Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report

Matthews, Brent; Hazratwala, Kaushik; Rosa, Sergio Barroso

doi:10.1177/2151458517710517

Cited by 30 publications

(30 citation statements)

References 30 publications

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“…Surgical is a common method for the treatment of displaced patella fracture, of which tension band fixation is the current treatment standard [ 14 ]. However, due to the complexity of patella fracture, there is no consistent conclusion on the best clinical treatment scheme at present.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Therapeutic Effects of Tension Band with Cannulated Screw and Tension Band with Kirschner Wire on Patella Fracture

Liu¹,

Ren

ChunYan³

et al. 2020

Computational and Mathematical Methods in Medicine

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Background. Patella fracture accounts for 1% of bone injury, of which anatomical reduction is of great significance to the recovery. Tension band with cannulated screw and Kirschner wire is commonly used methods for the treatment of displaced patella fracture. However, there is still some controversy on the clinical efficacy of the two treatment methods. Objective. This study aimed at comparing the therapeutic effects of the cannulated screw and Kirschner wire tension bands on patella fracture and at providing more data basis for clinical selection of treatment methods for patella fracture. Methods. Altogether, 146 patients with displaced patella fracture admitted to our hospital from March 2016 to February 2018 were selected and divided into two groups according to the different treatment methods. Among them, 71 patients received tension band with a cannulated screw (TBWCS group) and 75 patients received tension band with Kirschner wire (TBWKW group). Two groups of patients were compared in terms of surgical treatment effect after one year of treatment, complications within six months after the operation and operation-related indexes. The pain visual analogue scale (VAS) score, knee flexion degree, Lysholm score, and Bostman score were recorded at 1, 3, 6, and 12 months after operation, and the activity of daily living scale (ADL) score was evaluated at the last follow-up. Results. During the operation of patella fracture patients, the intraoperative blood loss, hospitalization time, and knee flexion loss of patients in TBWCS group were less than those in the TBWKW group (P<0.05), the starting time of postoperative functional exercise was earlier than that of patients in TBWKW group (P<0.05), and the incidence rate of secondary operation was lower than that of patients in the TBWKW group (P<0.05), but there was no statistical difference in the operation time, incision length, and postoperative fracture gap between the two groups. The results of curative effect analysis showed that the knee flexion, Lysholm score, and Bostman score of patients treated with tension band with cannulated screw were higher than those treated with Kirschner wire (P<0.05), and VAS score was lower. Tension band with cannulated screw had a better curative effect on patella fracture (P<0.05), lower complication rate (P<0.05), and higher quality of life of patients (P<0.05). Conclusion. Tension band with cannulated screw has a good curative effect on patella fracture, low incidence of complications, early start of postoperative functional exercise, and high quality of life.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Therapeutic Effects of Tension Band with Cannulated Screw and Tension Band with Kirschner Wire on Patella Fracture

Liu¹,

Ren

ChunYan³

et al. 2020

Computational and Mathematical Methods in Medicine

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“…Patella fractures account for approximately 1% of all skeletal fractures (1). Multi-fragmentary patella fractures (MFPFs) are common patella fracture type, but restoration of patellofemoral joint congruity and maintenance of stable fixation allowing for early postoperative rehabilitation remain challenging (2,3). Tension band wiring has been widely used in the treatment of patella fractures, however, it is associated with poor functional outcome and surgical complications, including a high rate of implant removal (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

“…Multi-fragmentary patella fractures (MFPFs) are common patella fracture type, but restoration of patellofemoral joint congruity and maintenance of stable fixation allowing for early postoperative rehabilitation remain challenging (2,3). Tension band wiring has been widely used in the treatment of patella fractures, however, it is associated with poor functional outcome and surgical complications, including a high rate of implant removal (3)(4)(5). Recently, a number of studies demonstrated that low-profile plating could fix patella fractures rigorously and improve postoperative knee function, particularly in comminuted patella fracture patterns (6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

Three-dimensional fracture mapping of multi-fragmentary patella fractures (AO/OTA 34C3)

Zhan¹,

Zhang²,

Xie³

et al. 2021

Ann Transl Med

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Background: Multi-fragmentary patella fractures (MFPFs) are common patella fracture type. Low-profile plate fixation seems to be promising advancement in the treatment of such difficult fractures. There is no systematic morphologic study specifically for MFPFs to provide objective reference for the improvement of future implants and biomechanical models. This study aimed to delineate and quantify the location and spatial frequency of fracture lines, comminution zones, and coronal plane fragments in MFPFs using threedimensional (3D) CT mapping technique.Methods: A total of 187 MFPFs were retrospectively reviewed and analyzed. Fractures were digitally reconstructed from CT data, and fracture lines, comminution zones, and coronal fragments were graphically overlaid onto a 3D patella template. Fracture characteristics were summarized qualitatively based on the fracture maps and quantitatively on the counts and volume of each fragment. Furthermore, according to the classic fracture patterns concerning MFPFs, subgroup analysis was conducted.Results: On average, we observed 7 fragments in each fracture, 3 of which were <1 cm 3 . Most fractures (81.2%) had coronal fragments on the anterior and/or posterior patella surfaces. We identified three classic patella fracture patterns: transverse with comminution, stellate, and "displaced comminuted" in 104, 54, and 29 knees, respectively. 3D maps demonstrated distinct distribution fracture patterns of fracture lines, comminution zones, and coronal fragments.Conclusions: Supero-medial corner of the patella was seldomly involved, and might be used as the cornerstone for fixation. Coronal fragments were common on both anterior and posterior patella surfaces, justifying the application of anterior plate osteosynthesis characterized by multi-planar fixation.Comminution areas mainly concentrated in the lower half of the patella, potentially suitable for an implant in combination with sutures or circumferential cerclage wiring. The described 3D features of MFPFs could provide reference for the design of future implants and biomechanical models.

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“…However in types 34C2-C3 the more complex and comminuted fractures of patella with gap of 3mm or more lack the adequate strength to support TBW resulting in the failure of fixation prior to bone union. Additionally, since the fracture is on the rise in the older population due to trivial fall the osteopenic bone does not support the tension band wiring alone [16] . This poor bone quality and lack of rigid fixation in 34C2-C3 type fractures has an effect on the range of motion which is restricted and delayed physiotherapy and also it was observed that there was guarded post op exercises to prevent loss of reduction.…”

Section: Discussionmentioning

confidence: 99%

“…The combination of TBW with augmentation plate works wonders as it uses the principles of TBW to its advantage and eliminates the disadvantages which are taken care of by the plate. The construct allows stable fixation, allows fixation in all planes, rigid stabilization, osseous union of the comminuted fragment, early mobilisation, shorter recovery period, early weight bearing, and decrease knee stiffness, reduction in chances of non unions and complications and improved functional outcome and preventing early onset patellofemoral arthrosis [16] . In our study we has one device complication where the implant was sitting on the inferior pole and patient sustained a fall post-operative 8 months and had ligamentum patella rupture which has to be treated surgically [19] .…”

Section: Discussionmentioning

confidence: 99%

A study of functional and clinical outcome for augmentation plating with tension band wiring for complex patella fractures

Joshi¹,

Kulkarni²,

Kulkarni³

et al. 2020

Int. J. Orthop. Sci.

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Background: Tension Band wiring is a standard age-old technique used for treating simple fracture patella. However comminuted fracture patella treated only with tension band wiring the results were not satisfying as the rigid and anatomical fragment fixation was not possible. Here we describe a newer method of using a low profile plate along with the standard tension band wiring for treating the comminuted fracture patella with the aim of getting anatomic and rigid fixation and good function. The purpose of this prospective study is to determine the effectiveness of this technique of augmentation plate with tension band wiring used in comminuted patella fracture and its effect on functional and clinical outcome. Methods: Between Jan 2015 and May 2019, 30 patients with displaced comminuted fracture of patella were included in the study. All the patients underwent fixation of fracture of patella with low profile plate and tension band wiring. The knee function of the patients and status of the patient were determined using Lysholm knee score and KOS score. Results: The average follow up period was 12-15 months. At 12 months follow up bone healing was satisfying in all the patients and the average range of motion was 0-120 degree at the end of 12 months. Score Lysholm knee scale: The results were excellent in 21patients, good in 8 patients and 1 patient with rupture of ligamentum patellae had gradual (excellent) results. One patient had complication with ligamentum patellae rupture on subsequent fall at 8 th month and required resurgery and repair for the same. Conclusions: The technique of augmentation plate is as effective and safe for treating complex comminuted fracture patella with excellent clinical outcome and results.

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Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report

Cited by 30 publications

References 30 publications

Comparison of the Therapeutic Effects of Tension Band with Cannulated Screw and Tension Band with Kirschner Wire on Patella Fracture

Comparison of the Therapeutic Effects of Tension Band with Cannulated Screw and Tension Band with Kirschner Wire on Patella Fracture

Three-dimensional fracture mapping of multi-fragmentary patella fractures (AO/OTA 34C3)

A study of functional and clinical outcome for augmentation plating with tension band wiring for complex patella fractures

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