Amit kumar

BPT 2nd year

CPRS,JMI
I. TENSION BAND WIRING(TBW)
II. Canulated lag-screw with tension
band
III. Himawari method for comminuted
patellar fracture
IV. Partial patellectomy
V. Total patellectomy
 This is a surgical procedure to treat
transverse patellar fractures.
transverse patellar fracture may be
non-displaced or displaced
• In non-displaced or minimally transverse
fracture-----the patient is able to do extend
the knee with full extension.In this condition
simply “knee immobiliser” or “knee brace” is
applied to treat the fracture.
• Whereas in transverse displaced fracture
the patient is unable to extend the knee.in
this condition TBW is applied.In this
surgery.....
 Reduction of fracture is done with reduction
clamp.
 K-wires are placed perpendicular to the
fracture.
 Figure of 8 tension band wire is applied for
compression of the fracture.
 Thewire convert anterior distractive forces
to compressive forces at the articular surface
during the knee flexion and extension.
 Wirespasses through the screws and across
the patella in figure of 8 tension band.
 A new surgical technique ‘Himawari (Sunflower
in Japanese) method’ realize these problem.
 In 1999 Tanaka developed this surgical procedure
for comminuted patellar fracture at Nippon Steel
Hirohata Hospital (Steel Memorial Hospital
present). This hospital is located in Himeji City
south west part of Japan and act as a trauma
center for half million resident medical zone.
 Maruo advanced this surgical technique and
spread whole over the Japan. The number of the
Himawari surgery are gradually increasin and
more than 2500 cases have done from 2007 in
Japan.
 Rigid stability :Even through severe
fracture achieved rigid fixation.
 Secure fixation : Low complication
rate such as loss of
reduction,implant failure.
 Early Recovery : Less implant
irrritation and stable fixation allow
early recovery.
 Whole patellar is exposed and each fragment is
reduced and held by forceps.
 Self locking pin sleeves were inserted
circumferentially by muti-directionally.
 Cable is passed through the sleeve and
 Tighten the cable by tensioner.
 If the fragment is not stable, add anterior
winding by passing anterior surface of patella.
 Finally tightening the cable and crimping the
sleeve to lock the system.
 17 years old male hit his knee in motorbike
accident.
Pre-operative
 Usually involving the distal pole,smaller
fragments are excised.
 The patellar tendon is attached anteriorly
with sutures.
 Indicated for comminuted and displaced
fractures that cannot be reconstructed.
 Bone fragments are excised before
reattachment of the patellar tendon.