Frakturversorgung der Patella

Zusammenfassung

Die Therapie für Patellafrakturen wird in Abhängigkeit von Klinik und radiologischer Diagnostik gestellt. Frakturen mit einer Gelenkstufe kleiner als 2 mm und erhaltener Streckfähigkeit des Kniegelenkes können konservativ behandelt werden. Die Zuggurtungsosteosynthese stellt eine Standardversorgung dislozierter Querfrakturen dar. Limitationen sind in der unzureichenden Stabilisierung von Mehrfragmentfrakturen sowie der hohen Komplikationsrate zu sehen. Die Schraubenosteosynthese mit mindestens zwei Schrauben ist eine Alternative für Querfrakturen mit niedriger Komplikationsrate. Die Kombination aus kanülierten Schrauben mit additiver Zuggurtung durch die Schrauben vereint die Vorteile beider Verfahren. Trotz der höheren Stabilität bleibt die Versorgung von Mehrfragmentfrakturen eingeschränkt. Moderne winkelstabile Platten ermöglichen durch ihre multiplen Schraubenlöcher eine Versorgung von Mehrfragmentfrakturen. Aufgrund ihrer hohen Stabilität ist eine sofortige Vollbelastung möglich. Erste klinische Ergebnisse sind vielversprechend.

Abstract

The treatment for patella fractures is based on the clinical examination and radiological diagnostic. Fractures with a fracture gap smaller than 2mm and obtained extension capability are treated non-operatively. Tension band wiring is a standard treatment for dislocated transverse fractures. Limitations of this treatment are a stable fixation of comminuted fractures and high complication rates. Screw osteosynthesis is an alternative for transverse patella fractures with lower complications rates. Cannulated screws with an additional tension band wiring are combining the benefits of both treatments. Nonetheless, the treatment of comminuted fractures is limited. Modern locking plates allows a stable fixation of comminuted fractured due to its multiple screw holes. An immediate full-weight bearing is allowed due to its high stability. Clinical results are promising.

Schlüsselwörter

winkelstabile Plattenosteosynthese - Zuggurtung - kanülierte Schrauben - konservativ

Key words

locking plate ostesynthesis - tension band wiring - cannulated screws - non-operative

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