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Garner MR, Homcha B, Cowman T, Goss M, Reid JS, Lewis GS. Transverse patella fracture fixation: A cadaveric biomechanical comparison of cannulated screws and anterior tension band versus low-profile, multiplanar mesh plating. Injury 2024; 55:111574. [PMID: 38669892 PMCID: PMC11111345 DOI: 10.1016/j.injury.2024.111574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/05/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Multiplanar mesh plating of patella fractures has become more popular in recent years. It was the goal of this study to compare the biomechanical stability of cannulated screw with anterior tension band to multiplanar mesh plating for fixation of transverse patella fractures in cadaver specimens. MATERIALS AND METHODS Eight matched pairs of fresh frozen cadaveric knees were obtained and soft tissues dissected leaving the extensor mechanism, joint capsule, and retinaculum intact. Transverse fractures were created at the mid-portion of the patella. For each pair, one specimen was repaired using cannulated screws with anterior tension band, and the second was repaired using multiplanar mesh plating. Each specimen underwent cyclic extension loading with loads increasing by 1.1 kg after every 50 cycles. Interfragmentary displacement was measured at the end of each interval at both 5° and 45° of knee flexion angle, with fixation failure defined by >2 mm displacement. RESULTS The specimens fixed with multiplanar mesh plating survived more cycles and higher loads than the specimens fixed with cannulated screws with anterior tension band (p = 0.011 comparing survival plots). After 150 cycles of extension loading, 3 of 8 of the specimens fixed with screws/tension band had failed, whereas none of the mesh plated specimens had failed. After 400 cycles, 7 of 8 of the screws/tension band had failed, whereas half of the mesh plated specimens had failed. CONCLUSIONS While a more technically challenging and expensive technique, mesh plating for patella fractures appears to offer greater durability than traditional cannulated screw with tension banding.
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Affiliation(s)
- Matthew R Garner
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA.
| | - Brittany Homcha
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Trevin Cowman
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Madison Goss
- Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - J Spence Reid
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
| | - Gregory S Lewis
- Department of Orthopaedics & Rehabilitation, Penn State College of Medicine, 500 University Dr. Hershey, PA 17033 USA
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Baid M, Narula S, Manara JR, Blakeney W. Evolution in the Management of Patella Fractures. J Clin Med 2024; 13:1426. [PMID: 38592262 PMCID: PMC10934211 DOI: 10.3390/jcm13051426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
Patella fractures usually occur as a result of direct trauma to the anterior knee joint, indirect injury as a result of eccentric muscle contraction, or rapid knee flexion against a contracted quadriceps muscle. The patella functions as part of the extensor mechanism of the knee, where large forces are transmitted, and its subcutaneous nature has made treatment of patella fractures a challenge. In this review article, we evaluate how the management of these fractures has evolved over time and the advantages associated with the various treatment techniques. There are few comparative studies looking at the different treatment types for fractures of the patella, with the goal of achieving a functional extensor mechanism with low rates of post-traumatic arthritis and metal-work irritation.
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Affiliation(s)
- Mahak Baid
- Aneurin Bevan University Health Board, Wales NP20 2UB, UK; (M.B.); (J.R.M.)
| | - Sid Narula
- Royal Perth Hospital, Perth, WA 6000, Australia
| | - Jonathan R. Manara
- Aneurin Bevan University Health Board, Wales NP20 2UB, UK; (M.B.); (J.R.M.)
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Tsotsolis S, Ha J, Fernandes ARC, Park JY, Dewhurst M, Walker T, Ilo K, Park SR, Patel A, Hester T, Poutoglidou F. To plate, or not to plate? A systematic review of functional outcomes and complications of plate fixation in patellar fractures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3287-3297. [PMID: 37286819 DOI: 10.1007/s00590-023-03597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Poor outcomes and high complication and reoperation rates have been reported with tension-band wiring (TBW) in the management of patellar fractures and particularly the comminuted ones. The purpose of this study was to investigate the functional outcomes and complication rates of patellar fractures managed with open reduction and internal fixation (ORIF) with a plate. METHODS MEDLINE, EMCare, CINAHL, AMED and HMIC were searched, and the PRISMA guidelines were followed. Two independent reviewers extracted the data from the included studies and assessed them for the risk of bias. RESULTS Plating of patellar fractures is associated with satisfactory range of movement (ROM) and postoperative function and low pain levels. We found a 10.44% complication rate and a low reoperation rate. Reoperations were mainly performed for metalwork removal. CONCLUSION ORIF with plating of patellar fractures is a safe alternative in the management of patellar fractures and may be associated with a lower complication and reoperation rate compared to TBW. Future randomized prospective studies are needed to validated the results of the present systematic review.
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Affiliation(s)
- Stavros Tsotsolis
- Department of Trauma and Orthopaedics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Joon Ha
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | | | - Jae Yong Park
- Faculty of Medicine, Imperial College London, London, UK
| | - Maximilian Dewhurst
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Thomas Walker
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Kevin Ilo
- University Hospitals of Derby and Burton NHS Trust, Royal Derby Hospital, Derby, UK
| | - Se Ri Park
- Faculty of Medicine, Imperial College London, London, UK
| | - Amit Patel
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK
| | - Thomas Hester
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Freideriki Poutoglidou
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, Royal London Hospital, Whitechapel Road, London, E1 1FR, UK.
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Neumann-Langen MV, Sontheimer V, Näscher J, Izadpanah K, Schmal H, Kubosch EJ. Incidence of postoperative complications in patellar fractures related to different methods of osteosynthesis procedures - a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:871. [PMID: 37946171 PMCID: PMC10634146 DOI: 10.1186/s12891-023-06998-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Patellar fractures have a comparatively low incidence compared to all fracture frequencies of the musculoskeletal system. However, surgical management is crucial to prevent postoperative complications that affect the knee joint. The purpose of the present study was to evaluate the incidence of postoperative complications and onset of postoperative osteoarthritis related to the chosen technique of patellar fracture management. METHODS In a retrospective cohort study consecutive managed, isolated patella fractures were reviewed for demographic data, trauma mechanism, patella fracture type, fixation technique and postoperative complications. The results were documented radiographically and clinically and analysed statistically. The reporting followed the STROBE guidelines. RESULTS A total of 112 patients were eligible for data evaluation. Surgical management of comminuted patellar fractures with small fragment screws showed significant fewer postoperative complications compared to other fixation techniques (8%, p < 0.043). The incidence of posttraumatic infection was significantly higher following the hybrid fixation technique with cannulated screws and tension wire than following the other analysed techniques (p = 0.024). No postoperative wound infection was observed after screw fixation or locking plate fixation. Symptomatic hardware was most frequently seen after tension-band fixation. Onset of posttraumatic osteoarthritis was most often found after the hybrid fixation technique (55%). CONCLUSION Surgical management of patellar fractures remains crucial but fracture fixation using plating systems or small fragment screws is least associated with postoperative complications. TRIAL REGISTRATION Trial registration number (DRKS):00027894.
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Affiliation(s)
- M V Neumann-Langen
- Department of Orthopaedic and Trauma Surgery, Klinikum Konstanz, Mainaustrasse 35, 78464, Konstanz, Germany.
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
| | - V Sontheimer
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - J Näscher
- Department of Mathematics and Statistics, University of Konstanz, Eggerthaldestrasse D, 78457, Konstanz, Germany
| | - K Izadpanah
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - H Schmal
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
- Department of Orthopedic Surgery, University Hospital Odense, Sdr. Boulevard 29, 5000, Odense C, Denmark
| | - E J Kubosch
- Department of Orthopedics and Trauma Surgery, Medical Center - Albert-Ludwigs-University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
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Wang X, Zi S, Wei W, Yao Q, Cao L. A study of fracture lines distribution characteristics in complete articular fractures of the patella. Front Surg 2023; 10:1284479. [PMID: 38026476 PMCID: PMC10644201 DOI: 10.3389/fsurg.2023.1284479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Objective The objective of this study was to unveil the characteristics of fracture lines distribution and explore its clinical significance of complete articular fractures of the patella. Methods A consecutive series of image data from 88 patients with complete articular patella fractures were retrospectively included. Three-dimensional reconstruction images of the patella fractures were created and collected. Subsequently, these reconstructed images were visually overlaid onto a standard anterior and posterior patella template. The fracture lines were then identified, traced onto the template, and utilized to generate patella fracture maps. Furthermore, the incidence rate of patella fracture lines involving the distal pole was analyzed. Results The maps depict the fracture lines of complete articular patella fractures. For simple and complex patella fractures, the primary fracture lines primarily converge within the Middle and Lower regions, exhibiting a transverse pattern. Conversely, the primary fracture lines in comminuted patella fractures are randomly dispersed across the patella. Examining the maps, approximately 63.6% (56/88) of complete articular patella fractures exhibited involvement of the distal pole in the anterior view, while 48.9% (43/88) displayed distal pole fractures in the posterior view. The incidence of distal pole injury increased progressively with the severity of patella fractures. Conclusion The patterns and distribution of fracture lines in cases of complete articular patella fractures are prominently illustrated on the constructed fracture maps. Familiarity with these common characteristics of complete articular patella fracture, especially with the distal pole injury, can aid surgeons in developing preoperative planning, executing surgical strategies effectively, and reducing inappropriate treatment.
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Affiliation(s)
| | | | | | | | - Liehu Cao
- Department of Orthopedics Trauma, Shanghai Baoshan Luodian Hospital, Shanghai, China
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Pesch S, Greve F, Zyskowski M, Müller M, Crönlein M, Biberthaler P, Kirchhoff C, Wurm M. High return to sports rates after operative treatment of patella fractures. Eur J Med Res 2023; 28:366. [PMID: 37736742 PMCID: PMC10514948 DOI: 10.1186/s40001-023-01359-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Patella fractures are relatively rare fractures and only little is known about the postoperative return to sports after patella fractures. METHODS This retrospective study presents information on functional outcome after operative treatment of patella fractures as well as time until return to sports and patients' complaints after open-reduction internal-fixation (ORIF) of patella fractures. RESULTS Overall, 39 patients after ORIF of patella fractures were evaluated at our Level-I trauma center with a mean follow-up of 42 months. The mean time until return to sports was 7 ± 3.9 months. No significant difference was found for functional outcome with respect to body mass index (BMI) or age. Fracture consolidation was accomplished after a mean of 6.9 ± 2.9 months besides a relatively low complication rate of 5.1% (n = 2). CONCLUSION The results demonstrate a high return to sports rate of 90.3%. However, only 51.6% were able to perform sports on their pre-injury level or above. Trial Registration The study was retrospectively registered at DRKS (No: DRKS00031146).
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Affiliation(s)
- Sebastian Pesch
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
- Department of Trauma Surgery, AUVA Trauma Center Meidling, Kundratstrasse 37, 1120, Vienna, Austria
| | - Frederik Greve
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Michael Zyskowski
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Michael Müller
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Moritz Crönlein
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Peter Biberthaler
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Chlodwig Kirchhoff
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Markus Wurm
- Department of Trauma Surgery, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
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Krause M, Frosch KH, Linke P. [Anterior plate osteosynthesis for multifragmentary patella fracture with additive stabilization of the distal pole using suture cerclage]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00113-023-01320-1. [PMID: 37171644 DOI: 10.1007/s00113-023-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/15/2023] [Indexed: 05/13/2023]
Abstract
OPERATION GOAL The aims of the surgical treatment are the anatomical reduction of the articular surface and stabilization of a multifragmentary patella fracture with a distal pole fragment using plate osteosynthesis and additive suture tape cerclage to secure the distal fragment. INDICATION Demonstration of the surgical procedure for a multifragmentary patella fracture in the knee joint of a male cadaver. SURGICAL TECHNIQUE Start with a median prepatellar skin incision and splitting of the bursa and surrounding fascia. Lateral arthrotomy with proximal and distal extension for complete eversion and articular exposure of the multifragmentary fracture. The fracture is then reduced from the articular side using temporary K‑wire fixation and reduction clamps, followed by screw osteosynthesis of the large fragments (e.g., distal and proximal poles). After selection of the plate it is fixed with locking screws. In addition, a suture cerclage according to Krakow and/or McLaughlin is applied distally and transosseously through the tibial tuberosity and proximally through the quadriceps tendon. The knotting of the McLaughlin suture cerclage should be done in 90° flexion of the knee joint. POSTOPERATIVE TREATMENT Functional postoperative treatment with hard shell orthesis with movement limitation (30°, 60° and 90° for 2 weeks each) and partial weight bearing of 15-20 kg for 6 weeks is recommended. Full weight-bearing is only allowed in full extension. EVIDENCE Plate osteosynthesis is biomechanically superior in comparison to the widely used tension band osteosynthesis. In multifragmentary fractures, additional augmentation with a suture tape cerclage seems to be appropriate. Due to the lack of study results there is currently no clinical evidence for this.
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Affiliation(s)
- Matthias Krause
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland.
| | - Karl-Heinz Frosch
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
- Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Bergedorfer Str. 10, 21033, Hamburg, Deutschland
| | - Philip Linke
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20251, Hamburg, Deutschland
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Rau Y, Huynh T, Frosch KH, Schultz C, Schulz AP. Developments in the epidemiology and surgical management of patella fractures in Germany. BMC Musculoskelet Disord 2023; 24:83. [PMID: 36721108 PMCID: PMC9887573 DOI: 10.1186/s12891-023-06162-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/12/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patella fractures account for approximately 1% of all skeletal injuries. Treatment options are vast and no definitive conclusion on what option is the most beneficial could be made so far. Plate osteosynthesis appears to gain in importance. We aim to give insight into the more recent trends and developments as well as establish the epidemiology of patella fractures in Germany by analysing treatment and epidemiological data from a national database. METHODS Anonymised data was retrieved form a national database. In the period of 2006 to 2020, all patients with patella fractures as defined in ICD-10 GM as their main diagnosis, who were treated in a German hospital were included. Patients were divided into subgroups based on gender and age. Age groups were created in 10-year intervals from 20 years old up to 80 years old with one group each encompassing all those above the age of 80 years old and below 20 years old and younger. Linear regression was performed were possible to determine statistical significance of possible trends. RESULTS A total of 151,435 patellar fractures were reported. 95,221 surgical interventions were performed. Women were about 1.5 times more likely to suffer from patella fracture than men. The relative number of surgical interventions rose from about 50% in 2006 to 75% in 2020. Most surgical interventions are performed in those over the age of 50. The incidence of complex fractures and plate osteosynthesis has significantly increased throughout the analysed period. CONCLUSIONS We found a clear trend for surgical treatment in Germany with an increase in surgical procedures. We could also show that this ratio is age-related, making it more likely for younger patients in the age groups from 0 to 70 years old to receive surgical treatment for their patella fracture.
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Affiliation(s)
- Yannick Rau
- grid.4562.50000 0001 0057 2672Faculty of Medicine, Universität Zu Lübeck, Lübeck, Germany
| | - Thomas Huynh
- grid.9764.c0000 0001 2153 9986Chair of Technology Management, Christian-Albrechts-Universität, Kiel, Germany
| | - Karl-Heinz Frosch
- grid.459396.40000 0000 9924 8700Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany ,grid.13648.380000 0001 2180 3484Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Schultz
- grid.9764.c0000 0001 2153 9986Chair of Technology Management, Christian-Albrechts-Universität, Kiel, Germany
| | - Arndt-Peter Schulz
- grid.4562.50000 0001 0057 2672Faculty of Medicine, Universität Zu Lübeck, Lübeck, Germany ,grid.459396.40000 0000 9924 8700Department of Trauma Surgery, Orthopaedics and Sports Traumatology, BG Klinikum Hamburg, Hamburg, Germany
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Buschbeck S, Götz K, Barzen S, Hoffmann R. [Patalla Fractures]. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:687-702. [PMID: 35259771 DOI: 10.1055/a-1623-6906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Patella fractures are rare injuries, accounting for 0.5 - 1.5% of all fractures, but they can lead to severe functional limitations if they do not heal properly. In addition to a prompt diagnosis, surgical treatment is usually necessary for multi-fragment fractures. The goals of every treatment are a biomechanically stable joint as well as a congruent restoration of the retropatellar joint surface. These results often remain a challenge, especially in multiple fragment fractures. The surgical treatment strategies have steadily evolved from tension band and screw osteosyntheses in combination with wire cerclages. Currently, angular stable plate systems are increasingly being used. This article gives an overview of the fracture anatomy, the classification and diagnosis of patella fractures and the currently used surgical treatment options.
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Ma X, Cui D, Liu B, Wang Z, Yu H, Yuan H, Xiang L, Zhou D. Treating Inferior Pole Fracture of Patella with Hand Plating System: First Clinical Results. Orthop Surg 2022; 15:266-275. [PMID: 36331126 PMCID: PMC9837230 DOI: 10.1111/os.13539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/20/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Inferior pole fractures of patella are notorious fractures where it is difficult to obtain rigid internal fixation by conventional methods. The objective of the study was to introduce the Hand Plating System (HPS), which was a novel surgical technique for inferior pole fractures of patella, and to report the radiological and clinical outcomes following the application of the surgical technique. METHODS The study was designed as a retrospective cohort study. Between July 2017 and December 2018, 30 patients who were diagnosed with inferior pole fracture of the patella without additional orthopaedic injuries were enrolled in this case series. After X-ray and 3D-CT examinations, all patients underwent open reduction and internal fixation by HPS with or without supplementary cannulated screw and lag screw stabilization. The bony union time, final range of motion (ROM), Bostman score, visual analog scale (VAS), and complications were measured as the clinical outcomes under a minimum of 12 months of follow-up. RESULTS All of the operations went well with the mean operative time of 76.2 ± 15.3 min. Bony union achieved in all the cases at an average of 9.5 ± 1.4 weeks after surgery. There was no loss of reduction, fixative failure, or surgical implant removal during follow-up. The average range of motion 1 year postoperatively was 0°-123.3°. The mean Bostman Score at the last follow-up was 26.8 ± 2.1 with the satisfactory rate of 100%. The pain feeling during walking as measured by VAS averaged at 0.9 ± 1.3. No complications developed except for one case of poor incision healing, which healed eventually after surgical debridement. CONCLUSIONS HPS was demonstrated as a secure fixation and as a kind of tension band for inferior pole fractures of the patella. Satisfactory recovery of knee function and low complication rate, including no need for hardware removal, could be expected.
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Affiliation(s)
- Xiang‐Yu Ma
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Dong Cui
- Department of Cardiology of No.967 Hospital of PLA Joint Logistics Support ForceDalianLiaoning ProvinceChina
| | - Bing Liu
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Zheng Wang
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Hai‐Long Yu
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Hong Yuan
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Liang‐Bi Xiang
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
| | - Da‐Peng Zhou
- Department of Orthopaedics of General Hospital of Northern Theater CommandShenyangLiaoning ProvinceChina
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Tengler MB, Lill H, Wente M, Ellwein A. Anterior Locking Plate Osteosynthesis of Patellar Factures - Analysis of Complications and Functional Outcome. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2022; 160:549-558. [PMID: 33873227 DOI: 10.1055/a-1403-3681] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Tension band wiring is the standard procedure for patellar fractures, but is associated with a high rate of implant related complications and implant failure. Tension band wiring may fail, especially with multifragmentary and comminuted fractures. Plate fixation of complex patellar fractures seems to be superior to wiring, both clinically and biomechanically. The aim of this study was to evaluate complications after locking plate fixation in patellar fractures two years after surgery and to access the functional outcome. MATERIAL AND METHODS As part of a prospective case series, all patients who had received locking plate fixation of a patellar fracture between April 2013 and May 2018 were clinically examined two years postoperatively and potential complications were evaluated. RESULTS A total of 38 patients aged 19 - 87 years were included. Complications occurred in a total of five patients (13%), including one reactive prepatellar bursitis, one chronic infection and loss of reduction due to a dislocated pole fragment in three cases. The average active range of motion of the affected knee joint two years postoperatively was 133°. The Tegner activity scale score reached 3 points, the Lysholm score 95 points and the Kujala score 95 points. CONCLUSION With an overall relatively low complication rate and good clinical outcome, dislocated distal pole fragments are a common complication after plate fixation of patellar fractures. If preoperative diagnostic testing shows a pole fragment, a modified hook-plate can be used, with the possibility of fixing the pole fragment.
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Affiliation(s)
- Maxi Benita Tengler
- Department of Orthopaedics and Trauma Surgery, DIAKOVERE Friederikenstift Hospital, Hannover, Germany
| | - Helmut Lill
- Department of Orthopaedics and Trauma Surgery, DIAKOVERE Friederikenstift Hospital, Hannover, Germany
| | - Maike Wente
- Department of Orthopaedics and Trauma Surgery, DIAKOVERE Friederikenstift Hospital, Hannover, Germany
| | - Alexander Ellwein
- Orthopaedic Clinic, Hannover Medical University (MHH), DIAKOVERE Annastift, Hannover, Germany
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Epidemiology, classification and treatment of patella fractures: an observational study of 3194 fractures from the Swedish Fracture Register. Eur J Trauma Emerg Surg 2022; 48:4727-4734. [DOI: 10.1007/s00068-022-01993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/01/2022] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Basic epidemiological data on patella fractures derived from large nationwide and multicenter studies are scarce. This observational register study describes patient epidemiology, fracture classification and treatment of patella fractures in adults in a Swedish population.
Methods
We conducted an observational study on data derived from the Swedish Fracture Register (SFR) on all patella fractures classified as non-periprosthetic and non-pathological, registered between 2014 and 2018 in individuals aged ≥ 18years. Epidemiological data on sex, age, side, seasonal variation, trauma mechanism, fracture classification (according to AO/OTA), and treatment were analyzed.
Results
3194 patella fractures were analyzed, occurring at a median age of 67 (range 19–100) years. 64% of all patients were female. Most fractures were caused by low-energy trauma, with 70% due to falling from a standing height. 1796 (56%) of the fractures were transverse compared to 845 (26%) vertical fractures. Most fractures (N=2148, 67%) were treated non-operatively. Operative treatment consisted mainly of Tension Band Wiring (TBW) performed in 774 (24%) patients.
Conclusions
Patella fractures mainly occur in elderly women (> 65 years), commonly caused by low-energy trauma. The main treatment is non-operative (67%), except for transverse (AO/OTA C3) fractures. TBW remains the most used operative treatment of choice. These results may help health care providers, researchers and clinicians better understand the panorama of patella fractures in Sweden.
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Checketts JX, Scott J, Fishbeck K, Hart T, Pham W, Dadgar A, Calder M, Norris BL. Reoperation and Complication Rates Following Patellar Fracture Repair with Plates: A Retrospective Analysis with Patient-Reported Outcomes at More than 1 Year of Follow-up. JB JS Open Access 2022; 7:JBJSOA-D-22-00012. [PMID: 35620525 PMCID: PMC9116955 DOI: 10.2106/jbjs.oa.22.00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Recent work has suggested good clinical and functional results with dorsal surface plating of patellar fractures. The primary outcome measurement of this study was reoperation rates for patellar fractures that had been treated with dorsal plating. Methods This work consists of a retrospective review of clinical and functional outcome data following repair of patellar fractures with dorsal plates. We obtained institutional review board approval for this study and conducted a review of 9 consecutive years of our group's trauma practice. We also contacted patients to assess patient-reported outcomes (PROs) after 12 months. Results Eighty-five patellar fractures were treated with open reduction and internal fixation (ORIF) via plating over 9 years. Eight (9.41%) of the patients required reoperation. Of the 72 patients with complete follow-up of ≥12 weeks, 3 (4.17%) had nonunion of the fracture site and 4 (5.56%) had loss of reduction of the fracture. The average Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score among our sample was 18.84 (slight symptoms); 72.41% of the patients in our sample had slight or no symptoms at ≥12 months postoperatively. Conclusions Our results indicated that plating of comminuted patellar fractures is a safe, viable treatment strategy. The PROs at ≥12 months of follow-up data were promising. Additionally, dorsal plating may allow for early return of function and less postoperative bracing. Level of Evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jake X. Checketts
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,Email for corresponding author:
| | - Jared Scott
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Keith Fishbeck
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma
| | - Thomas Hart
- University of Oklahoma College of Medicine, Tulsa, Oklahoma
| | - William Pham
- University of Oklahoma College of Medicine, Tulsa, Oklahoma
| | - Azad Dadgar
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
| | - Mark Calder
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
| | - Brent L. Norris
- Department of Orthopaedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma,University of Oklahoma College of Medicine, Tulsa, Oklahoma,Orthopaedic & Trauma Services of Oklahoma, Tulsa, Oklahoma
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15
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Berninger MT, Frosch KH. Wandel in der Behandlung der Patellafrakturen. Unfallchirurg 2022; 125:518-526. [DOI: 10.1007/s00113-022-01167-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
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16
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Comminuted AO-C3 fractures of the patella: good outcome using anatomically contoured locking plate fixation. INTERNATIONAL ORTHOPAEDICS 2022; 46:1395-1403. [DOI: 10.1007/s00264-022-05374-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 03/06/2022] [Indexed: 10/18/2022]
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17
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Raja BS, Jain A, Paul S, Choudhury AK, Kalia RB. Plate osteosynthesis in patellar fractures: a systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1627-1640. [PMID: 34664117 DOI: 10.1007/s00590-021-03143-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION To perform a systematic review and assess the indications, outcomes, complications, and union rates associated with plate osteosynthesis in patellar fractures compared to tension band wiring. METHODS The systematic search was conducted for articles in PubMed, Embase Biomedical, Cochrane central, and LILACS databases (date of inception to July 30, 2020). Articles were included if they were randomized control trials, cohort studies, case-control studies, and case series (with more than five cases), which focused on the clinical outcomes of patients with plate osteosynthesis as a treatment for fracture of the patella and had a minimum follow-up of 3 months. All studies were assessed according to their level of evidence, the number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Meta-analysis could only be done for two parameters (complications and reoperations) due to the paucity of data and heterogeneity of studies' limited statistical analysis. The data are presented as a review table with the key points summarized. RESULTS Twenty studies (seven prospective and 13 retrospective articles) identified 533 patients with 534 fractures who had undergone plate osteosynthesis for fracture of the patella. The most common fracture treated with plate osteosynthesis was 34C. CONCLUSION Basket plate was most commonly used for inferior pole fractures, while mesh plates were for intra-articular patella fractures. Overall plating was associated with better clinical outcomes, fewer complication rates, and high union rates compared to tension band wiring for patella fractures.
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Affiliation(s)
- Balgovind S Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203
| | - Aakash Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203
| | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203
| | - Arghya Kundu Choudhury
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203
| | - Roop Bhushan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India, 249203.
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[Osteosynthetic treatment of a periprosthetic patellar fracture : A case report]. Unfallchirurg 2021; 125:741-745. [PMID: 34643749 DOI: 10.1007/s00113-021-01088-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/27/2022]
Abstract
This case report describes the successful fixation of a periprosthetic patellar fracture in an 89-year-old female patient after total knee arthroplasty (TKA) and cemented retropatellar component. Fixation was performed by use of a fixed-angle plate combined with cerclage, under preservation of the firmly fixed retropatellar prosthetic component. No complications were observed postoperatively. Radiologic controls confirmed bone healing. A range of movement of the knee joint of 0/5/110° was achieved by the last clinical examination 5 years postoperatively. The patient was free of pain and had an age-appropriate mobility. The use of fixed-angle plates in the treatment of type II periprosthetic patellar fractures according to Ortiguera and Berry can provide stable fixation while preserving the retropatellar prosthetic component. Additional augmentation by cerclage, tapes or traction screws is recommended in cases of poor bone stock or severe osteoporosis.
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Zhang J, Wan S, Zhong Z, Zeng J, Wu C, Tan L, Lin X. [Comparative study on the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:994-999. [PMID: 34387428 DOI: 10.7507/1002-1892.202102065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To compare the effectiveness of improved and traditional Kirschner wire tension band fixation in treatment of type C patellar fractures. Methods Between January 2017 and January 2019, 26 patients with type C patellar fractures were treated with improved Kirschner wire tension band fixation (group A), and 24 patients were treated with traditional Kirschner wire tension band fixation (group B). There was no significant difference in gender, age, injury cause, disease duration, and side and type of fracture between 2 groups ( P>0.05). The operation time, intraoperative blood loss, the visual analogue scale (VAS) scores at 1 and 3 days after operation, the fracture healing time, and the occurrence of complications (skin irritation of Kirschner wires, failure of internal fixation, fracture reduction loss) were recorded, and the knee function was evaluated by Lysholm scoring standard in 2 groups. Results The operation time in group A was significantly less than that in group B ( t=-4.742, P=0.000). There was no significant difference in the intraoperative blood loss and VAS scores at 1 and 3 days after operation between 2 groups ( P>0.05). All incisions healed by first intention. All patients were followed up 8-15 months, with an average of 11 months. The fracture healing time was (3.3±0.6) months in group A and (3.2±0.6) months in group B, showing no significant difference ( t=0.589, P=0.559). At last follow-up, the knee joint function was evaluated according to Lysholm scoring standard. And there were 15 cases of excellent, 8 cases of good, and 3 cases of fair, with an excellent and good rate of 88.5% in group A; there were 8 cases of excellent, 7 cases of good, 7 cases of fair, and 2 cases of poor, with an excellent and good rate was 62.5%. The difference between 2 groups was significant ( Z=2.828, P=0.005). The internal fixators were removed after the fracture healed in 2 groups. At last follow-up, no skin irritation of Kirschner wires occurred in group A, but 3 cases in group B. X-ray films reexamination showed that 5 cases of internal fixation failure and no fracture reduction loss were found in group A, while 9 cases of internal fixation failure and 1 case of fracture reduction loss in group B. The incidence of complications in group A was 19.2% (5/26), which was significantly lower than that in group B (54.2%, 13/24) ( χ 2=6.611, P=0.010). Conclusion Compared with the traditional Kirschner wire tension band fixation, the improved Kirschner wire tension band fixation in treatment of type C patellar fracture can shorten the operation time, reduce the incidence of complications, and benefit the functional recovery of knee joint.
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Affiliation(s)
- Jian Zhang
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Shengyu Wan
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Zeli Zhong
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Jun Zeng
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Chao Wu
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Lun Tan
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
| | - Xu Lin
- No.1 Department of Orthopedics, Zigong No.4 People's Hospital, Zigong Sichuan, 643000, P.R.China
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20
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李 广, 刘 平. [Progress in the surgical treatment of the patellar fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1057-1062. [PMID: 34387438 PMCID: PMC8403998 DOI: 10.7507/1002-1892.202104068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To review research progress of surgical treatment of patellar fractures. METHODS The domestic and foreign literature about patellar fracture treatment in recent years was extensively consulted, and the advantages, disadvantages, and indications of various surgical treatments were summarized. RESULTS The patella plays an important role in knee flexion and extension activities, and the fracture significantly affects the patient's quality of life. At present, the surgical methods include open reduction and internal fixation and patella resection. The internal fixation methods include ring/binding patella fixation, tension band wiring and improved technology, tension band wiring combined with other methods, screw fixation (including absorbable screws), steel plate fixation, and patella fixator fixation. Each surgical method has different indications, advantages, and disadvantages. Choosing an appropriate treatment plan plays a crucial role in clinical prognosis. CONCLUSION There are many surgical treatments for patellar fractures. In order to improve the effectiveness and reduce postoperative complications, it is necessary to choose the most appropriate treatment strategy for the type of fracture.
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Affiliation(s)
- 广磊 李
- 华中科技大学同济医学院附属梨园医院骨科(武汉 430077)Department of Orthopedics, Liyuan Hospital Affiliated to Tongji Medical School of Huazhong University of Science and Technology, Wuhan Hubei, 430077, P.R.China
| | - 平 刘
- 华中科技大学同济医学院附属梨园医院骨科(武汉 430077)Department of Orthopedics, Liyuan Hospital Affiliated to Tongji Medical School of Huazhong University of Science and Technology, Wuhan Hubei, 430077, P.R.China
- 华中科技大学同济医学院附属梨园医院体检中心(武汉 430077)Physical Examination Center, Liyuan Hospital Affiliated to Tongji Medical School of Huazhong University of Science and Technology, Wuhan Hubei, 430077, P.R.China
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21
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Wang F, Xiong H, Long X, Li Y, Chen X, Wang G. A precise navigation device for fixation of patella fractures with modified K-wire tension band:a comparative retrospective study. J Orthop Surg Res 2021; 16:101. [PMID: 33526054 PMCID: PMC7851942 DOI: 10.1186/s13018-021-02235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Traditionally, the technique of modified tension band wires (MTBW) has been the most commonly used surgical procedure. The purpose of this study is to design a precise navigation device that can obtain a standard position of K-wires for (MTBW) and to compare the precise MTBW (P-MTBW) by a navigation device with the conventional MTBW (C-MTBW) by hands in a retrospective study. Methods The device was designed by solidworks2012 software (USA), which could provide a precise guidance for obtaining parallel K-wires. Besides, it could set the distance between two K-wires and the level of K-wires below patellar anterior surface. From June 2014 to August 2018, a total of 112 patients were employed in this retrospective study. The patients were divided into P-MTBW group and C-MTBW group according to the surgical technique with or without the precise navigation device. We needed to record and analyze the operation time and the number of fluoroscopy, postoperative internal fixation imaging, knee function and complications. Results There were 54 patients in P-MTBW group and 58 patients in C-MTBW group. There were statistically significant differences (P < 0.001) in the operation time between P-MTBW group (39.5 ± 4.7; range, 32–49 min) and C-MTBW group (53.7 ± 6.8; range, 42–71 min). The number of intraoperative fluoroscopy was significantly less (P < 0.001) in P-MTBW group (4.2 ± 1.4) versus that of C-MTBW group (8.3 ± 2.7). According to Iowa knee score, there was no significant difference (P = 0.268 at 1 year) in function between the two groups. According to our own evaluation criteria for MTBW, anyone in the P-MTBW group was excellent and 26 patients were excellent, 20 patients were good, and 2 patients were fair in the C-MTBW group. Conclusion The navigation device can reduce operation time and intraoperative fluoroscopy frequency. P-MTBW fixation is an accurate and effective surgical procedure for patella fractures.
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Affiliation(s)
- Fuming Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.,Department of Orthopaedics and Traumatology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Haolan Xiong
- Department of anesthesiology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Xiaotao Long
- Department of Orthopaedics and Traumatology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Yang Li
- Department of Orthopaedics and Traumatology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Xiaohua Chen
- Department of Orthopaedics and Traumatology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, People's Republic of China
| | - Gang Wang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
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Fehske K, Berninger MT, Alm L, Hoffmann R, Zellner J, Kösters C, Barzen S, Raschke MJ, Izadpanah K, Herbst E, Domnick C, Schüttrumpf JP, Krause M. [Current treatment standard for patella fractures in Germany]. Unfallchirurg 2020; 124:832-838. [PMID: 33331976 PMCID: PMC8460507 DOI: 10.1007/s00113-020-00939-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of patella fractures is technically demanding. Although the radiological results are mostly satisfactory, this often does not correspond to the subjective assessment of the patients. The classical treatment with tension band wiring with K‑wires has several complications. Fixed-angle plate osteosynthesis seems to be biomechanically advantageous. OBJECTIVE Who is treating patella fractures in Germany? What is the current standard of treatment? Have modern forms of osteosynthesis become established? What are the most important complications? MATERIAL AND METHODS The members of the German Society for Orthopedics and Trauma Surgery and the German Knee Society were asked to participate in an online survey. RESULTS A total of 511 completed questionnaires were evaluated. Most of the respondents are specialized in trauma surgery (51.5%), have many years of professional experience and work in trauma centers. Of the surgeons 50% treat ≤5 patella fractures annually. In almost 40% of the cases preoperative imaging is supplemented by computed tomography. The classical tension band wiring with K‑wires is still the preferred form of osteosynthesis for all types of fractures (transverse fractures 52%, comminuted fractures 40%). In the case of comminuted fractures 30% of the surgeons choose fixed-angle plate osteosynthesis. If the inferior pole is involved a McLaughlin cerclage is used for additional protection in 60% of the cases. DISCUSSION The standard of care for patella fractures in Germany largely corresponds to the updated S2e guidelines. Tension band wiring is still the treatment of choice. Further (long-term) clinical studies are needed to verify the advantages of fixed-angle plates.
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Affiliation(s)
- Kai Fehske
- Klinik und Poliklinik für Unfall‑, Hand‑, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
| | - Markus T Berninger
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Lena Alm
- Abteilung Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Unfallkrankenhaus Hamburg, Hamburg, Deutschland
| | | | - Johannes Zellner
- Klinik für Unfallchirurgie, Caritas-Krankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - Clemens Kösters
- Klinik für Orthopädie, Unfall- und Handchirurgie, Maria-Josef-Hospital Greven, Greven, Deutschland
| | - Stefan Barzen
- BG Unfallklinik Frankfurt am Main gGmbH, Frankfurt, Deutschland
| | - Michael J Raschke
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Kaywan Izadpanah
- Klinik für Orthopädie und Unfallchirurgie, Department für Chirurgie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - Elmar Herbst
- Klinik für Unfall‑, Hand und Wiederherstellungschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | | | | | - Matthias Krause
- Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
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23
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Pires RE, Giordano V, Boni G, Campos TVO, Lopes MTC, de Andrade MAP. Expanding the indications for calcaneal plates beyond foot fractures: a technical trick and case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:275-282. [PMID: 32809148 DOI: 10.1007/s00590-020-02757-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/01/2020] [Indexed: 11/30/2022]
Abstract
Although non-locking calcaneal plates are designed to treat calcaneal fractures, they present some interesting characteristics that justify using them beyond their current application in fractures of the foot. Calcaneal plates are malleable, have an increased footprint area for fracture containment or buttressing, and present several hole options for screw placement in different trajectories, thereby providing proper fixation even in comminuted fracture patterns. The aim of this study is to describe the unconventional use of calcaneal plates in the orthopaedic trauma scenario.
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Affiliation(s)
- Robinson E Pires
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil.
| | - Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Professor Nova Monteiro - Hospital Municipal Miguel Couto, Rio de Janeiro, RJ, Brazil
| | - Guilherme Boni
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Tulio Vinicius Oliveira Campos
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil.,Serviço de Ortopedia e Traumatologia. Hospital Metropolitano Célio de Castro, Belo Horizonte, MG, Brazil
| | - Marcos Tadeu Caires Lopes
- Serviço de Ortopedia e Traumatologia. Hospital Metropolitano Célio de Castro, Belo Horizonte, MG, Brazil
| | - Marco Antônio Percope de Andrade
- Departamento do Aparelho Locomotor, Universidade Federal de Minas Gerais, Av. Prof. Alfredo Balena, 190, Santa Efegênia, Belo Horizonte, MG, Brazil
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