Showing papers on "Patella fracture published in 2011"

Patellar Fractures in Adults

Abstract: Patellar fracture is a common injury caused by excessive tension through the extensor mechanism or a direct blow. The intact patella increases the leverage and efficiency of the extensor mechanism and articulates with the femoral trochlea. Patellar fractures can lead to stiffness, extension weakness, and patellofemoral arthritis. Nonsurgical management is indicated for nondisplaced fractures with an intact extensor mechanism. Surgical fixation is recommended for fractures that either disrupt the extensor mechanism or demonstrate >2 to 3 mm step-off and >1 to 4 mm of displacement. Anatomic reduction and fixation with a tension-band technique is associated with the best outcomes; however, symptomatic hardware is a frequent complication. Open fractures are associated with more complications than closed fractures. These complications can be mitigated with timely debridement, irrigation, and internal fixation.

Autografts commonly used in anterior cruciate ligament reconstruction.

Abstract: Anterior cruciate ligament reconstruction is among the most common orthopaedic procedures in the United States, with >200,000 performed annually. Much has been published regarding the use of autograft versus allograft. Bone-patellar tendon-bone is the most frequently used autograft, but hamstring and quadriceps tendon grafts are common alternatives. Each graft has distinct advantages and disadvantages, and selection is individualized. Fixation methods vary by graft type. Fixation resulting in a construct that is too rigid may restrict knee range of motion. Donor site morbidity must be considered, as well. Autograft harvest may result in anterior knee pain, kneeling pain, anterior knee numbness, muscle weakness, and patellar fracture. Appropriate graft selection is essential to optimize outcomes.

Cannulated Screw and Cable are Superior to Modified Tension Band in the Treatment of Transverse Patella Fractures

Abstract: Background Although the modified tension band technique (eg, tension band supplemented by longitudinal Kirschner wires) has long been the mainstay for fixation of transverse fractures of the patella, it has shortcomings, such as bad reduction, loosening of implants, and skin irritation.

Patellar Fracture After Medial Patellofemoral Ligament Surgery

Abstract: The medial patellofemoral ligament (MPFL) has been identified as the primary medial restraint to prevent lateral patellar displacement; it contributes up to 80% of the medial restraining forces on the patella1,2. Anatomically, the MPFL originates from the superior two-thirds of the medial patellar border and runs posteriorly toward the medial femoral epicondyle to insert in close relation to the origin of the superficial medial collateral ligament and slightly distal to the adductor tubercle3-5. Several techniques of MPFL repair and reconstruction have been described, with various graft options, tunnel placements, and fixation options, with or without concomitant procedures such as lateral retinacular release or tibial tuberosity osteotomy. Most techniques for patellar attachment of a reconstructed MPFL use patellar tunnels6-8, while some use suture anchors or soft-tissue fixation7,9,10. The potential complications of MPFL surgery include iatrogenic medial instability, persistent or recurrent lateral instability, patellofemoral arthrosis, loss of knee motion, and patellar fracture. In 1992, in a series of thirty patients, Ellera Gomes11 reported the first patellar fracture after MPFL reconstruction with use of a transverse patellar tunnel that traversed the entire width of the patella. Since then, eight patellar fractures have been reported after MPFL reconstruction with use of patellar bone tunnels. Four fractures in three series7,12,13 were attributed to technical errors associated with patellar tunnel placement. The other four fractures14,15 were medial rim avulsion fractures of the patella after MPFL reconstruction as the treatment for recurrent patellar dislocation. Fractures of the superior pole of the patella (superior pole sleeve avulsions) have been reported after medial soft-tissue imbrication and lateral retinacular release16-18; to our knowledge, similar proximal patellar fractures have not …

Dual tunnel medial patellofemoral ligament reconstruction for patients with patellar dislocation using a semitendinosus tendon autograft

Abstract: The purpose of this study was to describe a safer and more anatomical technique of MPFL reconstruction and to report the short-term results. The subjects included 20 patients with patellar dislocation with a mean age of 23. The operation was performed using a double-looped autogenous semitendinosus tendon graft. Two small bone tunnels were made at the medial edge of the patella, mimicking the wide patellar insertion of the MPFL and a bone tunnel was made at the femoral insertion site. The free ends of the graft attached to the patella and the loop end was fixed to the femoral side. Five patients were available for follow-up interviews by telephone and the remaining 15 were directly examined by physical examination and radiographic evaluation at 2 years or longer postoperatively. The average follow-up period was 30 months. Re-dislocation or patellar fracture was not seen in any patients. The average Kujala's score was 96 with a range from 84 to 100. Six patients were classified as excellent and 14 as good, according to the Crosby and Insall grading system. Radiographically, narrowing of the patellofemoral joint space was observed in 2 cases with previous osteochondral fracture out of those who were directly examined. The dual tunnel MPFL reconstruction produces favorable results in subjective and functional assessment of outcome without complications.

Reconstruction of the medial patellofemoral ligament using a longitudinal patellar tunnel technique – a review of twenty-five cases

Abstract: Purpose: Patellar instability is a common clinical problem affecting a young, active population. A large number of procedures have been described to treat patellar instability. We present the clinical results in a case series of 25 medial patellofemoral ligament reconstructions in 21 patients with up to 30 months follow-up (mean 7.3 months). Methods: Reconstruction was performed using either the gracilis tendon (6 cases) or semitendinosus tendon (19 cases) autograft. At follow-up the Tegner activity scores, objective knee function, complications and reoperations were assessed. Results: No patella re-dislocations were observed. Five patients (20%) required a manipulation under anaesthetic but subsequently regained a satisfactory range of motion. Two patients (8%) had post operative complications. One patient developed a post operative infection which required a washout and one patient developed a neuroma related to the hamstring harvest site which was excised. Both subsequently returned to work with a full range of motion. No patients sustained a patellar fracture. Conclusions: Medial patellofemoral reconstruction with both gracilis and semitendinosus tendon graft using a longitudinal tunnel technique provided good postoperative patellar stability restoring the primary soft tissue restraint to pathological lateral patellar displacement. Level of evidence: Level IV, therapeutic case series.

Midterm results of a porous tantalum monoblock tibia component clinical and radiographic results of 108 knees.

Abstract: The use of Trabecular Metal (TM), a biomaterial manufactured from elemental tantalum metal, has recently increased in orthopedics. One hundred eight consecutive TM monoblock tibias were implanted in 95 patients and followed for a minimum of 2 years. The average follow-up was 4.5 years. The average age was 65 years. The Knee Society score of 36 improved to 89. One hundred five of the knees were rated good/excellent, and 3 knees were rated poor. Two patellar revisions were performed for loose components and one for patellar misalignment. One patella fracture required open reduction and internal fixation. One femur was revised. There were no tibia revisions. There were no progressive radiographic lucencies. Midterm clinical and radiographic results of 108 consecutive TM tibia components have a high rate of success.

Double fixation of displaced patella fractures using bioabsorbable cannulated lag screws and braided polyester suture tension bands

Abstract: Summary Purpose To evaluate the effectiveness and safety of a new double fixation technique for displaced patellar fractures using bioabsorbable cannulated lag screws and braided polyester suture tension bands. Methods Fifteen patients (mean age of 46.2 years) with displaced transverse or comminuted patella fractures were enrolled in this prospective study. All of the patients were treated via the open reduction internal fixation (ORIF) procedure using bioabsorbable cannulated lag screws and braided polyester suture tension bands. The patients were followed post-surgery to evaluate (1) the time required for radiographic bone union, (2) the knee joint range of motion at the time of radiographic bone union, (3) the degree of pain assessed using the visual analogue scale (VAS), (4) the function of the knee using the Lysholm score and (5) the presence of any additional complications from the surgery. Results All of the patients were followed post-treatment for more than 1 year (range, 12–19 months; mean post-treatment follow up time, 14 months). The bone union of the fractures as seen radiographically occurred approximately 3 months from surgery in all cases without implant failure or redisplacement of the fractured site. The mean knee joint range of motion was from 0 to 134.6°, and the mean VAS score was 0.7 at the time of bone union. The mean Lysholm scores at the time of bone union and 12 months post-surgery were 86.7 and 95.7, respectively. No postoperative complications, such as infection, dislocation or breakage of the implants, were observed. Moreover, all of the patients returned to their previous activity level. Conclusion This new double fixation technique using bioabsorbable cannulated lag screws and braided polyester suture tension bands resulted in satisfactory outcomes for patella fractures without any obvious complications.

Fixed-angle plates in patella fractures - a pilot cadaver study

Abstract: Modified anterior tension wiring with K-wires and cannulated lag screws with anterior tension wiring are currently the fixation of choice for patellar fractures. Failure of fixation, migration of the wires, postoperative pain and resulting revision surgery, however, are not uncommon. After preliminary biomechanical testing of a new fixed-angle plate system especially designed for fixation of patella fractures the aim of this study was to evaluate the surgical and anatomical feasibility of implanting such a plate-device at the human patella. In six fresh unfixed female cadavers without history of previous fractures around the knee (average age 88.8 years) a bilateral fixed-angle plate fixation of the patella was carried out after previous placement of a transverse central osteotomy. Operative time, intra-operative problems, degree of retropatellar arthritis (following Outerbridge), quality of reduction and existence of any intraarticular screw placement have been raised. In addition, lateral and anteroposterior radiographs of all specimens were made. Due to the high average age of 88.8 years no patella showed an unimpaired retropatellar articular surface and all were severely osteoporotic, which made a secure fixation of the reduction forceps during surgery difficult. The operation time averaged 49 minutes (range: 36-65). Although in postoperative X-rays the fracture gap between the fragments was still visible, the analysis of the retropatellar surface showed no residual articular step or dehiscence > 0.5 mm. Also in a total of 24 inserted screws not one intraarticular malposition was found. No intraoperative complications were noticed. Osteosynthesis of a medial third patella fracture with a bilateral fixed-angle plate-device is surgically and anatomically feasible without difficulties. Further studies have to depict whether the bilateral fixed-angle plate-osteosynthesis of the patella displays advantages over the established operative procedures.

Gracilis tendon transfer associated with distal alignment for patella alta with recurrent dislocations: an original surgical technique.

Abstract: Many surgical techniques for the medial patellofemoral ligament have recently been suggested, all of which included problems identifying the femoral anchorage point and determining the proper extent of knee flexion for the transplant. P. Burdin proposed a different and original approach consisting in performing a gracilis muscle transfer to the medial edge of the patella, thus obtaining progressive tension of the transfer during knee flexion by means of the myotatic reflex. We report the results herein. We retrospectively assessed 17 knees treated for patellofemoral instability using this technique. Two cases presented subjective patellofemoral instability and 15 presented objective patellofemoral instability. The patients' mean age was 17.4 years (range, 8-47 years) during the first episode of dislocation. Two cases of instability were secondary to advanced neuromuscular disease. Two knees had already undergone two stabilization attempts. Fifteen knees presented trochlear dysplasia (four stage A, eight stage B, and three stage C). The mean age at surgery was 28.2 years (range, 16-47 years). In 15 cases, the gracilis transfer was associated with lowering the anterior tibial tuberosity (mean, 10mm). No patellar fracture occurred. A persistent sensory deficit of the anterior branch of the internal saphenous nerve was observed in 15 cases. One knee remained painful and retained subjective instability; total knee arthroplasty was performed 3 years after the intervention. The mean follow-up at revision was 5.5 years (range, 1.5-16.5 years). No recurrence of dislocation was reported. Eight cases retained subjective instability. The SF-36 and IKDC scores were good or excellent in 12 cases and the KOOS was good or excellent in 13 cases. Radiologically, patellar tilt persisted in six cases out of 14, translation persisted in two cases out of 14, and secondary patella baja was observed in one. Medial patellofemoral osteoarthritis was observed in five cases: one case IWANO stage I and four cases IWANO stage II. These satisfactory results seem stable over time and were acquired using a simple procedure with reduced morbidity, making it possible to avoid significant displacement of the anterior tibial tuberosity and stabilize the extensor apparatus. It can also be hoped that the onset of secondary patellofemoral osteoarthritis, undoubtedly inevitable, has been delayed.

Injury of a bipartite patella in a young upcoming sportsman.

Abstract: The aim of this study was to report the clinical features of a young athletic patient with bipartite patella, and review the literature to discuss the entity of this rare anomaly. In the course of an athletics competition, a 12-year-old top sportsman felt an intense pain around his left knee-cap while taking off from a jumping-board and broke down the competition. X-rays and magnetic resonance imaging showed an isolated distal pole of the patella with just minor diastasis; however, the X-rays did not suggest a recent fracture but rather hint at an atypically injured bipartite patella. A conservative therapy of 5 weeks with brace followed including a ban on sport activities for 12 weeks. Ten weeks later, the radiographs revealed a complete consolidation. Six months after the injury, MRI only presented a generally inconspicuous horizontal sclerosed structure. A fracture or separation of the bipartite patella was retrospectively diagnosed.

Mid-term (2-8 years) follow-up of open reduction and internal fixation of patella fractures: does the surgical technique influence the outcome?

Abstract: The objective of the study was to evaluate the clinical and radiological results of internal fixation of patella fractures, comparing tension band wiring techniques with proximal only and proximally and distally bend Kirschner wires (K-wires). Over a period of 6 years, 60 patients met the criteria to be included in this study of which 40 were available for mid-term (2–8 years) clinical and radiological follow-up. Out of 60, 9 failures of fixation occurred, 3 due to migration of the K-wires and 6 because of insufficient tensioning of the tension band. Failure due to migration, only occurred in the group with the proximally bend only K-wire technique. Our recommendation is to distally bend the K-wires as well as proximally to prevent migration of K-wires.

Ruptures de l'appareil extenseur du genou

Abstract: Knee extensor mechanism is composed of the quadriceps and its tendon, patella and patellar tendon. Rupture of either the quadriceps or patellar tendon, or of the patella itself, lead to a disruption of the knee extensor mechanism. Clinical examination reveals an inability to actively extend the knee. Standard radiographs of the knee show a suprapatellar swelling of the soft tissues in case of quadriceps tendon rupture, or a displaced patellar fracture, or a patella alta in case of patellar tendon rupture. Echography and MRI confirm the diagnosis and may reveal associated injuries. In case of knee extensor mechanism rupture, early surgical reconstruction of quadriceps or patellar tendon, or patella osteosynthesis, are mandatory to achieve early functional recovery.

Knee extensor mechanism ruptures

Abstract: Knee extensor mechanism is composed of the quadriceps and its tendon, patella and patellar tendon. Rupture of either the quadriceps or patellar tendon, or of the patella itself, lead to a disruption of the knee extensor mechanism. Clinical examination reveals an inability to actively extend the knee. Standard radiographs of the knee show a suprapatellar swelling of the soft tissues in case of quadriceps tendon rupture, or a displaced patellar fracture, or a patella alta in case of patellar tendon rupture. Echography and MRI confirm the diagnosis and may reveal associated injuries. In case of knee extensor mechanism rupture, early surgical reconstruction of quadriceps or patellar tendon, or patella osteosynthesis, are mandatory to achieve early functional recovery.

Extensor mechanism reconstruction: a novel technique for bone patella allograft post partial patellectomy failure.

Abstract: Extensor mechanism disruption, whether due to patella fracture or tendon rupture, generally occurs after low-energy trauma and frequently involves an indirect mechanism. When the fracture is comminuted and reconstruction is impossible, a partial or total patellectomy may be indicated. Although some authors advocate total patellectomy, partial patellectomy remains the standard treatment, especially for young and active patients. In the rare instance of a failed tendon repair after partial or total patellectomy, inadequate tissue is usually available for adequate restoration of the extensor mechanism. Extensor mechanism allograft, using the tibial tuberosity, patellar tendon, patella, and quadriceps tendon in continuity or the Achilles' tendon with calcaneal bone-block in continuity has been reported for extensor mechanism repair after total knee arthroplasty in patients who did not undergo patellectomy. We present a novel technique, using the bone patellar tendon bone allograft to reconstruct a posttraumatic defect of the extensor mechanism in a 28-year-old, active patient with a failed partial patellectomy following fracture of his patella. Union of the allograft was seen on x-ray after 4 months. After 6 months, the patient reached full range of motion and returned to his previous sporting activities.

Isolated osteochondral fracture of the patella without patellar dislocation.

Abstract: Chondral fractures of the patella are associated with acute dislocation of the patella. Osteochondral fracture in patellar dislocation is located in the medial facet of the patella. This article presents a case of a 15-year-old female ballerina with isolated displaced osteochondral fracture of the patella without patellar dislocation. She had no history of trauma. A Merchant's view of both knees showed mild subluxation of the patella, a small fragment on the lateral aspect of the knee, and a small defect of the centromedial patella. Axial magnetic resonance imaging (MRI) revealed an osteochondral fragment measuring 13 mm medial to the patella. However, the medial patellofemoral ligament and medial retinaculum were intact. An effusion on the medial side of the patella consistent with hemarthrosis was observed. An absence of a contusion or bone bruise on the lateral femoral condyle was shown. The loose body was removed arthroscopically. Intraoperative findings included a 1.5×2 cm osteochondral fragment. It is unusual that the osteochondral patellar defect site in this patient was in the inferior and central areas of the patella. Patellar chondral fractures without dislocation or patella fracture are rare. Therefore, the possibility of a trivial trauma leading to an osteochondral fracture should be kept in mind in adolescent and young adults who present with knee pain and hemarthrosis.

Patellar tendon reconstruction with semitendinosus-gracilis autograft.

Abstract: We present a case of a 24-year-old, otherwise healthy, man who sustained a right knee injury after a fall. A small, comminuted inferior pole patella fracture with medial and lateral retinacular tears was encountered that required a small, nonarticular partial patellectomy and patellar tendon repair. An uneventful postoperative course was complicated by a fall onto a flexed knee and rerupture of the patellar tendon at 3 months following surgery. Intraoperatively, a significant tissue void was seen in the area of the prior repair. The patellar tendon was reconstructed with semitendinosus and gracilis autograft. At 1 year follow-up, the patient had regained a normal gait, had no pain, and had full range-of-motion without extensor lag.

[Bilateral traumatic patella fracture: a case report].

Abstract: Patellar fractures are uncommon injuries and account for approximately 1% of all fractures. In this article, a 35-year-old male patient who sustained a collision deceleration accident with bilateral comminuted transverse patellar fractures is presented. For this patient, open reduction and internal fixation with tension band technique, using two Kirschner wires and cerclage wire was applied for both fractures. At the first postoperative day, isometric quadriceps and active range of motion exercises were begun and the patient was allowed to walk full weight bearing with two crutches while both extremities were immobilized in a hinged brace allowing maximum 30 degrees of flexion. At postoperative fourth week brace immobilization was terminated. However, the patient was advised to use crutches for two weeks more to prevent any complications that may arise during walking because of the bilaterally of the injury. At six weeks solid union was achieved. During the last visit at postoperative second year, the patient had no complaints and the range of motion was full. In this paper a case of bilateral patella fractures is presented as a consequence of a dashboard injury, and the pathomechanical and therapeutical aspects of such an injury is discussed.

Patellar Fracture Analysis Using Segmentation and Global Thresholding Techniques

Abstract: Radiologists identify abnormal pathologies including fractures with a high level of accuracy. However in some cases the examining reader accuracy may show high miss rate while reading X-rays containing abnormalities such as multiple patellar fracture. Accurate diagnosis of fractures is vital to the effective management of patient injuries. As a result, detection of patellar fracture is an important orthopedics and radiologic problem. In this paper, attempt has been made to develop an algorithm which will identify global thresholding ranges for different edge detection operators e.g. Sobel, Prewitt, Canny, Laplacian of Gaussian for analysis of fractured patella, which will help the orthopedic surgeons for analyzing the fracture in a better form than conventional method of diagnosis which is subjective, time consuming and tedious. The processing algorithms are developed on MATLAB 7.6.0 (R2008a) programming platform.

Long term outcome of patella fractures:open reduction and internal fixation with stainless steel wire vs.non-absorbable braided polyester suture

Abstract: Objective To determine the long term outcome of patella fractures managed surgically with two different types of fixation:stainless steel wire or non-absorbable,braided,polyester suture.Design A prospective trial where patients were recruited in a consecutive fashion between the years 2000 and 2005 and randomized into 2 treatment groups through random number generation and number assignments in sealed envelopes.Patients were blinded to the treatment group assigned.Surgical technique and post-operative protocol was the same for each group.Subjects Patients were over the age of 16 and medically fit who presented with a displaced patella fracture requiring operative fixation.Patients were able to give consent and could follow post-operative rehabilitation requirements.Interventions In the 2 groups,open reduction and internal fixation of the patella fractures was standardized with 2 longitudinal K-wires and a figure of eight tension band using either 18 G stainless steel wire or 2 #5 ethibond sutures.Outcome Measures The primary outcome measure was re-operation rate.Secondary outcomes included surgical procedure time,the presence of clinical and radiographic union,and validated functional outcome measures (knee questionnaire,Euroqol EQ-SD,SF-36)collected from patients at final follow up.Results Almost all patients were followed to clinical and radiographic union(20/22).Average follow-ups for the stainless steel wire and suture groups were 4 and 2.3 years respectively.The re-operations in the wire and suture groups was 4 (of 11)and 5(of 11)respectively.The majority of re-operations were due to longitudinal K-wire related irritation (6/9).The wire group had a slightly shorter average surgical time than the suture group(33 vs.44 minutes),which was not statistically significant.Long term functional outcome scores indicated that there was some residual disability in patellar fracture patients,although this was not debilitating.Conclusions We suggest that a major determinant of re-operation for patella fracture fixation in a tension band technique is unnecessary longitudinal K-wire length.Suture can be as good as wire in achieving clinical and radiographic union of patella fractures.Patients with patellar fractures can achieve a reasonable functional outcome but will have a high chance of re-operation during their recovery period. Key words: Patella; Fractures; Treatment outcome; Bone wires; Sutures

Patellar fracture masked by concomitant prepatellar bursitis: clinic-based ultrasonographic findings.

Abstract: U ltrasonography can be helpful in detecting signs of fracture. In acute knee trauma, high-resolution ultrasound was reported to show increased sensitivity of 97% versus 55% for conventional radiographs in detecting fractures. A 52-year-old woman was referred to the rheumatology clinic with a diagnosis of prepatellar bursitis by the orthopedic surgeon. After falling and hitting her patella on a hard floor, she complained of severe pain, which was managed with a cast and intravenous analgesics in the emergency department. No radiographic studies were performed at that time. Three days later in the rheumatology office, physical examination showed localized swelling in the prepatellar area with moderate pain to palpation. Sonographic study showed a disruption of the patellar bone compatible with fracture. The diagnosis of an incomplete patellar fracture was then corroborated by x-ray. In addition, a localized hypoechoic area was observed superficial to the patellar bone surface consistent with concomitant prepatellar bursitis (Fig.). We conclude that ultrasound may be useful in detecting fractures by identifying cortical bone disruption, such as in this case in which radiography was initially omitted. Real-time performance is one remarkable advantage of clinic-based musculoskeletal ultrasonography for rheumatologists. It can improve the accuracy of the clinical diagnosis, sometimes altering management.

Patella fracture reduction forceps

Abstract: The utility model relates to medical instruments, in particular to a patella fracture reduction forceps which comprises a forceps handle, a forceps body and a forceps head, and is characterized in that the forceps head is designed into forceps teeth for being in line with the shape of patella. As for the complicated comminuted patella fracture, after the fracture is exposed well in operation, the patella is clamped by the forceps teeth being in line with the shape of the patella of the patella fracture reduction forceps, so as to enable the comminuted patella fracture to be completely restored, thus carrying out internal fixing at ideal position, being simple and convenient as well as time-saving and effort-saving in operation, effectively shortening operation time and reducing the pain of a patient.

Encircling fixer for treating patellar fracture

Abstract: An encircling fixer for treating patellar fracture belongs to the technical field of orthopaedic medical instruments; and the fixer is used for avoiding various complications and fixing and resetting fractured patella exactly and firmly; the technical scheme is that the fixer comprises an encircling sheet and a side fork; the encircling sheet is a stripped sheet; the axial direction of the sheet has an radian matched with the upper periphery or lower periphery of the patella; two sides of the encircling sheet are provided with a plurality of side forks; the directions of the side forks are along the upper and lower surfaces of the patella; the plate face of the encircling sheet is provided with a plurality of screw holes. The encircling fixing guider has the advantages that a fixer can be used for fixing the reset fractured patella in a surgery; if an X-ray perspective result is not satisfied, the fixer can be adjusted directly until the anatomical reduction is realized; the screw holes are convenient for embedding guide pins exactly and finally fixing bolts; a minimally invasive surgery is adopted, which slightly damages soft tissues and is in favour of protecting the blood circulation of the patella and healing the facture. The utility model is an inventive medical instrument for treating patellar fracture; and the medical instrument is worth popularizing and applying clinically.

Braided Polyester Suture Fatigue Failure When Treating Transverse Patellar Fracture: A Case Report

Abstract: Patellar fractures account for 1% of all skeletal fractures and frequently require surgical intervention. Recently, non-absorbable polyester sutures have been advocated as good substitutes for stainless steel wire in certain fracture fixations, including patellar and olecranon fractures. They are said to be strong and have some advantages over conventional stainless steel wire. However, limited study scale and even experiences required in manipulation make it controversial to routinely use this relatively new method for fracture fixation. There are few reports describing complications with their use. Herein, we report a case of failed fixation using Ethibond sutures in a transverse patellar fracture. The sutures failed to sustain the repetitive loads of daily activities because of too few loops and inadequate knotting. Considering a stable and secure construct is prerequisite to bony union, surgeons should be knowledgeable of mechanical properties of these materials they use and the corresponding surgical techniques needed to avoid later fixation failure.

Fratura de patela com ruptura do tendão patelar em um cão: relato de caso (Patella fracture with rupture of the patellar tendon in a dog: case report)

Abstract: It is reported the occurrence of patellar fracture associated with rupture of the patellar tendon in a mongrel male dog referred to a Teaching Veterinary Hospital. The used technique was the combination of bone fixation with Kirschner wire and application of tension band recommended in most transverse fractures of the patella. To repair the damage to the patellar tendon, the modified Kessler suture with nylon 0.80mm was performed. When the patient returned 150 days after surgery, advanced bone healing process was observed in patella. It was concluded that the measures taken to repair the injury were effective.

A Case of Delayed Recurrent Hemarthrosis after Percutaneous Pin Fixation of the Patellar Fracture

Abstract: Received: March 26, 2010 Revised: (1st) April 20, 2010, (2nd) June 4, 2010, (3rd) July 27, 2010, (4th) August 30, 2010, (5th) November 24, 2010 Accepted: December 2, 2010 Corresponding author: Kyung Wook Nha, M.D. Department of Orthopedic Surgery, Inje University Ilsan Paik Hospital, Inje University College of Medicine, 2240 Daehwa-dong, Ilsanseo-gu, Goyang 411-702, Korea TEL: 82-31-910-7968, FAX: 82-31-910-7967 E-mail: kwnhamj@hotmail.com A 24-year-old man underwent percutaneous fixation with pins for an undisplaced patellar fracture. At 7 months follow-up postoperatively, he presented with recurrent, painful swelling of the operated knee following trivial activities of daily life. Aspiration had been performed two times before he presented to us with symptoms. An x-ray showed that one of the pins was suspected to be protruding at the inferior pole of the patella. Magnetic resonance imaging confirmed effusion in the joint. Arthroscopy revealed that the pin was prominent intraarticularly, and the adjacent infrapatellar fat pad with surrounding synovial tissue seemed to be abraded. The pins were removed under arthroscopic guidance and any pain or hemarthrosis disappeared thereafter.