Multifragmentary patellar fracture has a distinct fracture pattern which makes coronal split, inferior pole, or satellite fragments

Abstract

The present study aimed to map the location and frequency of fracture lines on the coronal articular and sagittal planes in multifragmentary patellar fractures. 66 multifragmentary patellar fractures were digitally reconstructed using the 3D CT mapping technique. The coronal articular surface and midsagittal fracture maps were produced by superimposing each case over a single template. Each fracture line was classified based on the initial displacement and orientation. We evaluated the frequency and direction of the fracture line, coronal split fragment area, and satellite and inferior pole fragment presence. Coronal articular surface fracture mapping identified primary horizontal fracture lines between the middle and inferior one-third of the articular surface in 63 patients (95.4%). Secondary horizontal fracture lines running on the inferior border of the articular facet were confirmed (83.3%). Secondary vertical fracture lines creating satellite fragments were mostly located on the periphery of the bilateral facet. Midsagittal fracture mapping of primary and secondary horizontal fracture lines with the main coronal fracture line revealed a predominantly X-shaped fracture map. The consequent coronal split fragment and inferior pole fracture were combined in most cases. In conclusion, the multifragmentary patellar fracture has a distinct pattern which makes coronal split, inferior pole, or satellite fragments.

Comparison of Fixation Methods between Transosseous Pull-Out Suture and Separate Vertical Wiring for Inferior Pole Fracture of Patella: A Systematic Review and Meta-Analysis

“…Inferior pole fractures of the patella commonly present comminution at the distal fragments, occurring in 88% of cases in a recent series report. 2 Cho et al 4 observed interesting results of fracture comminution patterns using a three-dimensional (3D) computed tomography mapping technique, in which they often observed that horizontal fracture lines at distal the 1/3 of the articular surface and inferior pole and vertical fracture lines creating satellite fragments on the periphery of the bilateral facet. 4 Furthermore, coronal splitting fracture lines were also occasionally observed in the sagittal plane.…”

“…2 Cho et al 4 observed interesting results of fracture comminution patterns using a three-dimensional (3D) computed tomography mapping technique, in which they often observed that horizontal fracture lines at distal the 1/3 of the articular surface and inferior pole and vertical fracture lines creating satellite fragments on the periphery of the bilateral facet. 4 Furthermore, coronal splitting fracture lines were also occasionally observed in the sagittal plane. 4 Owing to these multifragmentary fracture patterns and inherent weak small bone in distal fragments, the tension band wiring technique is not feasible because it requires an intact cortical buttress to withstand compression and firm fixation to withstand the tensile forces.…”

“…2 In this regard, the goal of the surgical treatment of inferior pole fracture of the patella is to restore the extensor mechanism of the knee rather than anatomical reduction. 3,4 However, secure fixation to allow early motion is challenging in traditional surgical options using the anterior tension band technique with Kirschner wire or screw fixations. 4,5 This is because the inferior pole is a weak cancellous bone, and these fractures are usually small and multifragmentary, involving both the coronal and sagittal planes.…”

“…3,4 However, secure fixation to allow early motion is challenging in traditional surgical options using the anterior tension band technique with Kirschner wire or screw fixations. 4,5 This is because the inferior pole is a weak cancellous bone, and these fractures are usually small and multifragmentary, involving both the coronal and sagittal planes. 4,5 Thus, partial patellectomy has been traditionally performed for these fractures; however, this method has some disadvantages because the change in patellar height after the resection of the inferior pole may disrupt the normal physiology of the patellofemoral joint and may cause critical problems at long-term follow-up.…”

“…4,5 This is because the inferior pole is a weak cancellous bone, and these fractures are usually small and multifragmentary, involving both the coronal and sagittal planes. 4,5 Thus, partial patellectomy has been traditionally performed for these fractures; however, this method has some disadvantages because the change in patellar height after the resection of the inferior pole may disrupt the normal physiology of the patellofemoral joint and may cause critical problems at long-term follow-up. 6 A variety of methods have been developed for the successful treatment of inferior pole fractures of the patella.…”