Fix It or Discard It? A Retrospective Analysis of Functional Outcomes After Surgically Treated Patella Fractures Comparing ORIF With Partial Patellectomy

Bonnaig, Nicolas S.; Casstevens, Chris; Archdeacon, Michael T.; Connelly, Camille L.; Monaco, Nathan A.; Wyrick, John D.; Le, Theodore T.

doi:10.1097/bot.0000000000000201

Cited by 35 publications

(27 citation statements)

References 17 publications

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“…The patient-reported functional outcome scores in this series were higher than those reported in the literature for tension band fixation and patellectomy. 5,9,24 The mean KOS-ADLS in our series was 83.9. Bonnaig et al reported mean KOS-ADLS scores of 64.1 and 62.1 for ORIF and patellectomy, respectively.…”

Section: Discussionmentioning

confidence: 51%

“…Tension band constructs employ a variety of implants including Kirschner wires, malleable steel wires, cannulated screws, cables, or suture, with no implant or combination of implants proving to be superior to another. 5,9,[18][19][20][21][22][23] Partial patellectomy with advancement of the patellar tendon remains the most common treatment when there is significant comminution of the inferior pole. Currently, there is no well-established method to effectively treat comminuted fractures and those that involve the inferior pole.…”

Section: Discussionmentioning

confidence: 99%

“…removal. [5][6][7][8][9] Modern techniques to address simple fracture patterns have been described, including cannulated screws, wires, and braided suture. These techniques can allow for more rapid rehabilitation and lower rates of implant removal, but data on failure rates remain conflicting.…”

mentioning

confidence: 99%

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Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures

et al. 2018

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Treatment of patella fractures is fraught with complications and historically poor functional outcomes. A fixation method that allows for early mobilization and decreases symptomatic hardware rates will improve knee range of motion, postoperative functional status, and reoperation rates. The purpose of this study was to evaluate the functional outcomes after locked plate osteosynthesis of patella fractures at a Level 1 trauma center. A retrospective case series was conducted of patients who underwent open reduction internal fixation (ORIF) of a patella fracture using a locked mesh plating technique coupled with neutralization of forces on the distal pole of the patella. Twelve patients were evaluated at a mean follow-up of 19 months (range, 6-30) with physical exam, functional outcomes, and radiographs. There were 9 women and 3 men with an average age of 66.1 years (range, 53-75). Radiographic bony union was achieved in all patients by 3-month follow-up. Visual Analog Pain Score averaged 1.7 (median, 1.0; range, 0-8), the mean Knee Outcome Score - Activities of Daily Living Scale was 83.9 (median, 92.1; range, 45.7-100.0), the mean Short Form Musculoskeletal Function Assessment (SMFA) Function Index was 9.9 (median, 3.7; range, 0.7-41.2), and the mean SMFA Bother Index was 11.1 (median, 3.1; range, 0-62.5). The SF-36 Physical Component Score mean was 48.4 ± 8.5 and the SF-36 Mental Component Score mean was 54.1 ± 9.6. No complications developed and there were no reoperations for nonunion, infection, or symptomatic hardware. This study demonstrates that locked plate osteosynthesis for operative patella fractures can reliably achieve bony union with potentially superior functional outcomes as compared with traditional methods. Further studies are needed to evaluate plate fixation for patella fractures, but early results are promising.

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Section: Discussionmentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

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Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures

et al. 2018

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“…I nferior pole fractures of the patella account for 9.3%-22.4% of all patellar fractures 2 , and various surgical procedures to preserve fragments of the inferior pole is gaining popularity recently [8][9][10]14 . However, it remains doubtful which surgical technique is superior.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a Novel Tension Band and Patellotibial Tubercle Cerclage in the Treatment of Comminuted Fractures of Inferior Pole of the Patella

Zhang

Zhou

et al. 2020

Orthopaedic Surgery

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Objective To assess the therapeutic effect of a novel tension band using 3.0 mm cannulated screw combined with a titanium cable and specific shims comparatively with patellotibial tubercle cerclage in comminuted fractures of the inferior pole of the patella. Methods The retrospective study from March 2012 to July 2017 was conducted in Peking University Third Hospital and comprised 63 patients with comminuted fractures of the inferior pole of the patella: 41 treated with new tension band using 3.0 mm cannulated screw combined with a titanium cable and specific shims (new tension band group) and 22 with patellotibial tubercle cerclage (tubercle cerclage group). Gender, age, AO/OTA fracture type, injury mechanism, inter‐fragmentary gap, and follow‐up time of patients were recorded. Two groups were compared regarding: operation time, blood loss, partial weight‐bearing time, fracture‐healed time, Bostman score and knee mobility at 12‐month follow‐up, and postoperative complications. Continuous and categorical parameters were analyzed by Mann‐Whitney U test and the chi‐squared test, respectively. Fisher's exact test was used for small data subsets. Results Between the two groups, no statistically significant difference was found in mean age, gender, AO/OTA fracture type, injury mechanism, mean inter‐fragmentary gap, or mean follow‐up time (P > 0.05). The mean operation time of new tension band group was significantly longer than that of tubercle cerclage group (76.4 min vs 64.2 min, P = 0.006), while there was no significant difference in blood loss. After surgery, new tension band group had a significantly earlier mean partial weight‐bearing time (5.2 weeks vs 7.4 weeks, P < 0.001) and fracture‐healed time (9.6 weeks vs 11.6 weeks, P < 0.001). At 12‐month follow‐up, patients of new tension band group had a significantly higher mean Bostman score (28.5 vs 25.8, P < 0.001) and knee mobility (126.7 vs 117.3, P < 0.001). Ten complications related with internal fixation were found in tubercle cerclage group including two cases of loose internal fixation, two cases of cerclage breakage, and six cases of low patella position who undertook secondary operation. No complications were found in new tension band group (0 in 41 vs 10 in 22, P < 0.001). Conclusion Patients with comminuted fractures of the inferior pole of the patella treated with a novel tension band experienced a longer operation time, but earlier partial‐weight‐bearing and fracture‐healed time, better clinical outcomes at 12‐month follow‐up, and less complications. It should be considered an alternative therapy for the treatment of distal pole patellar fractures.

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“…Her ne kadar amaç patellanın korunması olsa da, kısmi patellektomi ile tespitin benzer sonuçları olduğu da bildirilmiştir (Şekil 1). [14] Patellektomi sonrasında hareket kısıtlılığı, diz instabilitesi, ekstansör mekanizmada belirgin güç kaybı, yürüme ve merdiven çıkmada zorluk yaşanması nedeniyle, patellektomi en son tercih edilen kurtarıcı bir cerrahi yöntemdir. Patella kırıklarında geç kaynama ve kaynamamada kemik grefti kullanımı konusunda, bildirilen birkaç olgu dışında ayrıntılı bilgi bulunmamaktadır.…”

Section: Cerrahi Tedaviunclassified

Patella kırıklarında kaynamama ve gecikmiş kaynama konusunda güncel literatürün değerlendirilmesi –güncel tedavi yaklaşımları

Özkazanlı¹,

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2017

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Fix It or Discard It? A Retrospective Analysis of Functional Outcomes After Surgically Treated Patella Fractures Comparing ORIF With Partial Patellectomy

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 35 publications

References 17 publications

Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures

Outcomes Following Low-Profile Mesh Plate Osteosynthesis of Patella Fractures

Comparison of a Novel Tension Band and Patellotibial Tubercle Cerclage in the Treatment of Comminuted Fractures of Inferior Pole of the Patella

Patella kırıklarında kaynamama ve gecikmiş kaynama konusunda güncel literatürün değerlendirilmesi –güncel tedavi yaklaşımları

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