Indications and Results of Nonoperative Treatment of Patellar Fractures

Braun, W.; Wiedemann, Manfred; Rüter, Axel; Kundel, K.; Kolbinger, Stefan

doi:10.1097/00003086-199304000-00028

Cited by 54 publications

(23 citation statements)

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“…Excluding significant medical comorbidities as the sole indication, generally it seems that non-operative management can have satisfactory outcomes in fractures patterns with no or very little displacement [5,9]. This usually entails an above knee cast, from the malleoli to the greater trochanter, for 6 weeks.…”

Section: Managementmentioning

confidence: 99%

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Adult native knee extensor mechanism ruptures

Pengas

Assiotis

Khan

et al. 2016

Injury

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Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery. Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.

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Section: Managementmentioning

confidence: 99%

“…This usually entails an above knee cast, from the malleoli to the greater trochanter, for 6 weeks. Earlier resumption of knee motion is advocated by some authors [9].…”

Section: Managementmentioning

confidence: 99%

Adult native knee extensor mechanism ruptures

Pengas

Assiotis

Khan

et al. 2016

Injury

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“…(21) patella kırıklarında; kırığın açık olmaması, longitudinal kırıklarda kırık hattında ayrışmanın 1mm'den fazla olmaması, dışa doğru patellar çıkık olmaması, transvers kırıklarda diz ekleminde basamaklanmanın olmaması ve yine eklem yüzeyinde 1 m'den fazla çökmenin olmaması gibi durumlarda konservatif tedavinin daha uygun olduğunu öne sürmüşlerdir. Uzun süren immobilizasyon sonucu kas atrofisi ve hareketsizliği konservatif tedavinin önemli dezavantajlarıdır (4,21). Aktaş ve ark.…”

Section: Discussionunclassified

Evaluation of the Demographical Features and Clinical Outcomes of Patellar Fractures

Gökdemir¹,

Söğüt²,

Kaya³

et al. 2012

JAEM

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GirişPatella vücudumuzdaki en büyük sesamoid kemiktir. Patella kırıkları tüm iskelet sistemi kırıkların %1'ini oluşturmaktadır. Her yaş grubunda görülmekle beraber sıklıkla 20-50 yaş aralığında görülür. Patella dizin ekstansör mekanizmasının gücünü artırır ve diz eklemini korur (1, 2). Bu kırıklar genellikle yüksek enerjili travmalar sonucu oluşmakta, patellada ve dizin çevresinde tedaviyi güçleştiren geniş yumuşak doku yaralanmalarına neden olmaktadır (3). Patella ekstansör mekanizmanın kuvvet kolunu uzatarak gücünü arttırmasının yanı sıra dizin kilitlenme sisteminin bir parçasını oluşturarak stabiliteye katkıda bulunur (4). Bu fonksiyonlarının yanında troklea ile yaptığı eklemleşme nedeniyle patella kırıklarında uygun tedavi yönteminin seçimi oldukça önemlidir (5, 6). Patella kırıkları intraartriküler kırıklar olduğu için tedavideki amaç, anatomik redüksiyon, rijit fiksasyonla kaynamanın sağlanması ve erken harekete izin vere-Özet Amaç: Bu çalışmada travma nedeniyle patella fraktürü tespit edilen olgularımızın sosyodemografik özellikleri, tedavi yöntemleri ve sonuçları incelenmiştir. Gereç ve Yöntemler: Ocak 2008-Haziran 2010 tarihleri arasında acil serviste kapalı patella kemiği kırığı tanısı konulan 23 olgu retrospektif olarak değerlendirilmiştir. Olguların acil servise başvurusundaki ön-arka ve yan grafilerine göre kırıklar sınıflandırıldı. Klinik sonuçların değerlendirilmesinde Böstman ve arkadaşlarının geliştirdiği skorlama sistemi kullanıldı. Bulgular: Patella kırıklarında 16 olgu ile trafik kazası en sık rastlanan yaralanma nedeni mekanizması idi (%69.5). Kırıkların 21'i (%91.3) B1 tipi (nondeplase, parçalı olmayan) kırık iken, 2'si (%8.7) B2 tipi (deplase ve çok parçalı) kırık idi. B1 tipi kırıkların, 9'u distal uç, 8'i transvers, 4'ü ise longitudinal kırık idi. Olguların 21'i cerrahi, 2'si konservatif olarak tedavi edildi. Cerrahi olarak tedavi edilen olgulardan 7'sine vida veya kirschner telleri ile osteosentez, 6'sına modifiye anterior gergi bandı ile osteosentez, 5' ine kirschner teli ve modifiye anterior gergi bandı kombinasyonu, 3'üne parsiyel patellektomi uygulandı. Olguların 8'inde mükemmel (%34.8), 10'unda iyi, (%43.5) ve 5'inde kötü sonuç (%21.7) alındı. Sonuç: Patella kırıkları nadir rastlanan bir kırık çeşidi olmasına rağmen klinik sonuçları bakımından önemli bir sorun teşkil etmektedirler. AbstractObjective: The socio-demographic features, treatment methods, and clinical outcomes of our cases established to have patellar fractures due to trauma were assessed in this study. Materials and Methods: Twenty-three cases who were diagnosed with closed patellar bone fractures between January 2008 and June 2010 were retrospectively evaluated. The fractures were classified with respect to anteroposterior and lateral radiographies of the cases at the time of admittance to the emergency department. The scoring system developed by Böstman et al. was used in assessing clinical outcomes. Results: Motor vehicle accident was the most common injury mechanism of patellar fracture in 16 cases (69.5%). While 21...

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“…4 Irrespective of whether such injuries are treated surgically or not, they are often managed by partial weight-bearing and the use of a splint for approximately six weeks. 5,6 For most cases it is imperative that, in the early stages after injury, the tensile forces acting across the extensor mechanism are kept to a minimum. 5 In some operatively-managed cases, such as with tension-band wiring of patellar fractures, it is desirable that some force acts through the extensor mechanism.…”

mentioning

confidence: 99%

“…5,6 For most cases it is imperative that, in the early stages after injury, the tensile forces acting across the extensor mechanism are kept to a minimum. 5 In some operatively-managed cases, such as with tension-band wiring of patellar fractures, it is desirable that some force acts through the extensor mechanism. 6 We are not aware of any study of gaitanalysis which has related the angle of immobilisation of the knee to the forces acting on the extensor mechanism during restricted weightbearing.…”

mentioning

confidence: 99%

The relationship of the angle of immobilisation of the knee to the force applied to the extensor mechanism when partially weight-bearing

Khan

Nokes

Jones

et al. 2007

The Journal of Bone and Joint Surgery. British volume

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We describe the influence of the angle of immobilisation during partial weight-bearing on the forces across the extensor mechanism of the knee. Gait analysis was performed on eight healthy male subjects with the right knee in an orthotic brace locked at 0 degree, 10 degrees, 20 degrees and 30 degrees, with the brace unlocked and also without a brace. The ground reaction force, the angle of the knee and the net external flexion movement about the knee were measured and the extensor mechanism force was calculated. The results showed a direct non-linear relationship between the angle of knee flexion and the extensor mechanism force. When a brace was applied, the lowest forces occurred when the brace was locked at 0 degree. At 30 degrees the forces approached the failure strength of some fixation devices. We recommend that for potentially unstable injuries of the extensor mechanism, when mobilising with partial weight-bearing, the knee should be flexed at no more than 10 degrees.

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Indications and Results of Nonoperative Treatment of Patellar Fractures

Cited by 54 publications

References 0 publications

Adult native knee extensor mechanism ruptures

Adult native knee extensor mechanism ruptures

Evaluation of the Demographical Features and Clinical Outcomes of Patellar Fractures

The relationship of the angle of immobilisation of the knee to the force applied to the extensor mechanism when partially weight-bearing

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