RSS-Feed abonnieren
DOI: 10.1055/s-0033-1353988
Displaced Patella Fractures
Publikationsverlauf
01. Juli 2013
08. Juli 2013
Publikationsdatum:
21. August 2013 (online)
![](https://www.thieme-connect.de/media/jks/201305/lookinside/thumbnails/10.1055-s-0033-1353988-1.jpg)
Abstract
Displaced patella fractures often result in disruption of the extensor mechanism of the knee. An intact extensor mechanism is a requirement for unassisted gait. Therefore, operative treatment of the displaced patella fracture is generally recommended. The evaluation of the patella fracture patient includes examination of extensor mechanism integrity. Operative management of patella fractures normally includes open reduction with internal fixation, although partial patellectomy is occasionally performed, with advancement of quadriceps tendon or patellar ligament to the fracture bed. Open reduction with internal fixation has historically been performed utilizing anterior tension band wiring, although comminution of the fracture occasionally makes this fixation construct inadequate. Supplementation or replacement of the tension band wire construct with interfragmentary screws, cerclage wire or suture, and/or plate-and-screw constructs may add to the stability of the fixation construct. Arthrosis of the patellofemoral joint is very common after healing of patella fractures, and substantial functional deficits may persist long after fracture healing has occurred.
-
References
- 1 Stinner DJ, Orr JD, Hsu JR. Fluoroquinolone-associated bilateral patellar tendon rupture: a case report and review of the literature. Mil Med 2010; 175 (6) 457-459
- 2 Piva SR, Childs JD, Klucinec BM, Irrgang JJ, Almeida GJ, Fitzgerald GK. Patella fracture during rehabilitation after bone-patellar tendon-bone anterior cruciate ligament reconstruction: 2 case reports. J Orthop Sports Phys Ther 2009; 39 (4) 278-286
- 3 Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. J Bone Joint Surg Am 1993; 75: 1550-1561
- 4 Mounasamy V, Chadderdon RC, McDaniel C, Willis Jr MC. Bilateral synchronous quadriceps tendon rupture: a case report. Eur J Orthop Surg Traumatol 2008; 18: 63-67
- 5 Nord RM, Quach T, Walsh M, Pereira D, Tejwani NC. Detection of traumatic arthrotomy of the knee using the saline solution load test. J Bone Joint Surg Am 2009; 91 (1) 66-70
- 6 Konda SR, Howard D, Davidovitch RI, Egol KA. The saline load test of the knee redefined: a test to detect traumatic arthrotomies and rule-out periarticular wounds not requiring surgical intervention. J Orthop Trauma 2013; (e-pub ahead of print); doi: 10.1097/BOT.0b013e31828211f3
- 7 Metzger P, Carney J, Kuhn K, Booher K, Mazurek M. Sensitivity of the saline load test with and without methylene blue dye in the diagnosis of artificial traumatic knee arthrotomies. J Orthop Trauma 2012; 26 (6) 347-349
- 8 Konda SR, Davidovitch RI, Egol KA. Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: an improvement over the saline load test. J Orthop Trauma 2013; (e-pub ahead of print); doi: 10.1097/BOT.0b013e31828219bc
- 9 Lazaro LE, Wellman DS, Pardee NC , et al. Effect of computerized tomography on classification and treatment plan for patellar fractures. J Orthop Trauma 2013; 27 (6) 336-344
- 10 Pritchett JW. Nonoperative treatment of widely displaced patella fractures. Am J Knee Surg 1997; 10 (3) 145-147 , discussion 147–148
- 11 Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg 2011; 19 (4) 198-207
- 12 Eggink KM, Jaarsma RL. Mid-term (2-8 years) follow-up of open reduction and internal fixation of patella fractures: does the surgical technique influence the outcome?. Arch Orthop Trauma Surg 2011; 131 (3) 399-404
- 13 Weber MJ, Janecki CJ, McLeod P, Nelson CL, Thompson JA. Efficacy of various forms of fixation of transverse fractures of the patella. J Bone Joint Surg Am 1980; 62 (2) 215-220
- 14 Levack B, Flannagan JP, Hobbs S. Results of surgical treatment of patellar fractures. J Bone Joint Surg Br 1985; 67 (3) 416-419
- 15 Wu CC, Tai CL, Chen WJ. Patellar tension band wiring: a revised technique. Arch Orthop Trauma Surg 2001; 121 (1-2) 12-16
- 16 Miller MA, Liu W, Zurakowski D, Smith RM, Harris MB, Vrahas MS. Factors predicting failure of patella fixation. J Trauma Acute Care Surg 2012; 72 (4) 1051-1055
- 17 Lefaivre KA, O'Brien PJ, Broekhuyse HM, Guy P, Blachut PA. Modified tension band technique for patella fractures. Orthop Traumatol Surg Res 2010; 96 (5) 579-582
- 18 Carpenter JE, Kasman RA, Patel N, Lee ML, Goldstein SA. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma 1997; 11 (5) 351-356
- 19 Berg EE. Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws. J Orthop Trauma 1997; 11 (8) 573-576
- 20 Chang SM, Ji XL. Open reduction and internal fixation of displaced patella inferior pole fractures with anterior tension band wiring through cannulated screws. J Orthop Trauma 2011; 25 (6) 366-370
- 21 Hoshino CM, Tran W, Tiberi JV , et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg Am 2013; 95 (7) 653-659
- 22 McGreal G, Reidy D, Joy A, Mahalingam K, Cashman WF. The biomechanical evaluation of polyester as a tension band for the internal fixation of patellar fractures. J Med Eng Technol 1999; 23 (2) 53-56
- 23 Patel VR, Parks BG, Wang Y, Ebert FR, Jinnah RH. Fixation of patella fractures with braided polyester suture: a biomechanical study. Injury 2000; 31 (1) 1-6
- 24 Gosal HS, Singh P, Field RE. Clinical experience of patellar fracture fixation using metal wire or non-absorbable polyester—a study of 37 cases. Injury 2001; 32 (2) 129-135
- 25 Chatakondu SC, Abhaykumar S, Elliott DS. The use of non-absorbable suture in the fixation of patellar fractures: a preliminary report. Injury 1998; 29 (1) 23-27
- 26 Gardner MJ, Griffith MH, Lawrence BD, Lorich DG. Complete exposure of the articular surface for fixation of patellar fractures. J Orthop Trauma 2005; 19 (2) 118-123
- 27 Wild M, Thelen S, Jungbluth P , et al. Fixed-angle plates in patella fractures - a pilot cadaver study. Eur J Med Res 2011; 16 (1) 41-46
- 28 Thelen S, Schneppendahl J, Jopen E , et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury 2012; 43 (8) 1290-1295
- 29 Fortis AP, Milis Z, Kostopoulos V , et al. Experimental investigation of the tension band in fractures of the patella. Injury 2002; 33 (6) 489-493
- 30 Saltzman CL, Goulet JA, McClellan RT, Schneider LA, Matthews LS. Results of treatment of displaced patellar fractures by partial patellectomy. J Bone Joint Surg Am 1990; 72 (9) 1279-1285
- 31 Marder RA, Swanson TV, Sharkey NA, Duwelius PJ. Effects of partial patellectomy and reattachment of the patellar tendon on patellofemoral contact areas and pressures. J Bone Joint Surg Am 1993; 75 (1) 35-45
- 32 Sutton Jr FS, Thompson CH, Lipke J, Kettelkamp DB. The effect of patellectomy on knee function. J Bone Joint Surg Am 1976; 58 (4) 537-540
- 33 Lennox IA, Cobb AG, Knowles J, Bentley G. Knee function after patellectomy. A 12- to 48-year follow-up. J Bone Joint Surg Br 1994; 76 (3) 485-487
- 34 Günal I, Taymaz A, Köse N, Göktürk E, Seber S. Patellectomy with vastus medialis obliquus advancement for comminuted patellar fractures: a prospective randomised trial. J Bone Joint Surg Br 1997; 79 (1) 13-16
- 35 LeBrun CT, Langford JR, Sagi HC. Functional outcomes after operatively treated patella fractures. J Orthop Trauma 2012; 26 (7) 422-426
- 36 Tejwani NC, Lekic N, Bechtel C, Montero N, Egol KA. Outcomes after knee joint extensor mechanism disruptions: is it better to fracture the patella or rupture the tendon?. J Orthop Trauma 2012; 26 (11) 648-651
- 37 Sorensen KH. The late prognosis after fracture of the patella. Acta Orthop Scand 1964; 34: 198-212
- 38 Edwards B, Johnell O, Redlund-Johnell I. Patellar fractures. A 30-year follow-up. Acta Orthop Scand 1989; 60 (6) 712-714