Showing papers on "Patella fracture published in 1995"

Is there a place for patellofemoral arthroplasty

Abstract: Indications for patellofemoral arthroplasty were studied based on a 2- to 10-year followup review. Of 183 patellofemoral prostheses implanted between 1980 and 1990, 104 were associated with unicompartmental arthroplasty, and 79 were implanted alone. Thirteen patients were lost to followup. The results of 66 patellofemoral arthroplasties are reported at an average followup of 66 months. The mean age of the patients at surgery was 57 years. Underlying causes of the osteoarthritis included patellar dislocation or dysplasia (22), patellar fracture (20), and primary osteoarthritis (24). A metallic femoral groove was associated with a polyethylene patella with no metal backing. Two (9%) prostheses were revised in the dysplasia group, 1 (5%) in the posttraumatic group, and 7 (29%) in the primary osteoarthritis group. In this latter group, the indications of patellofemoral arthroplasty must be restricted to lesions of the patellofemoral joint in a knee in neutral axis evaluated preoperatively on full standing and stress radiographs. The best results of patellofemoral arthroplasty were obtained in osteoarthritis after patellar dislocation or patellar fracture.

Use of radiography in acute knee injuries: need for clinical decision rules.

Abstract: Objectives: To study: 1) the efficiency of the current use of radiography in acute knee injuries, 2) the judgments and attitudes of experienced clinicians in their use of knee radiography, and 3) the potential for decision rules to improve efficiency. Methods: This two-stage study of adults with acute knee injuries involved: 1) a retrospective review of all 1,967 patients seen over a 12-month period in the EDs of one community and two teaching hospitals, and 2) a prospective survey of another 1,040 patients seen by attending emergency physicians. The prospective survey assessed each clinician's estimate of the probability of a knee or patella fracture; 120 patients were independently assessed by two physicians. Results: Of the 1,967 patients seen in the first stage, 74.1% underwent radiography but only 5.2% were found to have fractures. Of the 1,727 knee and patella radiographic series ordered. 92.4% were negative for fracture. In the second stage. experienced physicians predicted the probability of fracture to be 0 or 0.1 for 75.6% of the patients. The kappa value for this response was 0.51 (95% CI 0.34 to 0.68). The physicians also indicated that they would have been Comfortable or very comfortable in not ordering radiography for 55.5% of the patients. The area under the receiver operating characteristic curve for the physicians' prediction of fracture was 0.87 (95% CI 0.82 to 0.91). reflecting good discrimination between fracture and nonfracture cases. Likelihood ratios for the physicians' prediction ranged from 0.09 at the 0 level to 42.9 at the 0.9–1.0 level. Conclusions: Emergency physicians order radiography for most patients with acute knee injuries, even though they can accurately discriminate between fracture and nonfracture cases and expect most of the radiographs to be normal. These findings suggest great potential for more efficient use of knee radiography, possibly through the use of a clinical decision rule.

Indirect forces and patella fracture after anterior cruciate ligament reconstruction with the patellar ligament. Case report.

Abstract: Patella fracture is either an infrequent or underreported complication after anterior cruciate ligament (ACL) reconstruction using a portion of the patellar ligament. Patella fracture pattern has been related to the mechanism of injury. Direct fractures resulting from impaction forces delivered to the patella are typically stellate or comminuted. Indirect fractures resulting from tensile stresses applied across the extensor mechanism typically are displaced transverse disruptions. After ACL reconstruction using a portion of the patellar ligament, Y-shaped stellate fractures can occur. Fracture pattern seems related to the time elapsed since the harvest; stellate fractures occur following stumbles or slips without direct injury early in the postoperative period while transverse fractures occur late. This article describes two cases of patella stellate fractures that occurred in patients who underwent ACL reconstruction using patellar graft.

A unique complication following arthroscopic anterior cruciate ligament reconstruction

Abstract: The use of the middle third of a patellar tendon with bone blocks is a common and well-accepted technique for arthroscopic reconstruction of the anterior cruciate ligament. We report here a disconcerting fracture/avulsion pattern of the patella/patellar tendon mechanism that occurred in the early postoperative period.

A follow-up study of porous-coated anatomic knee arthroplasty.

Abstract: Ninety-four patients (105 knees) having a porous-coated anatomic total knee arthroplasty were retrospectively studied. The mean follow-up period was 5.8 years. The diagnoses were osteoarthritis (90.5%) and rheumatoid arthritis (9.5%). There were 80 women and 14 men. The mean age at operation was 58.5 years. Clinical evaluation, using the Hospital for Special Surgery knee score along with radiography, was used to assess knee status before and after surgery. The postoperative mean axial alignment was 3° varus compared with 11° varus before surgery. Placement of the prosthetic components was acceptable, with the femoral component in 6.5° of valgus and the tibial component in 1.9° of varus and 1.1° posterior inclination. Complications included eight aseptic loosenings, four patellar maltrackings, one patellar fracture, eight wound problems, and one extension contracture. Most of the patients' knee function improved after surgery. The initial, postoperative range of motion improved in patients receiving continuous passive motion (CPM) immediately after surgery ( P = .03) compared to patients without CPM application; however, the long-term follow-up data show no significance ( P = .06) whether CPM was used or not. Age, body weight, degree of arthritic change, and modes of fixation yielded no significant influence on the final outcome. The porous-coated anatomic total knee arthroplasty is a valuable alternative procedure in the advanced arthritic knee when the proper candidates are selected, accurate surgical technique is executed and a suitable fixation mode is chosen.

Tricon hybrid total knee arthroplasty: a review of 81 knees followed for 2 to 4 years

Abstract: The authors discuss the results of 81 total knee arthroplasties in 65 patients performed between April 1987 and April 1989 using a Tricon hybrid system, consisting of the Tricon M bio-ingrowth femoral prosthesis and the Tricon C cemented tibial component The Tricon metal-backed patella was used until February 29, 1988, when the all-plastic Tricon C patella was introduced With an average follow up of 24 months (range: 12 to 48), 38 arthroplasties using this hybrid system were rated as excellent (47%) and 38 were rated as good (47%) The Hospital for Special Surgery scores, which averaged 53 preoperatively, averaged 80 at the most recent followup assessment At the most recent follow-up assessment, 79% of osteoarthritis patients and 56% of rheumatoid arthritis patients have no pain at rest, while 19% of osteoarthritis patients and 44% of rheumatoid arthritis patients have mild pain at rest Sixty-four percent of osteoarthritis patients and 33% of rheumatoid arthritis patients have no pain while walking, whereas 26% of osteoarthritis patients and 56% of rheumatoid arthritis patients have mild pain while walking Postoperative complications included fragmentation of the patella in five patients, all occurring with the metal-backed patella Five patients also experienced patellar subluxation (two metal-backed and three all-polyethylene) One patient had deep venous thrombosis which was treated successfully by re-hospitalization and heparin therapy; one patient with chronic heart disease expired 4 days postoperatively Use of the Tricon hybrid system has resulted in 94% of all patients having a good or excellent result an average of 24 months postoperatively Moreover, problems of patellar fracture and subluxation have not occurred since we began using the all-plastic patella

A case for partial patellectomy.

Abstract: The treatment of fractures of the the patella is a subject of controversy. Partial patellectomy with retention of a major fragment and suture of the quadriceps to it, seems reasonable. 18 cases of patella fracture underwent such a procedure. The average age of the patients was 47 years. Maximum recovery took an average of 5 months. There were 6 excellent results, 9 good, 3 fair. Results were assessed on the basis of pain, muscle wasting, quadriceps power, and range of knee motion. Total patellectomy and patella fixation as alternative modes of treatment are discussed. Partial patellectomy, whenever possible, is a good choice.

[Inter-trochleo-bicondylar fracture of the femur. An unusually traumatic lesion. Mechanism. Therapeutic implications].

Abstract: UNLABELLED The authors present a curious type of fracture of the distal end of the femur. They discuss the mechanism and the factors responsible for that lesion. The treatment and results are finally presented. MATERIAL A 65 years old female, submitted to a crash accident while driving a car, with a seat in maximaly low position. She presented a bilateral open transverse fracture of the patella associated in the right limb to a fracture line between condyles and the patellar surface of the femur. METHOD Bilateral osteosynthesis of both patella had been realised in emergency through a transverse approach. Through the fractured right patella two anteroposterior screws had been used to fix the fractured femur. RESULT A plaster cst had been used for three weeks. Full weight bearing was permitted after three months. Full range of motion of both knees was noticed after six months follow-up. DISCUSSION The femoral fracture could have been fixed by another device like D.C.S. platescreen but it would be weaker. That type of fracture was produced because of flexed low position of the knee at the moment of the accident. Usually, supra-condylar femoral fractures are due to a force vector applied on the upper extremity of the tibia without any patellar fracture. In our case, the patella involved associated to a fracture line between the condyles and the patellar surface. The structural anatomy (noeud sutural de Chevrier) explains the solidarity of the two femoral condyles.