Showing papers on "Patella fracture published in 2006"

Clinical results of isolated reconstruction of the medial patellofemoral ligament for recurrent dislocation and subluxation of the patella.

Abstract: Complications and results of medial patellofemoral ligament (MPFL) reconstruction, performed between 2000 and 2003, were studied retrospectively in 24 randomised patients (24 knees). All procedures were performed for recurrent dislocation or subluxation of the patella, using an autogenous semitendinosus tendon. Two different methods of anchoring of the transplant were compared. After a 2-year follow-up, patellar stability was found to be similar, when the transplant was sutured to the fibrous tissue and periosteum overlying the patella or when it was fixed in a bone tunnel through the patella. The majority of the patients who had undergone MPFL reconstruction have returned to their previous level of sports activities. We had two cases of patella fracture and one case of persisting patella apprehension after surgery. Further studies must determine which measures are necessary to prevent these complications.

Migration of a broken cerclage wire from the patella into the heart. A case report.

Abstract: Fixation wires are used routinely for the treatment of fractures and dislocations. Wire migration is believed to be a rare but potential complication. We describe the case of a patient in whom a broken cerclage wire migrated from the right patella into the right ventricle. The patient was informed that data concerning this case would be submitted for publication. To our knowledge, no similar cases have been reported in the literature. Aforty-seven-year-old man underwent a barium swallow to evaluate gastroesophageal reflux due to a hiatal hernia. The radiographs demonstrated a metallic wire in the right ventricle of the heart (Figs. 1-A and 1-B). The clinical history revealed that the patient had undergone surgery with use of circumferential wiring for the treatment of a transverse patellar fracture of the right knee thirteen years previously. The fracture had healed, and the patient had not had any subsequent knee pain or swelling. The hardware had not been removed because there were no clinical symptoms related to the right knee. A radiograph of the right knee showed a broken patellar cerclage wire with absence of the superior part of the wire (Fig. …

Periprosthetic Patellar Fractures

Abstract: Patellar fracture after total knee arthroplasty is a rare yet challenging complication. Patellar fracture can occur as a result of trauma or it may be atraumatic. A multitude of factors can lead to periprosthetic patellar fracture including patient related factors, surgical technique related factors

Patella maltracking in posterior-stabilized total knee arthroplasty.

Abstract: Maltracking of the patella component in total knee arthroplasty usually leads to complications such as subluxation, dislocation, fracture, excessive wear, or implant failure. After using a new posterior-stabilized total knee arthroplasty and a specific protocol for the patellofemoral articulation we determined the incidence of lateral retinacular release and patella complications. We retrospectively reviewed 255 consecutive primary posterior-stabilized total knee arthroplasties with an anatomic femoral component and a three-peg offset-dome patella. Component alignment was achieved using Whiteside's lines for the femoral component, the medial border of the tubercle for the tibial component, and previously reported techniques for the patella. Lateral release was performed in 15 knees (6.2%), most of which had excessive preoperative valgus (mean, 15 degrees). There were no reoperations for the patellofemoral joint at a mean followup of 3.7 years (range, 2-7 years). Two patients had asymptomatic osteonecrosis of the patella with complete radiolucent lines, and one patella fracture was treated with immobilization. We believe patella maltracking a largely avoidable problem in total knee arthroplasty. We found a low incidence of lateral retinacular release and patella complications using these components and this protocol for the patellofemoral articulation.

Patellar complications following distal femoral replacement after bone tumor resection.

Abstract: Background: Patellar complications following endoprosthetic reconstruction can occur as a result of anatomic, physiologic, and surgical reasons. Patellar impingement on tibial polyethylene is a complication of distal femoral replacement, and it is frequently related to inaccurate restoration of the joint line and to soft-tissue contracture. The purpose of our study was to determine the prevalence and type of patellar complications following distal femoral replacements after excisions of bone tumors. Methods: The results of reconstruction with use of a rotating-hinge endoprosthesis following excision of a distal femoral tumor in forty-three patients were retrospectively reviewed. Patients were followed clinically and radiographically for a minimum of forty-eight months or until death. Pain status, functional scores, and the range of motion were determined from a prospectively maintained database. The ratio of the patellar tendon length to the height of the patellar tendon insertion, as described by Insall and Salvati, was calculated. In addition, we attempted to determine whether the position of the patella was associated with anterior knee pain or with the functional scores derived with use of the International Society of Limb Salvage (ISOLS) scoring system. Results: Thirty-five patellar complications, including eleven cases of impingement, occurred in twenty-seven patients (63%). We found no difference, on the basis of our sample size, with regard to the presence of patellar pain, the range of motion, or the Insall-Salvati ratio between the patients with and those without impingement. The ratio of the patellar tendon length to the height of the patellar tendon insertion averaged 0.9 in the group with impingement and 1.4 in the group without impingement (p = 0.07). The ISOLS score averaged 21.2 points in the group with impingement compared with 24.2 points in the group without impingement (p = 0.01). Patella baja occurred in nine patients. The average ISOLS score (and standard deviation) was 20.1 ± 4.4 points for the patients with patella baja compared with 24.8 ± 3.9 points in the group with a normal patellar position (p = 0.004). Patellar fracture occurred in two patients, and osteonecrosis occurred in two patients. These patients were treated nonoperatively. Conclusions: Patellar complications are common after distal femoral resection and endoprosthetic reconstruction. Patellar impingement on the polyethylene tibial bearing surface is a more common and important complication of distal femoral replacement than has been reported to date. Patella baja is also a relatively common complication, which has a negative impact on knee function. Level of Evidence: Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.

Case reports: pathologic fracture of the patella from a gouty tophus

Abstract: Fracture of the patella is a relatively common condition seen in patients with trauma. We report one patient with known gout who sustained relatively minor trauma that resulted in a patellar fracture. An intraoperative biopsy confirmed that much of the patella had been replaced with gouty tophus. Gout is a rare cause of patellar fracture, with few documented cases. Postoperative management of patients with patella fractures secondary to gout may be routine with the addition of medical management for the underlying pathologic process.

Vastus medialis muscle flap and hemi V-Y skin flap for knee extensor and soft tissue reconstruction

Abstract: Simultaneous reconstruction of extensor mechanism and skin defect of the knee joint is a difficult problem. We present a case of a 55-year-old man with loss of patella and 9 x 6 cm skin defect after total patellectomy for infected open patellar fracture. Vastus medialis muscle flap and hemi V-Y skin flap were elevated. Vastus medialis muscle flap was advanced and sutured to the remaining patellar tendon. Hemi V-Y skin flap covered the skin defect. The wound healed uneventfully. After a follow-up period of 30 months, active range of motion of the knee joint is 0-120 degrees, and extension strength of the knee joint is [4] in a manual muscle test. He can stand on his right leg without any assistance. The combination of vastus medialis flap and hemi V-Y skin flap is a valuable option in knee reconstruction after total patellectomy.

An Unusual Case of Bipartite Patella Fracture with Quadriceps Rupture

Abstract: Bipartite patella fracture with quadriceps rupture is an unusual injury. It is quite often mistaken as an avulsion fracture of patella, and the X-ray of contra-lateral knee is useful for diagnosis, and appropriate treatment should be decided at the time of surgery. We report a single case of this entity in which bipartite patella fracture was misdiagnosed initially as a patellar fracture.

Unicortical transverse osteochondral fracture of the patella: a case report.

Abstract: Chondral lesions are relatively common and they usually occur as a result of high energy trauma. Chondral fractures of the patella ordinarily occur during an acute dislocation of the patella. Patellar chondral fractures without either a dislocation or a patella fracture are extremely rare. We have treated a 25-year-old male who had a unicortical transverse osteochondral fracture of the patella without a dislocation which was produced by high energy trauma. Chondral fractures of the patella are often overlooked because they are difficult to detect on plain radiographs. A persistent cartilaginous irregularity from either a chondral or osteochondral fracture may lead to the development of secondary osteoarthrosis. In this case, restoration of the articular surface was achieved by elevation of the compressed osteochondral fragment. This case demonstrates that understanding the mechanism of injury can be helpful in the treatment of osteochondral lesions.

Pathologic fracture of the patella from a gouty tophus

Abstract: Fracture of the patella is a relatively common condition seen in patients with trauma. We report one patient with known gout who sustained relatively minor trauma that resulted in a patellar fracture. An intraoperative biopsy confirmed that much of the patella had been replaced with gouty tophus. Gout is a rare cause of patellar fracture, with few documented cases. Postoperative management of patients with patella fractures secondary to gout may be routine with the addition of medical management for the underlying pathologic process.

A Case of Dysfunction after Reconstruction of Knee Extensor Mechanism Using Artificial Ligament

Abstract: We report a case of dysfunction following reconstruction of the knee extensor mechanism using artificial ligament. Three years ago, a 49-year-old man sustained an injury of the patella fracture of the left knee in a traumatic event. Since then, he had not been able to walk without crutches or extend his left knee completely. Plain radiograph showed two divided bony fragments of the patella and that the periarticular bone had changed atrophically. The distance between the two fragments was approximately 7cm. The knee extensor apparatus recontruction was performed using the Leeds-Keio artificial ligament, which was fixed to the tibia with double staples. The rehabilitation program was controlled strictly. Eighteen weeks after the operation, no extension lag was found and he could walk by himself. At 28 weeks after the operation, however, he had not been able to extend the operated knee on his own and the extension lag increased to 20°suddenly. On examination at 47 weeks after operation, the MRI showed loosening of the artificial ligament resulting from weak fixation due to the tibial atrophy. Although the knee extensor apparatus recontruction using artificial ligament is a good method, results for this case were poor. We concluded that it is necessary to reinforce the fixation of the artificial ligament in such bone atrophy cases by the addition of another augmentation.