Selecting the appropriate and effective method and materials for treating patellar fractures is a tough challenge for orthopedists. [5–10] The main goal of the treatment of patella fractures is to provide a regular articular surface, to maintain rigid fixation, and to preserve joint function by initiating early knee range of motion. The widely accepted surgical technique is open reduction and the tension band technique. [11, 12]
Although open techniques are the standard method for reduction and fixation of displaced patellar fractures, many reports have described disadvantages and complications associated with traditional surgical treatments of patella fractures. [9, 13] Technique modifications such as cannulated screws, cannulated screws with tension band wire and plate fixation have been defined to enhance the surgical outcome. [14–17]
LeBrun et al evaluated functional outcomes after surgically treated patella fractures.  It was concluded that after operative treatment for patella fractures, significant symptomatic complaints and functional deficits persist based on validated outcome measures as well as objective physical evaluations. These results have encouraged scientists to define “new and minimally invasive” implant technologies.
With the patented EFECE systems, fractures can be treated with an internal fixation technique. EFECE systems include an EFECE device, EFECE wire and surgical kit. The EFECE device is cylinder-shaped with a hole for the insertion of the EFECE wire. The surgical kit for EFECE systems comprises a sleeve, working cannula, screwdrivers, wire tensioner, wire cutter and magnet. The surgical kit is designed for use in the percutaneous surgical technique. After reduction of the fracture and EFECE wire placement as in the conventional technique, using the sleeve, working cannula and screwdrivers, two reciprocal EFECE devices are pushed forward on EFECE wires until contact is made with the bone cortex. At this stage, there is no need to rotate the screwdriver on the EFECE wire and there is no need to measure the diameter of the implants, which are time-consuming procedures for screw insertion. Compression force can then be applied on the fracture fragments with adjustment of the EFECE wire tension using the wire tensioner. Once the implants are locked with the screwdrivers, these devices do not allow forward or backward movement on the EFECE wires. The remaining part of the wire should be cut with the percutaneous wire cutter.
As the balls in the locking mechanism are magnetically active, these implants can be removed with magnets. This implant removal technique is also an easy and new approach in orthopedic surgery.
There are limitations of the EFECE systems. The EFECE system needs at least two reciprocal EFECE devices for wire fixation. The counter part of the EFECE wire that goes through the fragments and leaves the bone cortex needs to be prepared for EFECE insertion. The fixation strength of the EFECE system is dependent on the mechanical properties of a thin EFECE wire.
The findings of this study suggest that osteosynthesis of patella fractures with EFECE systems provides sufficient mechanical stability to prevent fracture separation with postoperative functional loading. Compared with tension band wiring, the EFECE systems demonstrated greater fixation strength and no difference in fracture gap distraction. The tension band wiring failed at significantly lower loads than the EFECE systems ( P = 0.008).
In this study, the failure mechanism with EFECE systems was seen to be due to failure of the bone with sinking of the EFECE device into the patella. There were no failures in the EFECE device–EFECE wire interspace. The failure mechanism with tension band wiring was due to slippage of the cerclage wire and then sinking of the K-wire into the patella.