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DOI: 10.1055/s-0042-1744267
Management of Comminuted Fractures of the Distal Pole of the Patella with Vertical Wire Loops: Case Report[*]
Artikel in mehreren Sprachen: español | English Funding The present study did not receive any type of institutional or private funding.
Abstract
Introduction Comminuted fractures of the distal pole of the patella represent a challenge for the knee surgeon, as there is no standard treatment that enables accelerated rehabilitation. Osteosynthesis and reattachment of the distal pole using vertical wire loops has recently been described.
Materials and Methods We herein present two cases of comminuted fracture of the distal pole of the patella resolved with vertical wire loops and modifications of this technique.
Results Osteosynthesis of the distal pole of the patella was performed, achieving a satisfactory radiographic reduction and enabling accelerated rehabilitation, with a progressive range of motion the day after the surgery. The patients achieved full range of motion two and three months after surgery. They progressed satisfactorily, without complications related to this technique and its variations, and were discharged four months after the reduction and osteosynthesis.
Discussion The traditional techniques for the management of distal pole fractures involve special considerations regarding rehabilitation and associated complications. The vertical wire loop technique was used in two patients: in one of them, it was supplemented with a Krackow suture; and, in the other, with a mini-fragment plate, which enabled accelerated rehabilitation and early return to work.
Conclusion The use of vertical wire loops appears to be a safe technique, which enables accelerated rehabilitation and early return to work.
Level of evidence: V.
* Study conducted at Hospital del Trabajador ACHS, Santiago, Región Metropolitana, Providencia.
Publikationsverlauf
Eingereicht: 10. August 2021
Angenommen: 18. Januar 2022
Artikel online veröffentlicht:
20. Mai 2022
© 2022. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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Referencias
- 1 Larsen P, Court-Brown CM, Vedel JO, Vistrup S, Elsoe R. Incidence and Epidemiology of Patellar Fractures. Orthopedics 2016; 39 (06) e1154-e1158
- 2 Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl 1972; 143: 1-80
- 3 Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg 2011; 19 (04) 198-207
- 4 Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma 2018; 32 (Suppl. 01) S1-S170
- 5 Matejcić A, Puljiz Z, Elabjer E, Bekavac-Bešlin M, Ledinsky M. Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy. Arch Orthop Trauma Surg 2008; 128 (04) 403-408
- 6 Oh H-K, Choo S-K, Kim J-W, Lee M. Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing. Injury 2015; 46 (12) 2512-2515
- 7 Chang S-M, Ji X-L. Open reduction and internal fixation of displaced patella inferior pole fractures with anterior tension band wiring through cannulated screws. J Orthop Trauma 2011; 25 (06) 366-370
- 8 Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect 1994; 43: 97-108
- 9 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 (09) 1279-1285
- 10 Yang KH, Byun YS. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. J Bone Joint Surg Br 2003; 85 (08) 1155-1160
- 11 Anand A, Kumar M, Kodikal G. Role of suture anchors in management of fractures of inferior pole of patella. Indian J Orthop 2010; 44 (03) 333-335
- 12 He QF, Pan GB, Yu ZF. et al. Novel Rim Plating Technique for Treatment of the Inferior Pole Fracture of the Patella. Orthop Surg 2021; 13 (02) 651-658
- 13 Veselko M, Kastelec M. Inferior Patellar Pole Avulsion Fractures: Osteosynthesis Compared with Pole Resection. JBJS Essent Surg Tech . 2005 ; os-87(1_suppl_1):113-121.
- 14 Kelly MA, Insall JN. Patellectomy. Orthop Clin North Am 1986; 17 (02) 289-295
- 15 Zhang X, Chen X, Jiang J. et al. [Current situation of surgical treatment of inferior polar fracture of patella]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi Zhongguo Xiufu Chongjian Waike Zazhi Chin J Reparative Reconstr Surg 2010; 24 (04) 492-495
- 16 Petermann J, Ishaque B, Ziring E, Gotzen L. External patellotibial transfixation: indications, operative technique and outcome. Knee 2001; 8 (02) 111-121
- 17 Galla M, Lobenhoffer P. [Patella fractures]. Chir Z Alle Geb Oper Medizen . 2005 ; 76(10):987-997; quiz 998-999.
- 18 Henrichsen JL, Wilhem SK, Siljander MP, Kalma JJ, Karadsheh MS. Treatment of Patella Fractures. Orthopedics 2018; 41 (06) e747-e755
- 19 Buezo O, Cuscó X, Seijas R. et al. Patellar Fractures: An Innovative Surgical Technique With Transosseous Suture to Avoid Implant Removal. Surg Innov 2015; 22 (05) 474-478
- 20 Chang C-H, Chuang H-C, Su W-R, Kuan F-C, Hong C-K, Hsu K-L. Fracture of the inferior pole of the patella: tension band wiring versus transosseous reattachment. J Orthop Surg Res 2021; 16 (01) 365-372
- 21 Patel VR, Parks BG, Wang Y, Ebert FR, Jinnah RH. Fixation of patella fractures with braided polyester suture: a biomechanical study. Injury 2000; 31 (01) 1-6
- 22 Song HK, Yoo JH, Byun YS, Yang KH. Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella. Yonsei Med J 2014; 55 (03) 785-791
- 23 Kang NV, Pendegrass C, Marks L, Blunn G. Osseocutaneous integration of an intraosseous transcutaneous amputation prosthesis implant used for reconstruction of a transhumeral amputee: case report. J Hand Surg Am 2010; 35 (07) 1130-1134
- 24 Cho J-W, Kim J, Cho W-T, Gujjar PH, Oh C-W, Oh J-K. Comminuted inferior pole fracture of patella can be successfully treated with rim-plate-augmented separate vertical wiring. Arch Orthop Trauma Surg 2018; 138 (02) 195-202
- 25 Krkovic M, Bombac D, Balazic M. et al. Modified pre-curved patellar basket plate, reconstruction of the proper length and position of the patellar ligament–a biomechanical analysis. Knee 2007; 14 (03) 188-193
- 26 Matejčić A, Ivica M, Jurišić D, Ćuti T, Bakota B, Vidović D. Internal fixation of patellar apex fractures with the basket plate: 25 years of experience. Injury 2015; 46 (Suppl. 06) S87-S90