","doi-asserted-by":"publisher","first-page":"960310","DOI":"10.3389\/fbioe.2022.960310","article-title":"Finite element analysis of different fixation methods of screws on absorbable plate for rib fractures","volume":"10","author":"Xue","year":"2022","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B38","doi-asserted-by":"publisher","first-page":"107078","DOI":"10.1016\/j.cmpb.2022.107078","article-title":"Improve biomechanical stability using intramedullary nails with femoral neck protection in femoral shaft fractures","volume":"225","author":"Yuan","year":"2022","journal-title":"Comput. Methods Programs Biomed."},{"key":"B39","doi-asserted-by":"publisher","first-page":"105714","DOI":"10.1016\/j.cmpb.2020.105714","article-title":"Biomechanical evaluation of internal fixation implants for femoral neck fractures: a comparative finite element analysis","volume":"196","author":"Zeng","year":"2020","journal-title":"Comput. Methods Programs Biomed."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.13795\/j.cnki.sgkz.2014.12.011","article-title":"Biomechanical study of absorbable screws tension band in the treatment of transverse patella fractures","volume":"20","author":"Zhang","year":"2014","journal-title":"J. Pract. Orthop."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2024.1340482\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,7]],"date-time":"2024-03-07T05:04:54Z","timestamp":1709787894000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2024.1340482\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,7]]},"references-count":40,"alternative-id":["10.3389\/fbioe.2024.1340482"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2024.1340482","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,7]]},"article-number":"1340482"}}