A new study published in Injury evaluated intraoperative and early postoperative clinical outcomes using the Nice knot as an auxiliary reduction technique in displaced comminuted patellar fractures.

This was a retrospective review of 39 patients with unilateral closed displaced comminuted patellar fractures who received open reduction and internal fixation (ORIF), utilizing either Nice knot (the NK group – 24 patients) or traditional reduction (the TR group – 23 patients) techniques. Intra-operative surgical time and peri-operative hemoglobin were recorded. Post-operative clinical outcomes were measured using the visual analgesic score, range of motion of the knee joint and the Böstman scales. Radiographic outcomes were used to evaluate fracture healing.

Hospital records disclosed significantly shorter surgical duration (32.6 min) in the NK group compared to the TR group (63.9 min). Intraoperative blood loss was also notably lower in the NK group (64.7 ml) than the TR group (189.1 ml). Patients in the NK and TR groups were followed for mean of 12.9 months and 12.5 months, respectively. The union rate was 100% in the NK group and 91.3% in the TR group. Meanwhile, in the latter there were two non-unions, which included one infected non-union. There was no difference in the visual analgesic score, range of motion of the knee joint nor Böstman scale at the last follow-up, between the two groups.

Hence, it was concluded that the sliding, self-stabilizing Nice knot technique was associated with reduced surgical time, decreased intraoperative blood loss and satisfactory postoperative outcomes in treatment of displaced patellar fractures.

Source: Chen M, Jin X, Fryhofer G et al. The application of the Nice knots as an auxiliary reduction technique in displaced comminuted patellar fractures. Injury. 2019. doi:10.1016/j.injury.2019.12.005