Open Fractures of the Patella

Abstract

Seventy-nine open patella fractures in 76 patients were treated between 1986 through 1994, with an 80% incidence of multiple injuries. All were treated with irrigation and debridement, open reduction, internal fixation, and reconstruction of the extensor mechanism. In no case was a primary patellectomy performed, even with severe comminution. There were three failures of initial fixation and one asymptomatic nonunion. Average range of motion for all groups was 112 degrees, at an average follow-up of 21 months. Secondary surgical procedures were performed in 65% of knees, the majority for symptomatic hardware. To determine long-term functional outcome, a modified Hospital for Special Surgery knee score was used. At an average of 36 months, good to excellent knee scores were observed in 17 of 22 patients. We conclude that all attempts for preservation of bone substance and precise reconstruction of the extensor should be attempted, reserving total patellectomy as a salvage procedure.

Percutaneous Cannulated Screws with Tension Band Wiring Technique in Patella Fractures

“…The objectives of surgical treatment include preservation of the knee cap to the greatest possible extent, precise anatomic reduction of the joint surface by stable fixation, and restoration of the knee-extensor mechanism, thus allowing early mobilization3,4). The usual surgical intervention is carried out through a long skin incision with a substantial soft tissues dissection to sufficient for fracture and joint-surface visualization.…”

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

“…Of those, only approximately one-third requires surgical attention [2,3]. The aim of surgical treatment in addition to the preservation of most of the kneecap, is anatomical reduction of the articular surface, followed by stable fixation, restoration of the extensor mechanism and early mobilization [4-11]. …”

“…Despite several technical modifications of the anterior tension wiring, early fracture dislocation can be observed in 22-30% of all cases [15,16]. Apart from failure of fixation, migration of the wires, postoperative pain and resulting revision surgery are not uncommon, making the long-term outcome in clinical studies quite poor [4,17,5,7,9,18]. Secondary postoperative pain due to skin irritation caused by the K-wires also is a common problem in the tension-band wiring of patellar fractures [14,4,5,9,19,18].…”

“…Apart from failure of fixation, migration of the wires, postoperative pain and resulting revision surgery are not uncommon, making the long-term outcome in clinical studies quite poor [4,17,5,7,9,18]. Secondary postoperative pain due to skin irritation caused by the K-wires also is a common problem in the tension-band wiring of patellar fractures [14,4,5,9,19,18]. Thus, revision surgery with K-wire removal becomes necessary in up to 65% of cases [2,4,5,9].…”

“…Secondary postoperative pain due to skin irritation caused by the K-wires also is a common problem in the tension-band wiring of patellar fractures [14,4,5,9,19,18]. Thus, revision surgery with K-wire removal becomes necessary in up to 65% of cases [2,4,5,9]. …”