Multifragmentary patellar fracture has a distinct fracture pattern which makes coronal split, inferior pole, or satellite fragments

AbstractThe present study aimed to map the location and frequency of fracture lines on the coronal articular and sagittal planes in multifragmentary patellar fractures. 66 multifragmentary patellar fractures were digitally reconstructed using the 3D CT mapping technique. The coronal articular surface and midsagittal fracture maps were produced by superimposing each case over a single template. Each fracture line was classified based on the initial displacement and orientation. We evaluated the frequency and direction of the fracture line, coronal split fragment area, and satellite and inferior pole fragment presence. Coronal articular surface fracture mapping identified primary horizontal fracture lines between the middle and inferior one-third of the articular surface in 63 patients (95.4%). Secondary horizontal fracture lines running on the inferior border of the articular facet were confirmed (83.3%). Secondary vertical fracture lines creating satellite fragments were mostly located on the periphery of the bilateral facet. Midsagittal fracture mapping of primary and secondary horizontal fracture lines with the main coronal fracture line revealed a predominantly X-shaped fracture map. The consequent coronal split fragment and inferior pole fracture were combined in most cases. In conclusion, the multifragmentary patellar fracture has a distinct pattern which makes coronal split, inferior pole, or satellite fragments.

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Characteristics of Multifragmentary Patellar Fractures: Three-dimensional Computed Tomography-based Fracture Mapping Study

10.21203/rs.3.rs-414289/v1 ◽

2021 ◽

Author(s):

Jae-Woo Cho ◽

Zepa Yang ◽

Eic Ju Lim ◽

Seungyeob Sakong ◽

Wonseok Choi ◽

...

Keyword(s):

Articular Surface ◽

Three Dimensional ◽

Fracture Line ◽

Midsagittal Plane ◽

Inferior Pole ◽

Horizontal Fracture ◽

Average Value ◽

Inferior Border ◽

Fracture Mapping ◽

Patellar Fractures

Abstract Limited literature is available regarding anatomic patterns of articular injuries in comminuted patellar fractures. The present study aimed to map the location and frequency of fracture lines on the coronal and sagittal planes of the articular surface in AO/OTA 34C3 fractures. The directions of the fracture lines from the CT scans of 66 multifragmentary patellar fractures were highlighted in the coronal plane of the articular surface and in the midsagittal plane. The images of all fractures were then oriented to fit and superimposed over a single template. The primary horizontal fracture lines were identified in 63 patients (95.4%) using coronal articular surface fracture mapping. The average value of the primary horizontal fracture line was located between the middle and inferior facets. The secondary horizontal fracture lines ran frequently on the inferior border of the articular facet (83.3%). The secondary vertical fracture lines created satellite fragments and were mostly located on the periphery of the bilateral facet. Sagittal fracture mapping of the primary and secondary horizontal fracture lines with the main coronal fracture line revealed a predominantly X-shaped fracture map. The presence of the free articular type of coronal split fragment was significantly related to inferior pole fractures (OR: 8.15, P = 0.01).

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Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

10.21203/rs.3.rs-89189/v1 ◽

2020 ◽

Author(s):

Hanru Ren ◽

Lianghao Wu ◽

Rongguang Ao ◽

Zheng Jian ◽

Xinhua Jiang ◽

...

Keyword(s):

Range Of Motion ◽

Study Design ◽

Fracture Line ◽

Morphometric Study ◽

Mapping Technique ◽

Intertrochanteric Fractures ◽

Fracture Feature ◽

Fracture Patterns ◽

Medial Group ◽

Fracture Mapping

Abstract Background: The purpose of this study was to analyze the fracture patterns of different posterior-medial wall types of intertrochanteric fractures by 3-D fracture-mapping technique and to further assess their clinical utility.Methods: In a retrospective analysis of interochanteric fractures treated in a large trauma center, fractures were classified into predesigned groups based on 3D-CT imaging techniques, and a 3-D template of the intertrochanteric region was graphically superimposed on the fracture line. Fracture characteristics were then summarized based on fracture-mapping. Finally, radiographic parameters, function, and range of motion were recorded in different fracture classification states.Results: A total of 348 intertrochanteric fractures were included. There were 111 patients (31.9%) in the posterolateral + posteromedial + medial group, with the most severe fracture displacement (typically characterized by fragmentation of the posteromedial wall into three isolated fragments). There were 102 cases (29.3%) in the posterolateral + posteromedial + simple medial group, and the most common fracture feature was a complete fragment posteromedially. A total of 81 cases (23.3%) were classified into the posterolateral + medial group, with the medial fracture line extending the anterior fracture line but leaving the lesser trochanter intact. In the isolated medial group of 33 cases (9.5%), the fracture type was similar to type IV, but the integrity of the greater trochanter was ensured. In the posteromedial + medial group of 12 cases (3.4%), the fracture was characterized by an interruption when the fracture line of the anterolateral wall extended to the posteromedial wall, often resulting in a complete isolated fragment posteromedially and medially. There were 9 patients (2.6%) in the isolated posterolateral group. In addition, we found significantly different radiographic scores and range of motion scores between groups.Conclusions: This morphometric study helps us to further characterize posterior-medial fracture patterns of intertrochanteric fractures, which may be closely related to different clinical outcomes. Further studies are needed to verify the reliability of this classification scheme in clinical application.Study Design: Crossover Study Design; Level of evidence, 3.

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Results of surgical treatment of patellar fractures

Kazan medical journal ◽

10.17816/kazmj83928 ◽

1929 ◽

Vol 25 (5) ◽

pp. 577-577

Author(s):

I. Tsimkhes

Keyword(s):

Surgical Treatment ◽

Transverse Fracture ◽

Patellar Fracture ◽

Patellar Fractures

K. Werwarth (Zentralblatt f. Chir. No. 11, 1929) gives 45 cases. patellar fracture observed for 10 years at the Klose clinic (Danzig). There was a transverse fracture in 26 cases

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Three-Dimensional CT Mapping of Intra-articular Calcaneal Fractures

10.21203/rs.3.rs-898497/v1 ◽

2021 ◽

Author(s):

Haichao Zhou ◽

Wenbao He ◽

Zhendong Li ◽

Shaochen Xu ◽

Fajiao Xiao ◽

...

Keyword(s):

Articular Surface ◽

Compression Fracture ◽

3D Models ◽

Calcaneal Fracture ◽

Fracture Line ◽

X Rays ◽

Calcaneal Fractures ◽

Secondary Fracture ◽

Fracture Group ◽

Primary Fracture

Abstract Background: Intra-articular calcaneal fracture is a challenge for surgeons, which must be understood to provide optimal treatment. The aim of this study was to define the distribution of the primary fracture line and the secondary fracture line of intra-articular calcaneal fractures. Methods: All X-rays and CT scans of intra-articular calcaneal fractures were collected from January 2014 to July 2020. According to the classification of Essex-Lopresti, these fractures were divided into tongue-fracture group and compression-fracture group. Construct 3D models of intra-articular calcaneal fractures in all patients, and record the location of all fracture lines, which were marked and integrated on the 3D model of intact calcaneus after virtual reduction. Heat mapping were created based on the occurrence frequency of fracture lines. Results: A total of 171 patients with intra-articular calcaneal fractures were included in this study, 4 of whom were bilateral. There were 87 cases in the tongue-fracture group, 37 cases (42.5%) involved 4 anterior articular surface, 16 cases (18.4%) involved middle articular surface, and 52 cases (59.8%) involved calcanecuboid articular surface. There were 88 cases in the compression-fracture group, including 43 cases (48.9%) involving anterior articular surface, 21 cases (23.9%) involving middle articular surface, and 63 cases (71.6%) involving calcanecuboid articular surface. Conclusion: The distribution of the primary fracture line and the secondary fracture line of intra-articular calcaneal fractures has a certain rule and correlation. Whether in tongue-fracture group or compression-fracture group, the fracture line is most often involves the calcanecuboid articular surface, followed by anterior articular surface, at least involves middlearticular surface. This study provides a theoretical basis for further exploration of calcaneal injury mechanism, construction of biomechanical model, and choice of surgical approach.

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Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescence: management and outcome

10.21203/rs.3.rs-27907/v1 ◽

2020 ◽

Author(s):

quanwen yuan ◽

Zhixiong Guo ◽

Xiaodong Wang ◽

Jin Dai ◽

Fuyong Zhang ◽

...

Keyword(s):

Computerized Tomography ◽

Articular Surface ◽

High Energy ◽

Fracture Pattern ◽

Malleolar Fracture ◽

Malleolar Fractures ◽

Ankle Stability ◽

Anatomic Reduction ◽

The Mean ◽

Tillaux Fracture

Abstract Background The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescence commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis and treatment of this complex fracture pattern. Methods The charts and radiographs of six patients were reviewed. The functional was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores. Results The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. Talar subluxation laterally with medial space widening in three, and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6–8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7. Conclusions Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.

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Concurrent ipsilateral Tillaux fracture and medial malleolar fracture in adolescents: management and outcome

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-01961-7 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Quanwen Yuan ◽

Zhixiong Guo ◽

Xiaodong Wang ◽

Jin Dai ◽

Fuyong Zhang ◽

...

Keyword(s):

Computerized Tomography ◽

Articular Surface ◽

High Energy ◽

Fracture Pattern ◽

Malleolar Fracture ◽

Malleolar Fractures ◽

Ankle Stability ◽

Anatomic Reduction ◽

The Mean ◽

Tillaux Fracture

Abstract Background The concurrent ipsilateral Tillaux fracture with medial malleolar fracture in adolescents commonly suffer from high-energy injury, making treatment more difficult. The aim of this study was to discuss the mechanism on injury, diagnosis, and treatment of this complex fracture pattern. Methods The charts and radiographs of six patients were reviewed. The function was assessed by the American Orthopedic Foot and Ankle Society ankle-hindfoot scores. Results The mean age at operation was 12.8 years. The mean interval from injury to operation was 7.7 days. Five Tillaux fractures and all medial malleolar fractures were shown on AP plain radiographs. One Tillaux fracture and two cases with avulsion of posterolateral tibial aspect were confirmed in axial computerized tomography. There was talar subluxation laterally with medial space widening in three and syndesmotic disruption in one. There were five patients sustaining ipsilateral distal fibular fractures. All fractures, except nonunion in two medial malleolar fractures and in one Tillaux fracture, healed within 6–8 weeks. There was one case of osteoarthritis of ankle joint. The average AOFAS score was 88.7. Conclusions Computerized tomography is helpful in identifying the fracture pattern. Anatomic reduction and internal fixation of Tillaux and medial malleolar fracture was recommended to restore the articular surface congruity and ankle stability.

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Treatment of pelvic fractures in cats with patellar fracture and dental anomaly syndrome

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x20959616 ◽

2020 ◽

pp. 1098612X2095961

Author(s):

Natalia Andrea Reyes Rodriguez ◽

Steven J Bailey ◽

Sorrel J Langley-Hobbs

Keyword(s):

Normal Activity ◽

Pelvic Fractures ◽

Fracture Repair ◽

Direct Result ◽

Acetabular Fractures ◽

Patellar Fracture ◽

Dental Anomaly ◽

Joint Congruency ◽

Outcome Information ◽

Patellar Fractures

Objectives The aim of this study was to describe the treatment and outcome of acetabular and other pelvic fractures in cats with patellar fracture and dental anomaly syndrome (PADS) and to provide advice on how to manage these cases in practice. Methods Data were collated on cats with PADS that were reported to have sustained pelvic fractures or had fractures or fissures of the pelvis identified on submitted radiographs. The details of the fractures were recorded, in addition to any treatment and outcome information. Results Of the 215 cases reported with PADS, 58 cats (27%) were found to have pelvic fractures, none of which were known to have resulted from significant trauma. There were 101 fractures in total and of these 15 were treated with surgery, including 10 acetabular fractures, two ilial, two pubic and one ischial fracture. Screw loosening and loss of fracture reduction was seen in four of the surgically treated fractures (two pubic fractures, one ilial and one acetabular fracture). Fourteen cats were euthanased as a direct result of a fracture occurring. While most pelvic fractures healed uneventfully, some cats remained intermittently lame, but it was not always possible to determine the cause of the lameness from the information available and because all cats had concurrent patellar fractures. Conclusions and relevance Many of the pelvic fractures healed with conservative management. Fractures involving articular surfaces such as acetabular fractures may benefit from surgical stabilisation as surgery may offer the benefits of articular fracture repair with improved joint congruency and a faster return to normal activity.

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Application of Three-Dimensional Computed Tomography Improved the Interrater Reliability of the AO/OTA Classification Decision in a Patellar Fracture

Journal of Clinical Medicine ◽

10.3390/jcm10153256 ◽

2021 ◽

Vol 10 (15) ◽

pp. 3256

Author(s):

Seong-Eun Byun ◽

Oog-Jin Shon ◽

Jae-Ang Sim ◽

Yong-Bum Joo ◽

Ji-Wan Kim ◽

...

Keyword(s):

Computed Tomography ◽

Interrater Reliability ◽

Three Dimensional ◽

Treatment Recommendations ◽

Ct Imaging ◽

Plain Radiography ◽

Imaging Modalities ◽

Patellar Fracture ◽

Patellar Fractures

We investigated whether interrater reliabilities of the AO/OTA classification of patellar fracture and treatment recommendations change with the imaging modalities applied, including plain radiography and two- and three-dimensional (2-D and 3-D) computed tomography (CT). Seven orthopedic specialists and four orthopedic residents completed a survey of 50 patellar fractures to classify the fractures according to the AO/OTA classification for patellar fractures. Initially, the survey was conducted using plain radiography only, then with 2-D CT introduced three weeks later and 3-D CT introduced six weeks later. Fleiss’ Kappa coefficients were calculated to determine interrater reliability, respectively. The overall interrater reliability of the AO/OTA classifications was 0.40 (95% CI, 0.38–0.42) with plain radiography only and 0.43 (95% CI, 0.41–0.45) with the addition of 2-D CT. With the addition of 3-D CT, the reliability was significantly improved to 0.54 (95% CI, 0.52–0.56). In specialists, interrater reliability of the classifications was moderate with all three imaging modalities. With the use of 3-D CT, interrater reliability of the classification was 0.53 (95% CI, 0.50–0.56), which was significantly higher than that with the use of 2-D CT (κ = 0.45; 95% CI, 0.42–0.48). In residents, interrater reliability of the classification was 0.30 (95% CI, 0.24–0.36) with plain radiography. The reliability improved to 0.49 (95% CI, 0.43–0.56) with the addition of 2-D CT, which was significantly higher than that with plain radiography only. The use of 3-D CT imaging improved interrater reliability of the classification. Therefore, surgeons, especially residents, may benefit from using 3-D CT imaging for classifying and planning the treatment of patellar fractures.

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Arthroscopic treatement of patella fractures in children

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors5153-57 ◽

2017 ◽

Vol 5 (1) ◽

pp. 53-57

Author(s):

Igor V. Timofeev ◽

Elena Yu. Dyakonova ◽

Aleksei A. Gusev ◽

Ekaterina A. Romanova ◽

Polina V. Khrolenko

Keyword(s):

Surgical Treatment ◽

Articular Surface ◽

Knee Extensor ◽

Quadriceps Tendon ◽

Minimal Invasiveness ◽

Fractures In Children ◽

Patella Fractures ◽

Highly Effective ◽

Patellar Fractures ◽

Longitudinal Fractures

Introduction. The frequency of patellar fractures is approximately 0.5% to 1.5% of all skeletal injuries. The following types of fractures can be distinguished: avulsive, transverse, longitudinal, and comminuted. In cases of displacement of more than 2–3 mm and quadriceps tendon injuries open reduction and internal fixation with the restoration of the articular surface is more preferable. In cases of longitudinal fractures, arthroscopy is regarded as a highly effective method of surgical treatment. Materials and methods. Using arthroscopy, we have operated on 4 patients with longitudinal fracture of the patella. The average age of the injured persons was 15.4 years (14–17). These were 3 males and 1 female. All patients had sport-related injuries. Because of the longitudinal fracture of the patella, the lateral knee extensor mechanism remained intact, and arthrosopy-assisted surgical intervention with closed reposition of fragments and transcutaneous wire fixation was performed without wire suturing. Results and discussion. Minimal invasiveness, the possibility of visual control over the recovery quality of patellar surface, the reliability of fragment fixation, and a significant reduction in the subsequent rehabilitation make arthroscopy a highly effective method of surgical treatment for patellar fractures.

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Use of 3D modelling and 3D printing for the diagnostic process, decision making and preoperative planning of periprosthetic acetabular fractures

BMJ Case Reports ◽

10.1136/bcr-2019-233117 ◽

2020 ◽

Vol 13 (1) ◽

pp. e233117 ◽

Cited By ~ 4

Author(s):

Giuseppe Marongiu ◽

Roberto Prost ◽

Antonio Capone

Keyword(s):

Bone Loss ◽

Bone Quality ◽

Surgical Simulation ◽

Articular Surface ◽

Real Life ◽

Fracture Morphology ◽

Fracture Pattern ◽

3D Modelling ◽

Diagnostic Process ◽

Acetabular Fractures

Periprosthetic acetabular fractures represent an uncommon but challenging complication of total hip arthroplasty (THA), mostly related to low-energy trauma and pathological conditions that reduce bone quality. Therefore, particularly in elderly patients, these fractures are associated with periprosthetic osteolysis and bone loss. CT scan is considered the gold standard to define the fracture pattern; however, the presence of the prosthetic implants in situ limits the full view of the articular surface and bone loss. A three-dimensional (3D) modelling software allows precise tridimensional reconstructions of the bony surface, virtually removing the metallic implants trough DICOM image segmentation. We highlight the case of a periprosthetic acetabular fracture around THA which occurred to a 75-year-old woman, in which a 3D modelling software was used to improve the assessment of fracture morphology and bone quality. Moreover, the 3D images were printed in a real-life size model and were used for preoperative implant templating, sizing and surgical simulation.

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