scholarly journals Actualización en osteonecrosis y fractura de rótula tras prótesis total de rodilla.

2020 ◽  
pp. 119-125
Author(s):  
JUAN RAMON RODRIGUEZ-COLLELL ◽  
DAMIAN MIFSUT MIEDES
Keyword(s):  
Extensor Mechanism ◽  
Patella Fracture ◽  
Risk Of Infection ◽  
Knee Prostheses ◽  
Patella Fractures ◽  
Extensor Apparatus ◽  
Traumatic Origin ◽  
Displaced Fracture ◽  
Standard Techniques

Periprosthetic patella fractures are much more common in knee prostheses in which the patella has been replaced. The aetiology of periprosthetic patella fractures has a traumatic origin in 12% of cases and atraumatic secondary to avascular necrosis in the remaining 88%. Peri-implant fractures, in which the patella has been replaced and the implant is stable with an integral extensor mechanism, resolve with conservative treatment. In cases of stable implant, with a displaced fracture of the upper or lower pole of the patella, the implant is left in situ and the extensor apparatus is repaired according to standard techniques. If there is disruption of the extensor apparatus with an unstable implant, the patellar button should be removed and continuity of the extensor apparatus repaired with a patellectomy. In these cases, internal fixation with wire cerclages is discouraged. In cases where the extensor mechanism is intact and the implant is unstable, the removal of the patellar button is sufficient. The risk of infection after surgery for a periprosthetic patella fracture is high.

scholarly journals The “invisible” wiring technique for displaced fracture patella

2020 ◽  
Vol 27 (2) ◽  
pp. 252-257
Author(s):  
Andrew LY Wong ◽  
Kevin KH Wong ◽  
Kam Kwong Wong ◽  
Wing Cheung Wong
Keyword(s):  
Tensile Strength ◽  
Operation Time ◽  
Wound Complication ◽  
Patella Fracture ◽  
High Tensile Strength ◽  
Steel Wires ◽  
Patella Fractures ◽  
Fracture Patella ◽  
Displaced Fracture

Background: Operative treatment of displaced patella fracture dates back to Lister in 1877. Nowadays, steel wires remain the material of choice in tension band technique despite complications such as wire breakage, suboptimal placement, or skin impingement. We propose using a high-tensile strength braided tape-shaped polyblend suture (FiberTape®, Arthrex, Naples, Florida, USA) as an alternative that could minimize complications related to steel wires. Method: Between February 2014 and April 2018, 15 patients with displaced patella fractures (three distal pole, five transverse, and seven comminuted fractures) underwent our proposed method. Open fracture reduction was performed to optimize anatomy before figure-of-eight fixation with FiberTape®. An Ethibond-2 suture was also added as cerclage for stability. Postoperatively, an extension brace was given for wound resting, before progressing to mobilization exercises with a hinge-knee brace. At follow-ups, the knee’s range-of-motion (ROM), along with bone healing status from radiographs, was assessed. Results: The mean operation time was 84.5 min, and all surgeries were performed or supervised by the same senior surgeon. Eight patients were discharged from follow-up (mean follow-up of 9.9 months) after achieving good ROM and fracture healing. One patient defaulted, and the remaining is still being followed-up. There was no wound complication or knot impingement in all cases. One patient required manipulation under anesthesia due to stiffness, and one experienced malunion due to poor compliance to rehabilitation protocol. Conclusion: Fixation using a high-tensile strength braided suture may be an equally effective method in the management of displaced patella fracture. However, larger sample size is useful to provide a more definitive conclusion.

scholarly journals Early Outcomes After Surgical Management of Geriatric Patella Fractures

2021 ◽  
Vol 12 ◽  
pp. 215145932098769
Author(s):  
Jaclyn Kapilow ◽  
Junho Ahn ◽  
Kathryn Gallaway ◽  
Megan Sorich
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Geriatric Patients ◽  
The United States ◽  
Unplanned Readmission ◽  
Patella Fracture ◽  
Factors Associated ◽  
Prolonged Hospitalization ◽  
Patella Fractures

Objectives: To report the incidence and risk factors for prolonged hospitalization, discharge to a facility, and postoperative complications in geriatric patients who underwent surgery for patella fracture. Design: Retrospective database review. Setting: The American College of Surgeons—National Surgical Quality Improvement Program (NSQIP) collects data from 600 hospitals across the United States. Patients/Participants: NSQIP patients over 65 years of age with patella fractures. Intervention: Surgical fixation of patella fracture including extensor mechanism repair. Main Outcome Measurements: Prolonged hospitalization, discharge to a facility, and 30-day post-operative complications. Results: 1721 patients were included in the study. The average age was 74.9 years. 358 (20.8%) patients were male. 122 (7.1%) patients had a length of stay greater than 7 days. Factors associated with prolonged length of stay include pre-existing renal failure, need for emergent surgery, and time to surgery greater than 24 hours from admission. 640 patients (37.2%) of patients were discharged to a facility after surgery. Discharge to facility was associated with age >77 years, obesity, anemia, thrombocytopenia, pre-operative SIRS, and CCI > 0.5. Admission from home decreased the odds of discharge to a facility. The most common postoperative complications in this population were unplanned readmission (3.4%), unplanned reoperation (2.7%), surgical site infection (1.1%), mortality (1.0%), venous thromboembolism (0.8%), and wound dehiscence (0.2%). Complication rates increased with anemia and ASA class IV-V. Conclusions: Geriatric patients undergoing operative intervention for patella fractures are at high risk for prolonged hospitalization, discharge to facility, unplanned readmission or reoperation, and surgical site complications in the first 30 days following surgery. This study highlights modifiable and non-modifiable risk factors associated with adverse events. Early recognition of these factors can allow for close monitoring and multidisciplinary intervention in the perioperative period to improve outcomes. Level of Evidence: Prognostic level III.

scholarly journals Bilateral Traumatic Patella Fracture

2015 ◽  
Vol 13 (1) ◽  
pp. 43-45
Author(s):  
Ritesh Sinha ◽  
Amit Joshi ◽  
Nirab Kayastha ◽  
Bharat Prasad Singh
Keyword(s):  
Rare Case ◽  
Patella Fracture ◽  
Patella Fractures ◽  
Healthy Female ◽  
Bilateral Fracture

Fracture of Patella is rare and constitutes almost 1% of all skeletal injuries. Bilateral fracture of patella is even rarer accounting for 2.9% of all patella lesion. Very few cases of bilateral patella fractures have been reported in literature. We report the rare case of bilateral patella fracture in a healthy female and discuss the management challenges. doi:  http://dx.doi.org/10.3126/mjsbh.v13i1.13005   

scholarly journals A rare case of patellar fracture with quadriceps tendon rupture

2021 ◽  
Vol 7 (2) ◽  
pp. 406
Author(s):  
K. N. Subramanian ◽  
Ganesan G. Ram ◽  
Muthukumar S. ◽  
Mathiyazhagan Babu
Keyword(s):  
Patellar Tendon ◽  
Rare Case ◽  
Tendon Rupture ◽  
Quadriceps Tendon ◽  
Extensor Mechanism ◽  
Patella Fracture ◽  
Patellar Fracture ◽  
Quadriceps Tendon Rupture ◽  
Patellar Tendon Rupture ◽  
Bone Level

<p>Quadriceps tendon rupture is the rarest injury with an incidence of 1.37/1,00,000/year. A patellar fracture is the most common injury associated with extensor mechanism lag, but it is rarely found to have quadriceps rupture rather than patellar tendon rupture. Normally when patella fracture occurs the force is disseminated at the bone level rather than at the muscular level. In this case, the force has disseminated at both muscle and bone leading to fracture of patella and quadriceps tendon rupture. Here we report a case of patellar fracture along with quadriceps tendon rupture.<strong></strong></p>

Fixation of Closed Transverse Patella Fracture with Cannulated Cancellous Screws and Anterior Tension Band Wiring- A Prospective Study

2020 ◽  
Vol 11 (4) ◽  
pp. 7985-7989
Author(s):  
Senthil Loganathan ◽  
Raghavendran B ◽  
Thiyagarajan U ◽  
Pradeep J
Keyword(s):  
Prospective Study ◽  
Steel Wire ◽  
Knee Function ◽  
Tension Band ◽  
Tension Band Wiring ◽  
Patella Fracture ◽  
Cancellous Screw ◽  
Patella Fractures ◽  
Cancellous Screws ◽  
A Prospective Study

Patella fractures accounts for 1% of all skeletal injuries.  Patella fractures usually need to be treated with accurate reduction and fixation to obtain optimal knee function. Improper reduction of the articular fragments leads to complications like arthritis and quadriceps dysfunction. Tension band wiring and pasting are commonly performed fixation methods. Tension band wiring with K-wires is associated with wire prominence and soft tissue irritation. Cannulated cancellous screw fixation of the fracture and tension band wiring through the cannulated screws avoid the complication of wire migration and breakage.   In our study, we fixed these fractures with cannulated cancellous screws and tension band. This is a prospective study done in SRMC from 2012-2017. A total of 17 Patients with transverse patella fracture are taken into a study, 4mm cannulated cancellous screws with 18 mm stainless steel wire is used for anterior tension band wiring. Extensor retinaculum closure is done for all these patients. All patients had excellent knee function, according to KSS. There was no case of implant prominence or soft issue irritation in any of these patients. One patient had extensor lag. Cannulated cancellous screw with anterior tension band wiring is a reliable, effective and reproducible technique in treating transverse patella fractures.

scholarly journals Patella Fracture Identified Using Point-of-care Ultrasound

2021 ◽  
Vol 122 (4) ◽  
pp. 308-312
Author(s):  
Mark Richman ◽  
Andrew Kieffer ◽  
Rachel Moss ◽  
Daniel Dexeus
Keyword(s):  
Predictive Value ◽  
Point Of Care ◽  
Weight Bearing ◽  
Quadriceps Tendon ◽  
Point Of Care Ultrasound ◽  
Patella Fracture ◽  
Dynamic Nature ◽  
Early Evaluation ◽  
Patella Fractures ◽  
Anterior Knee

A 49-year-old female fell from standing. Her right knee extended into the air. She had acute right knee pain preventing weight-bearing. Her knee was most comfortable fully-extended. She could not flex it due to pain, nor extend it against resistance. Tenderness and a horizontal defect were noted over the anterior knee. Bedside ultrasound demonstrated a horizontally-fractured patella (confirmed on X-ray) with intact femoral and patellar tendons. She was put in a knee immobilizer and underwent surgery, with return to full function and activities. Ultrasound can identify patella fractures and help with early evaluation, management, and specialty referral, as well as ordering more-focused imaging. In one study, POCUS (point-of-care ultrasound) for patella fracture had 95% sensitivity, 63% specificity, 86% positive predictive value, and 83% negative predictive value. The dynamic nature of ultrasound allows a ruptured patella (87% sensitivity) or quadriceps tendon (100% sensitivity) to be excluded with high certainty.

Patella Fractures and Extensor Mechanism Injuries

2009 ◽  
pp. 2131-2166
Author(s):  
Michael T. Archdeacon ◽  
Roy W. Sanders
Keyword(s):  
Extensor Mechanism ◽  
Patella Fractures

scholarly journals Comparing 3 Different Techniques of Patella Fracture Fixation and Their Complications

2019 ◽  
Vol 10 ◽  
pp. 215145931982714 ◽  
Author(s):  
Graham Ka-Hon Shea ◽  
Karen Hoi-Ting So ◽  
Kin-Wai Tam ◽  
Dennis King-Hang Yee ◽  
Christian Fang ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Fracture Fixation ◽  
Reoperation Rate ◽  
Tension Band ◽  
Implant Removal ◽  
Patella Fracture ◽  
Suture Fixation ◽  
Hybrid Fixation ◽  
Fixation Methods ◽  
Patella Fractures

Introduction: Patella fractures managed by fixation with metal implants often cause local soft tissue irritation and necessitate implant removal. An alternative is to utilize suture-based fixation methods. We have adopted suture and hybrid fixation in the routine management of patella fractures. Here, we compare the results of 3 fixation techniques. Materials and Methods: Eighty-seven eligible patients underwent patella fracture fixation over a 3-year period. As determined by fracture configuration, patients received (1) suture fixation (transosseous sutures and figure-of-eight tension banding with FiberWire), (2) hybrid fixation (transosseous FiberWire sutures and metal tension banding), or (3) metal fixation. Primary outcome measures included reoperation rate and soft tissue irritation. Secondary outcomes included surgical complications, radiological, and functional parameters. Results: Reoperation rate was highest for metal fixation (25/57, 43.9%) and lowest for suture fixation (2/13, 15.4%). Soft tissue irritation necessitating implant removal was the predominant reason for reoperation and was significantly less prevalent following suture fixation (1/13, 7.7%, P < .01). Hybrid fixation resulted in similar rates of soft tissue irritation (6/17, 35.3%) and implant removal (7/17, 41.2%) as compared to metal fixation. There was a significant increase in patella baja (13/17, 76.5%) and reduction in Insall-Salvati ratio (0.742; 95% confidence interval: 0.682-0.802) following hybrid fixation as compared to the other 2 fixation methods ( P < .05). Discussion: Suture fixation results in the least amount of soft tissue irritation and lowest reoperation rate, but these advantages are negated with the addition of a metal tension band wire. Hybrid fixation also unbalances the extensor mechanism. Conclusion: Patients should be counseled as to the expected sequelae of their fixation method. Suture fixation is the favored means to fix distal pole fractures of the patella. An additional metal tension band loop may confer additional stability but should be applied with caution.

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