Fraturas da patela: uma década de tratamento no IOT-HC-FMUSP - parte 1: análise funcional

Abstract

As fraturas da patela são prevalentes na faixa etária de 20 a 50 anos e representam 1% das fraturas. São classificadas através de 2 aspectos principais: característica do traço de fratura e presença de exposição óssea, o que dirige a escolha do tratamento dentro das diversas técnicas propostas. Este trabalho objetivou estudar a incidência dos padrões de fraturas patelares e analisar os resultados funcionais encontrados com as diferentes modalidades de tratamento no IOT-HC-FMUSP. Levantou-se 103 prontuários de pacientes com fratura de patela tratados no IOT no período de 1988 - 1999 com seguimento mínimo de 5 anos. A média etária foi de 39,4 anos, 68% do sexo masculino, 51,5% de acometimento do lado direito e 2,9% de bilateralidade. Prevaleceram fraturas transversas (36%); 30% de exposição óssea; técnicas mais utilizadas patelectomia parcial (46,6%), banda de tensão (20,4%), imobilização gessada (17,5%), cerclagem (4,8%) e patelectomia total (2,9%); notou-se 57,1% de excelentes e bons resultados com banda de tensão AO e 44,4% nas patelectomias parciais. Concluiu-se que o resultado funcional final do tratamento da fratura de patela é multifatorial; o tipo de fratura, o modo de tratamento - conservador ou cirúrgico, a idade e o mecanismo de trauma não influenciam, isoladamente, o sucesso da terapêutica.

Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation

“…The patient’s clinical and functional final evaluation was similar to other works such as Pailo et al [ 6 ] that showed 53.3% of good results are considered to be those in which the patient did not have pain, joint swelling and had a range of motion at least 110º of flexion and full extension. Torchia and Lewallen [ 9 ] also demonstrated similar outcomes.…”

“…Regarding the Gustilo and Anderson [ 10 ] classification, Torchia and Lewallen [ 9 ] described in their study about open patella fracture that 14.5% of all open patella fracture were classified as type I, 76.4% were type II, 1.8% were type IIIA and 7.3% were type IIIB. Catalano et al [ 7 ] and Pailo et al [ 6 ] reported similar incidences of open fracture in this joint, 15% type I, 53% type II and 32% type III. At present, no article was found reporting the incidence of open vertical patella fracture.…”

“…Open patella fracture compared with closed fracture of the same joint is in majority attributed to high-energy trauma such as in car accidents [ 6 , 9 ] and the direct trauma is the main mechanism [ 3 ]. Comminuted patella fracture and associated fractures of the other joints can also be found due to the nature of the trauma that caused the patella fracture [ 7 ], unlike this case that did not demonstrate this situation.…”

“…The transversal type is more frequent corresponding to 50-80%, comminuted 30-35% and vertical fractures 12-17% [ 2 , 3 ] and these are rarely displaced [ 5 ]. Open patella fracture expresses 6-30% of all patella fractures [ 6-9 ].…”

Open vertical sagittal fracture patella with fracture lateral condyle femur: approach to a rare injury

“…Open patella fracture compared with closed fracture is in majority attributed to high-energy trauma such as in car accidents (5,6) and the direct trauma is the main mechanism (3). There is sparse literature available about the incidence of open vertical patella fracture (7).…”