- •
The patella is a crucial component of the extensor mechanism.
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Modern surgical techniques provide good results with proper indications.
- •
Management of patella fractures depends on the fracture morphology.
- •
Symptomatic implants often lead to additional surgery.
- •
New techniques aim to reduce implant complications.
Surgical Management of Patellar Fractures
Section snippets
Key points
Introduction: nature of the problem
The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Forces up to 5 times the body weight have been recorded from the extensor mechanism; the patella displaces the quadriceps tendon-patellar tendon link away from the axis of knee rotation, effectively increasing the moment arm of the quadriceps.1, 2
Every year, roughly 1 in every 100 fractures will involve the patella.3 Fractures can be classified based on displacement, comminution,
Indications/contraindications
Indications for treatment of patellar fractures are largely determined by the type of fracture encountered. However, the goals of treatment remain the same: (1) restoration of the extensor mechanism and (2) maintenance of a congruous articular surface. Thus, the literature often has focused on treatment type rather than fracture type.
Surgical Indications
Indications for surgery include open fracture, articular step of 2 mm or greater, and loss of knee extension (Fig. 1). Comminuted stellate fractures typically present with intact retinaculum; however, because of the articular incongruity, surgical intervention may be recommended (Fig. 2). Highly comminuted and displaced fractures can present as transverse fractures with massive comminution or stellate fractures with massive diastasis. These injuries are often open.
Preoperative Planning
Standard radiographic views
Summary
- 1.
The patella is a crucial component of the extensor mechanism.
- 2.
Modern surgical techniques provide good results with proper indications.
- 3.
Management of patella fractures depends on the fracture morphology.
- 4.
Symptomatic implants often lead to additional surgery.
- 5.
New techniques aim to reduce implant complications.
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Cited by (60)
Metal vs non-metal fixation methods for patellar fractures: A systematic review and meta-analysis of clinical and radiographic outcomes
2023, Journal of Clinical Orthopaedics and TraumaDoes pin configuration matter in modified tension band wiring for transverse patellar fracture? A biomechanical study
2022, KneeCitation Excerpt :As a result of successful outcomes and high union rates, modified anterior tension band has become a standard procedure in the treatment of transverse patellar fractures. Over time, there has been an evolution in the types of implants used in the technique such as lag screws and suture materials, with the aim of improving the stability of the construct and decreasing soft tissue irritation [3–7]. The tension band construct should stabilize the fracture and enhance bone healing in an environment of large distraction forces during postoperative rehabilitation.
Concentrations of co-administered vancomycin and meropenem in the internal dead space of a cannulated screw and in cancellous bone adjacent to the screw – Evaluated by microdialysis in a porcine model
2022, InjuryCitation Excerpt :Multiple studies have found that a combination of vancomycin and meropenem as first-line empiric antibiotics in open lower extremity fractures covers up to 93–96% of the encountered bacteria leading to infection, most commonly being Staphylococcus aureus, Enterococcus spp., Pseudomonas aeruginosa, Enterobacter species, and coagulase-negative staphylococci (CoNS) [5–8]. When managing open lower extremity fractures requiring absolute stability, cannulated screws are often used for fracture stabilization [9,10]. In the context of open fractures, it is important to provide the best possible protection of the screws from being colonized with bacteria, when inserted into a potential contaminated field.
Treatment of patellar fractures using bioresorbable forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide cannulated screws and nonabsorbable sutures
2021, InjuryCitation Excerpt :Although many fixation methods have been previously described, the modified tension-band wiring method using Kirshner wires (K-wires) and stainless-steel wires is the most widely performed [4]. On the other hand, multiple cannulated screws and supplemental wiring also have been used for fixation of patellar fractures [5]. Forged composites of raw particulate unsintered hydroxyapatite/poly-L-lactide (F-u-HA/PLLA) implants are highly suitable for use in bone fixation because of their bioactivity, bioabsorbability, and conservation of high mechanical strength [6,7].
Disclosures: No disclosures (R. Kakazu); Consultant: Stryker; Speaker: AO North America, Stryker; Royalties: Stryker, Slack, Inc (M.T. Archdeacon).
Funding Source: None.