Abstract
To the editor,
Firstly, we would like to appreciate the interest and comments on our article “Treatment of displaced fractures of the patella: Tension band wiring technique with the one-end or both-ends K-wire bending fixation method.” We agreed that the TBW technique with bending the K-wire at one end is very easy for removal. 1 However, both-ends bending method is neither difficult to remove. 2 Being similar to the technique of removing the wire in one-end bending method, additional another small wound about 2 cm is needed in the patella’s lower pole and find the bending end. Then we used the wire cutter to cut the curve wire and pull the K-wire from the other site. It is not necessary to straighten the bent distal end of the wire. Furthermore, comparing with one-end bending technique, TBW with both-ends bending method has advantages of stability and clinical benefits, which is more important than the issue of hardware removal. We also concerned the hardware migration, especially in a comminuted fracture, uneven fracture fragment, sub-optimal tension of TBW construct, or poor bone quality. To clarify the stability of these two different surgical techniques in the patella fracture, we only included the AO/Orthopaedic Trauma Association (OTA) 34-C1 and AO/OTA 34-C2 fractures in our serious. Because in comminuted patella fracture, additional K-wire or circumferential wiring will be applied in most cases. This additional internal fixator maybe interferes with the clinical result between these two methods. TBW combine with cannulated screw is a good solution to prevent K-wire migration. 3 Nevertheless, due to that cannulated screw fixation is rigid, the dynamic compression effect will lower than the K-wire. 4 Finally, thank you again for your valuable suggestions of the expulsion-proof pin. 5 These novel designs have the same effect of preventing K-wire migration, just like our both ends bending method. But that is not available in the other country.
