Download PDF
CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2022; 63(03): e171-e177
DOI: 10.1055/s-0042-1750695
Artículo Original | Original Article

Uso de placa malla en el manejo de fracturas conminutas de patela: Reporte de caso

Article in several languages: español | English
Nicolás Franulic 
1   Equipo de Rodilla, Hospital del Trabajador ACHS, Santiago, Chile
2   Equipo de Rodilla, Hospital Militar de Santiago, Santiago, Chile
,
José Ignacio Laso 
1   Equipo de Rodilla, Hospital del Trabajador ACHS, Santiago, Chile
3   Equipo de Rodilla, Hospital Barros Luco Trudeau, Santiago, Chile
,
Carlos Rojas 
1   Equipo de Rodilla, Hospital del Trabajador ACHS, Santiago, Chile
,
Rodrigo Olivieri 
1   Equipo de Rodilla, Hospital del Trabajador ACHS, Santiago, Chile
,
Nicolás Gaggero 
1   Equipo de Rodilla, Hospital del Trabajador ACHS, Santiago, Chile
4   Equipo de Rodilla, Clínica Las Condes, Santiago, Chile
› Author Affiliations Finaciamiento Los autores declaran que este estudio no recibió ningún tipo de financiamiento institucional ni particular.
› Further Information
Also available at
   Permissions and Reprints

Resumen

Objetivos Describir la técnica quirúrgica para el uso de placa malla en un caso de fractura conminuta de patela y sus resultados en el seguimiento a mediano plazo.

Materiales y Métodos Presentamos un caso de fractura conminuta de patela manejada con el uso de una placa malla y un tornillo canulado asociado, evitando de esta forma la patelectomía parcial y sus posibles complicaciones.

Resultados El paciente presentó una evolución satisfactoria, con rango de movimiento de rodilla completo y en condiciones de alta laboral a los cuatro meses desde la cirugía, sin complicaciones ni reintervenciones.

Discusión El uso de placas malla permite el manejo de fracturas conminutas de patela preservando stock óseo y restaurando la indemnidad del aparato extensor, con una osteosíntesis estable y poco prominente. Casos en que antiguamente la única alternativa era la patelectomía parcial y reinserción del tendón patelar ahora tienen etas placas como opción de manejo.

Conclusión El uso de placas malla en fracturas conminutas de patela es una alternativa atractiva por la estabilidad que brindan, la capacidad de preservar stock óseo, y la baja tasa de reintervenciones.

Nivel de evidencia V.

Palabras Clave

patela - fractura conminuta - placa malla - fractura patelar difícil


Publication History

Received: 09 August 2021

Accepted: 17 May 2022

Article published online:
28 December 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/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referencias

  • 1 Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg 2011; 19 (04) 198-207
    CrossrefPubMedGoogle Scholar
  • 2 Tornetta P. Rockwood and Green's fractures in adults [Internet]. 2020 [citado 23 de junio de 2021]. Disponible en: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=booktext&D=books3&AN=02112923/9th_Edition
    PubMedGoogle Scholar
  • 3 Larsen P, Court-Brown CM, Vedel JO, Vistrup S, Elsoe R. Incidence and Epidemiology of Patellar Fractures. Orthopedics 2016; 39 (06) e1154-e1158
    CrossrefPubMedGoogle Scholar
  • 4 Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury 1981; 13 (03) 196-202
    CrossrefPubMedGoogle Scholar
  • 5 Moore TB, Sampathi BR, Zamorano DP, Tynan MC, Scolaro JA. Fixed angle plate fixation of comminuted patellar fractures. Injury 2018; 49 (06) 1203-1207
    CrossrefPubMedGoogle Scholar
  • 6 Macausland WR. Total patellectomy: report of twenty-eight cases. Am J Surg 1953; 87 (02) 221-226
    CrossrefPubMedGoogle Scholar
  • 7 Khermosh O, Weissman SL. Total patellectomy in fractures of the patella. Isr J Med Sci 1973; 9 (01) 67-70
    PubMedGoogle Scholar
  • 8 Pandey AK, Pandey S, Pandey P. Results of partial patellectomy. Arch Orthop Trauma Surg 1991; 110 (05) 246-249
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Carpenter J, Kasman R, Matthews L. Fractures of the Patella. J Bone Joint Surg 1993; 75 (10) 1550-1561
    CrossrefPubMedGoogle Scholar
  • 11 Sutton Jr FS, Thompson CH, Lipke J, Kettelkamp DB. The effect of patellectomy on knee function. J Bone Joint Surg Am 1976; 58 (04) 537-540
    CrossrefPubMedGoogle Scholar
  • 12 Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl 1972; 143: 1-80
    CrossrefPubMedGoogle Scholar
  • 13 Lee B-J, Chon J, Yoon J-Y, Jung D. Modified Tension Band Wiring Using FiberWire for Patellar Fractures. Clin Orthop Surg 2019; 11 (02) 244-248
    CrossrefPubMedGoogle Scholar
  • 14 Agarwala S, Agrawal P, Sobti A. A novel technique of patella fracture fixation facilitating early mobilization and reducing re-operation rates. J Clin Orthop Trauma 2015; 6 (03) 207-211
    CrossrefPubMedGoogle Scholar
  • 15 Yang L, Yueping O, Wen Y. Management of displaced comminuted patellar fracture with titanium cable cerclage. Knee 2010; 17 (04) 283-286
    CrossrefPubMedGoogle Scholar
  • 16 Sun Y, Sheng K, Li Q, Wang D, Zhou D. Management of comminuted patellar fracture fixation using modified cerclage wiring. J Orthop Surg Res 2019; 14 (01) 324-331
    CrossrefPubMedGoogle Scholar
  • 17 Chen M, Jin X, Fryhofer GW. et al. The application of the Nice knots as an auxiliary reduction technique in displaced comminuted patellar fractures. Injury 2020; 51 (02) 466-472
    CrossrefPubMedGoogle Scholar
  • 18 Zhai Q, Yang J, Zhuang J, Gao R, Chen M. Percutaneous cerclage wiring for type 34-C patella fracture in geriatric patients. Injury 2020; 51 (06) 1362-1366
    CrossrefPubMedGoogle Scholar
  • 19 Lue TH, Feng LW, Jun WM, Yin LW. Management of comminuted patellar fracture with non-absorbable suture cerclage and Nitinol patellar concentrator. Injury 2014; 45 (12) 1974-1979
    CrossrefPubMedGoogle Scholar
  • 20 Zhao QM, Yang HL, Wang L, Liu ZT, Gu XF. Treatment of comminuted patellar fracture with the nitinol patellar concentrator. Minim Invasive Ther Allied Technol 2016; 25 (03) 171-175
    CrossrefPubMedGoogle Scholar
  • 21 Yao C, Sun J, Wu J. et al. Clinical outcomes of Ti-Ni shape-memory patella concentrator combined with cannulated compression screws in the treatment of C2 and C3 patella fracture: a retrospective study of 54 cases. BMC Musculoskelet Disord 2020; 21 (01) 506-513
    CrossrefPubMedGoogle Scholar
  • 22 Wild M, Fischer K, Hilsenbeck F, Hakimi M, Betsch M. Treating patella fractures with a fixed-angle patella plate-A prospective observational study. Injury 2016; 47 (08) 1737-1743
    CrossrefPubMedGoogle Scholar
  • 23 Ellwein A, Lill H, Jensen G, Gruner A, Katthagen JC. Plate osteosynthesis after patellar fracture – the technique and initial results of a prospective study. Unfallchirurg 2017; 120 (09) 753-760
    CrossrefPubMedGoogle Scholar
  • 24 Wurm S, Bühren V, Augat P. Treating patella fractures with a locking patella plate - first clinical results. Injury 2018; 49 (Suppl. 01) S51-S55
    CrossrefPubMedGoogle Scholar
  • 25 Cho J-W, Kent WT, Cho W-T. et al. Miniplate Augmented Tension-Band Wiring for Comminuted Patella Fractures. J Orthop Trauma 2019; 33 (04) e143-e150
    CrossrefPubMedGoogle Scholar
  • 26 Blum L, Hake M. ORIF Patella Fracture With a Tension Band Construct. J Orthop Trauma 2017; 31 (Suppl. 03) S8-S9
    CrossrefPubMedGoogle Scholar
  • 27 Tan H, Dai P, Yuan Y. Clinical results of treatment using a modified K-wire tension band versus a cannulated screw tension band in transverse patella fractures: A strobe-compliant retrospective observational study. Medicine (Baltimore) 2016; 95 (40) e4992
    CrossrefPubMedGoogle Scholar
  • 28 Vajapey S, Santiago J, Contreras E, Quatman CE, Phieffer LS. Contourable craniofacial mesh plate osteosynthesis of patellar fractures: A new, low-profile fixation technique. J Clin Orthop Trauma 2019; 10 (Suppl. 01) S201-S206
    CrossrefPubMedGoogle Scholar
  • 29 Rajagopalakrishnan R, Soraganvi P, Douraiswami B, Velmurugesan P, Muthukumar S. “Is articular cartilage reconstruction feasible in OTA-C2, C3 comminuted patellar fractures?”. A prospective study of methodical reduction and fixation Journal Arthrosc Joint Surg 2016; 3 (02) 66-70
    PubMedGoogle Scholar
  • 30 Thelen S, Betsch M, Schneppendahl J. et al. Fixation of multifragmentary patella fractures using a bilateral fixed-angle plate. Orthopedics 2013; 36 (11) e1437-e1443
    CrossrefPubMedGoogle Scholar
  • 31 Wagner FC, Neumann MV, Wolf S. et al. Biomechanical comparison of a 3.5  mm anterior locking plate to cannulated screws with anterior tension band wiring in comminuted patellar fractures. Injury 2020; 51 (06) 1281-1287
    CrossrefPubMedGoogle Scholar
  • 32 Müller EC, Frosch K-H. Plattenosteosynthese bei Patellafrakturen. Oper Orthop Traumatol 2017; 29 (06) 509-519
    CrossrefPubMedGoogle Scholar
  • 33 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
    CrossrefPubMedGoogle Scholar
  • 34 Dickens AJ, Salas C, Rise L. et al. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury 2015; 46 (06) 1001-1006
    CrossrefPubMedGoogle Scholar
  • 35 Volgas D, Dreger TK. The Use of Mesh Plates for Difficult Fractures of the Patella. J Knee Surg 2017; 30 (03) 200-203
    Article in Thieme ConnectPubMedGoogle Scholar
  • 36 Singer MS, Halawa AM, Adawy A. Outcome of low profile mesh plate in management of comminuted displaced fracture patella. Injury 2017; 48 (06) 1229-1235
    CrossrefPubMedGoogle Scholar
  • 37 Siljander M, Vara AD, Koueiter DM. et al. Plate Osteosynthesis of Patella Fractures-A Video Case Report. J Orthop Trauma 2017; 31 (Suppl. 03) S26-S27
    CrossrefPubMedGoogle Scholar
  • 38 Siljander M, Koueiter DM, Gandhi S, Wiater BP, Wiater PJ. Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures. J Knee Surg 2018; 31 (09) 919-926
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Lorich DG, Warner SJ, Schottel PC, Shaffer AD, Lazaro LE, Helfet DL. Multiplanar Fixation for Patella Fractures Using a Low-Profile Mesh Plate. J Orthop Trauma 2015; 29 (12) e504-e510
    CrossrefPubMedGoogle Scholar
  • 40 Wurm S, Augat P, Bühren V. Biomechanical Assessment of Locked Plating for the Fixation of Patella Fractures. J Orthop Trauma 2015; 29 (09) e305-e308
    CrossrefPubMedGoogle Scholar
  • 41 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 (08) 1290-1295
    CrossrefPubMedGoogle Scholar
  • 42 Wild M, Eichler C, Thelen S, Jungbluth P, Windolf J, Hakimi M. Fixed-angle plate osteosynthesis of the patella - an alternative to tension wiring?. Clin Biomech (Bristol, Avon) 2010; 25 (04) 341-347
    CrossrefPubMedGoogle Scholar
  • 43 Yoon Y-C, Sim J-A, Hong J-H. Surgery of patellar fractures using a medial parapatellar approach. J Orthop Surg (Hong Kong) 2017; 25 (02) 2309499017719378
    CrossrefPubMedGoogle Scholar
  • 44 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 (07) 653-659
    CrossrefPubMedGoogle Scholar
  • 45 Lazaro LE, Wellman DS, Sauro G. et al. Outcomes after operative fixation of complete articular patellar fractures: assessment of functional impairment. J Bone Joint Surg Am 2013; 95 (14) e96 , 1–8
    CrossrefPubMedGoogle Scholar