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"Intra-Articular Intrusion of Broken Patella Cerclage Wire and the Importance of Higher Imaging in Its Rescue" - A
Adithyaa Sivaramakrishnan1, Sitsabesan Chokkalingam1, P Gopinath Menon1
1Department of Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Introduction:
In this case report, we would like to discuss about a 51-year-old gentleman, who had underwent patella tension band wiring for transverse patella fracture 3 years ago and presented with a painful knee with broken cerclage wire with a fragment migrating into the joint.
Case Report:
The aim of the study was to highlight the importance of higher imaging (Computed tomography) in deciding whether the retrieval of the fragment can be attempted through a minimally invasive arthroscopic technique.
Result:
CT of the knee joint with 3D reconstruction was done and it showed the broken migrated fragment to be intra-articular and intracapsular. Hence, through conventional anteromedial and anterolateral arthroscopic ports, the broken fragment was completely removed with ease, followed by open removal of the remaining cerclage wire.
Discussion:
Breakage of patella cerclage wire is rare in clinical practice due to loss of follow-up and migration of the broken fragment is even more rarer with reportedly only six other cases in literature. In similar two cases, without higher imaging, arthroscopic retrieval of the broken fragment was attempted, where in one of the cases it was unsuccessful and they had to convert to an open procedure. Hence, this reiterates the significance of higher imaging to decide on the approach for a functionally better outcome to the patient with less morbidity.
Conclusion:
This particular case of broken fragment intrusion into the joint signifies the importance of higher imaging in deciding the surgical approach of its removal in the best possible way without cause higher morbidity to the patient and resulting in better functional outcomes.
