AIM: To observe the curative effect of internal fixation of patellar fracture by cannulated compression screws combined with circumferential loop and tension band wire. METHODS: From May 2001 to February 2006, 24 cases of patellar fracture treated with cannulated compression screws combined with circumferential loop and tension band wire were enrolled at Department of Orthopaedics, Renmin Hospital, Wuhan University. It involved 15 males and 9 females, averagely 32 years (18-60 years). There were 14 cases of transverse fracture, 10 cases of comminuted fracture, and all cases were closed fracture. The operation was performed 2-6 hours after injury. X-ray was done at weeks 4, 6, 8 and 10 after operation respectively to observe the material and host reaction. Function was assessed by curative effect assessment criteria made by Lu et al. RESULTS: Totally 22 cases were followed-up. Follow-up period was 4 months to 24 months (mean 10 months). One patient was followed up for 4 months, 5 cases for 6 months, 5 cases for 8 months, 4 cases for 10 months, 3 cases for 12 months, 2 cases for 14 months, 1 case for 18 months and 1 case for 24 months. ①Reduction rate of fracture was 100%. Incision was primary healing. The fractures healed 4-10 weeks after operation, averagely 6 weeks. ②Twenty patients had excellent curative effect, and two patients had good curative effect. ③No corrosion, cinch and breakage were found after operation. ④Peplos appeared at the junction of steel-wire when the fracture was healed. CONCLUSION: Cannulated compression screws combined with circumferential loop and tension band wire is the ideal implant for the patellar fracture. No pain or steel-wire cinch induced by soft tissue stimulation is found.

How to select effective therapy has been a troublesome problem in Orthopaedic Surgery. The authors introduced several operative approaches and discussed some commonly used operative methods to correct deformity, improve life and professional exercise ablilty.

Objective To evaluate the biomechanism of three kinds of internal fixations in treatment of complex tibial plateau fractures. Methods Eighteen human antiseptic cadaver tibial plateau specimens were used to make models of complex tibial plateau fracture (type Ⅵ fractures of Schatzker classification). The models were fixated with a lateral Golf-buttress plate (GP), modified dual plate (a lateral Golf-buttress plate plus a medial five-hole one-third tubular antiglide plate) (DP) or a lateral locking compression plate (LCP) respectively to compare strength, rigidity and stability of different fixation methods. Results The biomechanical strength, rigidity and stability in DP group and LCP group were better than those in GP group (P<0.05), while there was no statistical difference between LCP group and DP group (P>0.05). Conclusions Locking compression plate and modified dual plate are fairly ideal internal fixators for treatment of complex tibial plateau fractures. In the meantime, locking compression plate emphasizes conservation of soft tissues and blood supply, can better meet the requirement of the biological fixation of fracture and is the most ideal internal fixator at present.