Showing papers on "Patella fracture published in 2014"

Patellar resurfacing complications in total knee arthroplasty

Abstract: Purpose The ideal management of the patella during total knee arthroplasty (TKA) is still controversial. Patellar retention is generally associated with an increased rate of anterior knee pain; however, patient satisfaction is similar in cases of replacement or retention. When the patella is replaced, potential severe complications can occur. Aim of this study was to retrospectively review results of a continuous series of patients having been treated with TKA and patella resurfacing.

The management of extensor mechanism complications in total knee arthroplasty. AAOS exhibit selection.

Abstract: Complications involving the knee extensor mechanism and patellofemoral joint occur in 1% to 12% of patients following total knee arthroplasty and have major negative effects on patient outcomes and satisfaction. The surgeon must be aware of intraoperative, postoperative, and patient-related factors that can increase the rate of these problems. This review focuses on six of the most commonly encountered problems: patellar tendon disruption, quadriceps tendon rupture, patellar crepitus and soft-tissue impingement, periprosthetic patellar fracture, patellofemoral instability, and osteonecrosis of the patella. The goals of this report are to (1) review the relevant anatomy of the knee extensor mechanism, (2) present risk factors that may lead to extensor mechanism complications, (3) provide a diagnostic and treatment algorithm for each of the aforementioned problems, and (4) review the specific surgical techniques of Achilles tendon allograft reconstruction and synthetic mesh augmentation. Extensor mechanism disorders following total knee arthroplasty remain difficult to manage effectively. Although various surgical techniques have been used, the results in patients with a prior total knee arthroplasty are inferior to the results in the young adult without such a prior procedure. Surgical attempts at restoration of the knee extensor mechanism are usually warranted; however, the outcomes of treatment of these complications are often poor, and management of patient expectations is important.

Patella fracture fixation with suture and wire: you reap what you sew.

Abstract: Introduction Operative fixation of displaced inferior pole patella fractures has now become the standard of care. This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring.

Exhibit Selection The Management of Extensor Mechanism Complications in Total Knee Arthroplasty AAOS Exhibit Selection

Abstract: Complications involving the knee extensor mechanism and patellofemoral joint occur in 1% to 12% of patients following total knee arthroplasty and have major negative effects on patient outcomes and satisfaction. The surgeon must be aware of intraoperative, postoperative, and patient-related factors that can increase the rate of these problems. This review focuses on six of the most commonly encountered problems: patellar tendon disruption, quadriceps tendon rupture, patellar crepitus and soft-tissue impingement, periprosthetic patellar fracture, patellofemoral instability, and osteonecrosis of the patella. The goals of this report are to (1) review the relevant anatomy of the knee extensor mechanism, (2) present risk factors that may lead to extensor mechanism complications, (3) provide a diagnostic and treatment algorithm for each of the aforementioned problems, and (4) review the specific surgical techniques of Achilles tendon allograft reconstruction and synthetic mesh augmentation. Extensor mechanism disorders following total knee arthroplasty remain difficult to manage effectively. Although various surgical techniques have been used, the results in patients with a prior total knee arthroplasty are inferior to the results in the young adult without such a prior procedure. Surgical attempts at restoration of the knee extensor mechanism are usually warranted; however, the outcomes of treatment of these complications are often poor, and management of patient expectations is important.

A simple technique for reconstruction of medial patellofemoral ligament with bone-fascia tunnel fixation at the medial margin of the patella: a 6-year-minimum follow-up study

Abstract: Medial patellofemoral ligament (MPFL) reconstruction has become an accepted technique to treat patellofemoral instability, and numerous surgical techniques have been described to reconstruct the MPFL. We describe a MPFL reconstruction procedure where bone-fascia tunnel fixation occurs at the medial margin of the patella for recurrent patellar dislocation. MPFL reconstruction is the preferred operative treatment for recurrent patellar dislocation. The purpose of this study was to report a simple technique for reconstruction of medial patellofemoral ligament with bone-fascia tunnel fixation at the medial margin of the patella for recurrent patellar dislocation and to evaluate the results at 6-year-minimum follow-up. The study included 65 patients (28 males, 37 females; mean age, 29.4 ± 5.6 years) who underwent MPFL reconstruction using the bone-fascia tunnel fixation at the medial margin of the patella technique and who were followed for a mean duration of 78.5 ± 3.8 months. Objective assessment, Kujala scale, Lysholm score, and Tegner activity score were obtained preoperatively and at the time of final follow-up. There were no patellar complications, including redislocation, in the present study. The congruence angle had significant improvement from 19.2° ± 6.3° before surgery to −6.03° ± 0.50° at the last follow-up. The lateral patellar angle had significant improvement from −6.9° ± 3.5° before surgery to 5.1° ± 2.4° at the last follow-up. The patellar tilt angle had significant improvement from 24.5° ± 5.2° before surgery to 12.30° ± 1.90° at the last follow-up. The Kujala score was significantly increased from 52.9 ± 3.2 points preoperatively to 90.1 ± 5.8 points postoperatively (P < 0.05). The mean Lysholm score was significantly increased from 47.2 ± 5.2 to 92.5 ± 6.2 points postoperatively (P < 0.05). The Tegner activity score improved overall from 3.1 ± 0.6 points to 5.8 ± 0.9 points at follow-up. We have done a simple technique where the MPFL is reconstructed safely to avoid patella fracture, anatomically to restore physiological kinematics and stability, and economically to reduce costs with bone-fascia tunnel fixation at the medial margin of the patella.

A retrospective comparison of the modified tension band technique and the parallel titanium cannulated lag screw technique in transverse patella fracture

Abstract: Objective To compare efficacy between the modified tension band technique and the parallel titanium cannulated lag screw technique for the transverse patella fracture. Methods Seventy-two patients were retrospectively analyzed aged 22 to 79 years (mean, 55.6 years) with transverse patella fractures, among whom 37 patients underwent the modified tension band and 35 patients received the titanium cannulated lag screw. Patients were followed up for 1-3 years. We analyzed the difference of operation time, complications, fracture reduction, fracture healing time, and the Iowa score for knee function between both groups. Results In modified tension band group, five patients had skin irritation and seven suffered wire migration, two of whom required a second operation. In comparison, there were no complications in the titanium cannulated lag screw group, which also had a higher fracture reduction rate and less operation time. Conclusion The parallel titanium cannulated lag screw technique has superior results and should be considered as an alternative method to treat transverse patella fracture.

Percutaneous cerclage wiring for the surgical treatment of displaced patella fractures.

Abstract: The patella plays an important role in the knee joint extension, and a patella fracture requires surgical treatment when it is accompanied by displacement of bone fragments and a joint surface gap. In patella fractures, there is disruption of the soft tissue structures that support the knee extension mechanism. We use a method of percutaneous cerclage wiring to fix the patella and include the peripatellar soft tissues in five patients. All cases were closed fractures, and the AO classification was type A in 1 and type C in 4. At a mean follow-up of 11.2 months, union was achieved in four cases with failure in one inferior pole fracture avulsion. There was no extensor lag noted in any patient, with mean flexion at 141° (120–160). As this percutaneous cerclage wiring method includes soft tissue approximation in the wiring, it may be especially suitable for comminuted fractures for which classic tension band wiring techniques cannot be used. We employed this procedure to atraumatically manipulate peripatellar soft tissues together with the fracture fragments in order to obtain optimal restoration of continuity of the extensor mechanism.

Open reduction and internal fixation of patellar fractures with tension band wiring through cannulated screws.

Abstract: The purpose of this study was to evaluate effectiveness and safety of a relatively new technique of open reduction and internal fixation of displaced transverse patellar fractures with tension band wiring (TBW) through parallel cannulated compression screws. A total of 30 patients with displaced transverse patellar fracture were enrolled in this prospective study. Of the 30 patients, 20 patients had trauma due to fall, 5 due to road traffic accident, 2 due to fall of heavy object on the knee, 2 due to forced flexion of knee, and 1 had fracture due to being beaten. All 30 patients were treated with vertical skin exposure, fracture open reduction, and internal fixation by anterior TBW through 4.0 mm cannulated screws. The postoperative rehabilitation protocol was standardized. The patients were followed postsurgery to evaluate time required for radiographic bone union, knee joint range of motion (ROM), loss of fracture reduction, material failure, and the overall functional result of knee using Bostman scoring. All the fractures healed radiologically, at an average time of 10.7 weeks (range, 8–12 weeks). The average ROM arc was 129.7 degrees (range, 115–140 degrees). No patient had loss of fracture reduction, implant migration, or material failure. The average Bostman score was 28.6 out of 30. Anterior TBW through cannulated screws for displaced transverse fractures is safe and effective alternative treatment. Good functional results and recovery can be expected.

Locked tension band wiring using ring pins for patellar fractures: a method of minimising implant migration

Abstract: A modified K-wire attached with ring (ring pin) was used to treat a displaced patellar fracture, and the ring pin was locked with tension band wiring. The purpose of this study was to evaluate the surgical outcome of this method with respect to its procedural safety. The authors retrospectively reviewed 36 patients treated for a displaced patellar fracture and assessed bone union, fixation failure, postoperative pain, range of motion, and incidence of hardware removal. Clinical outcome was evaluated using the Bostman scoring system. The mean follow-up period was 27 (range 13–47) months. Bony union was achieved in all patients. No fixation failure and pin migration were detected. Hardware was removed in three cases (8.3 %). Reasons for removal were pain in one case and vague discomfort in two cases. The average Bostman scores at 12 months postoperatively were 29.6, with 34 (94.4 %) patients graded as excellent. The average active flexion of the knee joint was 130.4° (range 125°–150°), with an average flexion contracture of 3° (range 0°–10°). This implant could facilitate satisfactory fixation, restore the integrity of the extensor mechanism, and reduce the possibility of implant migration and implant-related discomfort.

Management of comminuted patellar fracture with non-absorbable suture cerclage and Nitinol patellar concentrator.

Abstract: Purpose To evaluate the effectiveness and safety of a fixation technique for comminuted patellar fracture using non-absorbable suture cerclage and nickel-titanium patellar concentrator (Ni-Ti PC). Methods Twenty-nine consecutive patients with displaced comminuted patellar fractures accepted internal fixation procedure using Ni-Ti PC augmented with different types of non-absorbable suture cerclage. During follow-up, the clinical grading scales of Bostman, including range of movement, pain, work, atrophy, assistance in walking, effusion, giving way, and stair-climbing, were used to evaluate the clinical results. Complications including implant loosening, fragment displacement, bone nonunion, infection, breakage of the implants, painful hardware, and post-traumatic osteoarthritis were also assessed. Results Patients were followed up for a mean period of 27 months. The bone union radiographically occurred approximately 2.5 months without implant loosening and fragment displacement. According to Bostman method, satisfactory results were obtained, and the mean score at final follow-up was 28 (range 20–30) points. Twenty-two patients with excellent results had mean score of 29.8 ± 0.5 (range 28–30) and seven patients with good results had mean score of 22.7 ± 3.14 (range 20–27). No postoperative complications, such as infection, dislocation, breakage of the implants, painful hardware, and post-traumatic osteoarthritis, were observed. Conclusion Ni-Ti PC fixation with non-absorbable suture cerclage is a feasible approach for comminuted patellar fractures. Firm fixation with this technique resulted in satisfactory outcomes without obvious complications.

Suture anchor repair of quadriceps tendon rupture

Abstract: Knee extensor mechanism rupture is an uncommon, but significant, injury. The inability to actively extend the knee precludes normal gait. Quadriceps tendon injuries usually result from a simple fall in middle-aged men.1 Although low-energy fall mechanism of injury is most common, spontaneous rupture tends to occur in a subset of medical conditions (Table).2,3 Patients with quadriceps tendon ruptures are typically older (>40 years) than those who sustain patellar tendon injuries (<40 years).4 Optimal treatment mandates early evaluation, diagnosis, and surgical treatment,5 as operative treatment of chronic ruptures and nonsurgical treatment have inferior outcomes.2,6 Operative management of quadriceps tendon rupture has traditionally used either longitudinal (superior to inferior) trans-patellar drill holes (for tendinous avulsions) or simple suture repair with or without reinforcement (for intratendinous midsubstance ruptures).2 The complication and re-rupture rates after surgical repair have been approximately 14% and 2%, respectively.2 However, recent literature has demonstrated a previously unreported complication of displaced patellar stress fracture in patients undergoing extensor mechanism reconstruction using trans-patellar drill holes.7 In addition, normal anatomic studies of the quadriceps-patella tendo-osseous junction illustrate a more superficial junction (anterior 50%) with a footprint on the superior and anterior surface.8 Recently, surgeons have used a novel “pulley technique” with suture anchors to anatomically re-create the anatomic footprint for other tendinous avulsion repairs, including proximal hamstrings.9,10 Therefore, given the drill hole stress-riser effect and reproduction of normal anatomy, the authors recommend a suture anchor-based pulley technique repair that best replicates the normal anatomic footprint and may potentially avoid the risk of patellar fracture.

Effect of patellar thickness on early results of total knee replacement with patellar resurfacing

Abstract: Patellar thickness is a concern in total knee replacement with patellar resurfacing because of the risk of patellar fracture or implant loosening. The aim of this study was to evaluate if patellar thickness is related to clinical outcome in the absence of patellar fracture or implant loosening. Early results of 169 patients who underwent total knee replacement with patellar resurfacing were reviewed to assess the effect of patellar thickness on clinical outcome. The mean follow-up was 13 months. The range of motion, Knee Society Score, Function Score and WOMAC Score were assessed preoperatively, at day 0, 6 months and 1 year. Radiographs were assessed for patellar fracture or implant loosening. Thirty-one percent of all patients had preoperative thickness <21 mm. Seven percent had <12 mm residual thickness after patellar cut, all were female. Twenty-three percent had ≥1 mm increase of thickness after surgery. Radiographs did not show any patellar fracture or implant loosening. However, preoperative patellar thickness <21 mm had poorer gain in range of motion at 1 year. Preoperative range of motion had greater influence on postoperative range of motion than preoperative patellar thickness. Residual thickness <12 mm had lower gain in WOMAC score at 1 year and an increase in thickness ≥1 mm postoperatively was associated with lower gain in WOMAC score at 6 months. Early results of patellar resurfacing with preoperative thickness <21 mm or residual thickness <12 mm were found to be inferior even in the absence of patellar fracture or implant loosening. Conservative cutting resulting in 1 mm increase in thickness was also found to have inferior clinical results. II.

Treatment of patella infera by patellar tendon lengthening and augmentation with tibialis anterior tendon allograft.

Abstract: Management of patella infera remains a difficult therapeutic endeavor. We report a case of a 21-year-old man, who had development of patella infera and knee flexion contracture after a patella fracture. Patella infera was treated by patellar tendon lengthening and augmentation with a tibialis anterior tendon allograft fixed with bioabsorbable cross-pins. The patient regained an anatomic patellar position and full range of motion at two years after surgery.

Patella resurfacing during total knee arthroplasty: have we got the issue covered?

Abstract: There is no clear consensus on the optimal management of the patella during total knee arthroplasty (TKA). While original prosthetic designs did not include a patella resurfacing option,1) all contemporary designs provide this option. Indications for resurfacing include grade2,3) cartilage degeneration as well as the presence of inflammatory arthritis.4) The main contraindication to resurfacing is insufficient patellar bone stock. Arguments for and against resurfacing the patella exist. While anterior knee pain has been described after TKA when the patella is not resurfaced3) complications including patella fracture, osteonecrosis, instability, and patella clunk syndrome have been described in cases in which it was resurfaced.4) Contributing to this therapeutic dilemma is a large body of evidence supporting both practices. Waters and Bentley2) found a significantly higher incidence of anterior knee pain in unresurfaced patients. They also found that patients who had bilateral TKAs where only one side was resurfaced reported better outcomes on the resurfaced side. Burnett and Bourne5) in the longest published follow-up study to date found a 4 times revision rate in the nonresurfaced group (primarily for anterior knee pain) but no difference in functional outcome at 10 years. Recent meta-analyses by Parvizi et al.,6) Pakos et al.,7) and Nizard et al.8) have all concluded that resurfacing the patella decreases the incidence of anterior knee pain post-TKA and reduces the risks of revision surgery. Given this large number of studies comparing these practices and the inconclusive results of these, we set out to examine the views of practicing orthopaedic surgeons in the United Kingdom on patella resurfacing during TKA as well as their practice and the rationale for this in order to derive a consensus on this issue.

Bicondylar Hoffa's fracture with patellar dislocation - a rare case.

Abstract: Bicondylar Hoffa's fractures of the femur is very uncommon. Conjoint bicondylar Hoffa fracture with ipsilateral patellar dislocation, Bicondylar Hoffa's with patellar fracture and extensor mechanism rupture has been described in literature. We report a case of unconjoint bicondylar Hoffa's fracture with lateral patellar dislocation in 17-year-old male patient treated with open reduction and cancellous screw fixation that subsequently healed well with good functional outcome.

Extensor-mechanism-reconstruction of the knee joint after traumatic loss of the entire extensor apparatus

Abstract: Injuries to the extensor apparatus of the knee joint have an incidence of 0.5% to 6%. Although previous studies have described the advantages and disadvantages of operative treatment in cases of patellar tendon rupture, patella fracture or quadriceps tendon lesions, a report on the reconstruction of the extensor apparatus after traumatic loss of the patella, the patellar tendon, the tibial tuberosity and parts of the lateral quadriceps muscle is absent from the literature. We present the case of a young motorcyclist who underwent a reconstruction of the extensor apparatus using autologous tendon grafts. At a 24-month follow-up, the patient has a nearly physiological range of motion of the knee joint and is able to cope well with everyday life.

Patella rings for treatment of patellar fracture

Abstract: To evaluate a new fixation technique for patellar fracture using patella rings. A total of 75 patients (average age of 51.3 years) with comminuted or transverse patellar fractures were treated by fixation with patella rings. The Bostman scores at the time of bone union and at 12 months postoperatively were recorded, as was the degree of pain on a visual analogue scale (VAS), the range of motion of the knee at 12 months postoperatively, and any signs of postoperative complications. The average Bostman scores for patients in the transverse fracture group were 25.2 and 29.4 at 3 and 12 months postoperatively, respectively, while the scores for patients in the comminuted fracture group were 27.6 and 28.7, at the same time points. Bostman scores were graded as excellent and good in more than 90 % for patients with either a transverse or comminuted fracture. At the time of 12 months after surgery, the VAS score for patients with comminuted fractures was 0.38, whereas the score for patients in the transverse fracture group was 0.35. No statistically significant difference was found in the range of motion between the affected and uninjured knee at 12 months after surgery for patients in both groups (P > 0.05). This new fixation technique using a patella ring resulted in good outcomes for both transverse fracture and comminuted fracture and is beneficial for patients wishing to commence early functional activity.

Open, combat-related loss, or disruption of the knee extensor mechanism: treatment strategies, classification, and outcomes

Abstract: OBJECTIVE To report the outcomes of repair or reconstruction of high-energy, open knee extensor disruption or loss due to combat-related injuries. DESIGN Retrospective review. SETTING Tertiary (Level/Role V) Military Treatment Facility. PATIENTS Fourteen consecutive patients who sustained 17 complex, open knee extensor mechanism injuries during combat operations between March 2003 and May 2012. INTERVENTION Primary repair or staged allograft extensor reconstruction after serial debridement and closure or soft tissue coverage. MAIN OUTCOME MEASURES Final knee range of motion, extensor lag, ambulatory ability and assist devices, and complications requiring reoperation or salvage procedure. RESULTS The open knee extensor mechanism injuries required a mean of 11 procedures per injury. At a mean final follow-up of 39 months (range, 12-89 months), all patients achieved regular community ambulation, with 36% requiring assist devices due to concomitant or bilateral injuries. Average knee flexion was 92 degrees, and 35% of extremities had an extensor lag >10 degrees; however, 6 of 9 extremities with allograft reconstructions had extensor lags of <10 degrees, and 5 had no extensor lag. The presence of a major periarticular or patellar fracture was significantly associated with the knee requiring a subsequent extensor mechanism allograft reconstruction procedure. One extremity each underwent knee arthrodesis or transfemoral amputation due to severe infection. CONCLUSIONS High-energy, open knee extensor mechanism injuries are severe and rarely occur in isolation, but limb salvage is generally successful after multiple procedures. Patients who required staged allograft reconstruction, despite high complication rates, generally had favorable results. LEVEL OF EVIDENCE Therapeutic level IV. See instructions for authors for a complete description of levels of evidence.

A new technique for closed reduction of traumatic posterior dislocations of the hip: the 'PGI technique'.

Abstract: Many techniques have been described for closed reduction of posterior hip dislocations, but most require forceful and sustained traction, assistants to stabilise the pelvis and awkward positioning of the surgeon and/or the patient. We describe a new technique of closed reduction that does not need traction-countertraction or special positioning and can be safely and effectively performed by one surgeon.Fifteen patients, mean age 36.4 years, were subjected to reduction. There were five type I, four type II and six type III dislocations; ipsilateral injuries included one knee dislocation with patellar fracture, and two cases of tibia fracture. Closed reduction was achieved in 14 (93.3%) hips, with single attempt successful in 13 cases, while one needed two attempts. One hip could not be reduced due to incarceration of a posterior wall fragment and was managed by open reduction and internal fixation.Our new technique has proved to be a reliable, safe and effective alternative for closed reduction of posterior hip dislocations. It can be carried out by one surgeon, does not need traction and can be especially beneficial in polytrauma patients and also in those patients who have pelvic fractures and ipsilateral lower limb injuries.

Guider applied to patella fracture reduction and fixation

Abstract: The utility model discloses a guider applied to patella fracture reduction and fixation. The guider is composed of an arc fixed arm, an arc sliding arm, an external thread fastening needle penetrating guiding tube, a needle withdrawing guiding tube, a fixing bolt and a handle rotating nut. The two ends of the arc fixed arm formed by pressing a stainless steel square steel bar are provided with the needle withdrawing guiding tube and the external thread fastening needle penetrating guiding tube respectively. The center lines of the two tubes point to the center of the arc and are correspond to each other in parallel, and a kirschner needle is allowed to penetrate into or out of the tubes. The arc fixed arm is sleeved with the arc sliding arm, the fixing bolt penetrates through a central through hole of the arc fixed arm and a central through hole of the arc sliding arm from bottom to top, and the arc fixed arm and the arc sliding arm are fixed into a whole by screwing down the handle rotating nut. A plurality of needle penetrating through holes arranged at equal intervals are formed in the arc fixed arm and the arc sliding arm respectively from the arc faces to the two ends, so that the kirschner needle penetrates through the needle penetrating through holes. According to the guider applied to patella fracture reduction and fixation, a patella can be firmly fixed, the kirschner needle is accurately penetrated into the patella, the operation time is shortened, operation wounds are reduced, and safety and reliability are achieved. The guider can also be used for accurate special part fracture fixation for a distal humeral fracture, a talus fracture, an inferior tibiofibular screw, a tibial plateau fracture, a distal femur fracture and the like.

Multiple brown tumors and pathologic patellar fracture in a patient with secondary hyperparathyroidism.

Abstract: A 79-year-old woman presents with left anterior knee pain after a fall.

Arthroscopically Assisted Percutaneous Screwing of Patellar Fractures

Abstract: Objectives:Restore patellar anatomy and function of extensor mechanism. Reduction of surgical time, improval of rehabilitation and reduce complications of open surgery.Methods:37 patients with transverse patella fracture operated from June 2004 to April 2012. Inclusion criterion: Both sexes, age 20 to 65 years. Less than 10 days since fracture. Transverse fractures. Exclusion criterion: Comminuted , longitudinal and open fractures. More than 10 days since fracture. Fractures classified with AO and Watson Jones classifications. In all cases close reduction and percutaneous osteosynthesis with conic,canulated, compressive, full threaded screws of 3,5 and/or 5 mm diameter under fluoroscopic and arthroscopic assistance, was performed. Medium follow-up was 31 months (range 24-46) Comparative clinical evaluation of both knees was done: physical exam, X-rays and functional scales ( IKDC ; Lisholm Score, Knee Society score ).Results:Excellent results were achieved in 34 of 37 cases (91.9%). Three patients that ha...

Patella fracture stabilization splint

Abstract: The utility model provides a patella fracture stabilization splint, belongs to the medical sanitary technology and relates to the field of the department of orthopedics, in particular to the fixing technology for patella fractures. The patella fracture stabilization splint comprises connecting nails and is characterized in that the connecting nails are screws, and the screws penetrate through screw holes in an annular molding steel plate band wound around the fractured patella and are fastened and screwed on the fractured patella attached according to a fracture line; the thigh bone, the tibia and the fibula are located around the patella; the annular molding steel plate band is bent in the shape similar to that of the patella, recessed parts and protruding parts of the band are distributed at intervals and holes allowing the screws to penetrate through are formed in the protruding parts. The patella fracture stabilization splint has the advantages that mechanics stability is good and patient function exercise is facilitated; the integrity of an annular structure is high, the splint is suitable for fixing multiple fractures of the patella and is large in application range; the recessed parts and the protruding parts are designed at intervals, so that the influence on blood supply of the surface of the patella is reduced, growth and union are promoted, and the foreign body sensation of a patient is reduced; the patella fracture stabilization splint is convenient to use and operate.

Patellar fracture fixation: An unreported complication occurring directly attributable to tension band fixation of the patella.

Abstract: Patella fractures account for 1% of all fractures but there is little in the contemporary literature regarding either an optimal standardized post-operative rehabilitation regimen or the long-term outcomes following these fractures. Tension band wire fixation for displaced patella fractures is a well-recognised and accepted method of operative treatment for these fractures. In this case the authors report a new complication, yet to be documented in the literature that was directly attributable to a well-recognised complication resulting from this method of fixation. An atypical osteochondral defect, from the lateral femoral condyle, was generated as a direct result of bony spur at the site of the previous patella fracture malunion. As the patient fell on to her knee the bony spur was driven into the femoral condyle in a similar fashion to an osteotome, generating the atypical osteochondral defect. This patient had chronic anterior knee pain following the tension band fixation of her patella. An inadequate standardised follow-up regimen failed to identify her fracture malunion that was responsible for her ongoing persistent symptoms. Only as a result of this previously unreported complication, we were able to identify and surgically address the underlying primary pathology responsible for her persistent symptoms. This case highlights the importance for the identification and establishment of a more robust imaging follow-up regimen post patella fracture fixation.

Lower pole patella fracture: a combination of cancellous screw fixation and tension band wiring

Abstract: The fracture of the lower pole of the patella is a common type of fracture of the patella. The treatment involves internal fixation or excision of the lower fragment. This study was undertaken to study the efficacy of cancellous screw fixation combined with tension band wiring in the treatment of these fractures. Twenty patients with lower pole patellar fractures were treated by this technique and evaluated by Gaur's criteria for knee evaluation. Excellent good results were noted in 19 cases and fair result in one case. There were no poor results and there were no major complications hence it was concluded that cancellous screw fixation combined with tension band wiring is a good method for treating lower pole patellar fractures.

Split fracture: a complication of cerclage wiring of acute patellar fracture.

Abstract: INTRODUCTION Iatrogenic patellar fracture is reported as a complication of patella procedures, such as medial patellofemoral ligament reconstruction, reconstruction of the anterior cruciate ligament of the knee using bone-patellar tendon-bone technique, and resurfacing the patella in total knee arthroplasty. CASE PRESENTATION A 65-year-old lady with right patella fracture was treated with open reduction and cerclage wiring. An iatrogenic split fracture was noted during tension of the cerclage wire and was successfully managed by screw fixation of the split fracture. CONCLUSIONS Split fracture is a rare complication of circumferential cerclage wiring of patellar fracture. The surgeon should be aware of the contributing factors in order to avoid this complication.

Observation of Clinical Efficacy on Patellar Fracture Treated with Arthroscopy- Assisted Internal Fixation

Abstract: Objective To discuss the clinical efficacy on patellar fracture treatment with arthroscopy- assisted internal fixation. Methods Forty- five cases of patellar fracture were randomized into a control group( 19 cases) and an observation group( 26 cases). In the control group,the traditional open reduction and internal fixation was used. In the observation group,the arthroscopy- assisted minimally invasive internal fixation was adopted. The incision size,fracture healing time,overall efficacy and postoperative adverse conditions were observed in the patients of the two groups. Results The overall efficacy in the observation group was significantly better than that in the control group,indicating the significant difference( P 0. 05). In the observation group,the incision,fracture healing time,knee joint flexion range and Lysholm knee joint score were all superior to the control group( P 0. 05). Additionally,the postoperative infection incidence in the observation group was lower than that in the control group,indicating the significant difference( P 0. 05).Conclusion The arthroscopy- assisted internal fixation achieves the superior efficacy on patellar fracture as compared with traditional open reduction and internal fixation and can be the first approach to the treatment of patellar fracture.

Patellar fracture fixation splint

Abstract: The invention provides a patellar fracture fixation splint, belongs to the medical treatment and public health technology, and relates to the field of the department of orthopaedics, in particular to a patellar fracture fixation technology. The patellar fracture fixation splint comprises connecting nails and is characterized in that the connecting nails adopts screws, and the screws penetrate through screw holes in an annular shaping steel plate belt surrounding fractured patella and are tightly screwed on the fractured patella fit according to a fracture line; the femur, the tibia and the fibula surround the patella; the annular shaping steel plate belt bends like the patella and has alternate concave-convex distribution thicknesses, and the holes allowing penetration of the screws are formed in convex parts. The patellar fracture fixation splint has the benefits that good mechanical stability is achieved, and functional exercise of a patient is facilitated; the integrity of the annular structure is high, and the splint is suitable for fracture fixation of multiple patellae and has a large application range; blood supply influence on the patella surface is reduced due to the alternate concave-convex design, growth and union are promoted, and foreign body sensation of the patient is reduced; and the splint is convenient to use and operate.