Outcomes After Operative Fixation of Complete Articular Patellar Fractures: Assessment of Functional Impairment

Lazaro, Lionel E.; Wellman, David S.; Sauro, Gina; Pardee, Nadine C.; Berkes, Marschall B.; Little, Milton T. M.; Nguyen, Joseph; Helfet, David L.; Lorich, Dean G.

doi:10.2106/jbjs.l.00012

Cited by 83 publications

(71 citation statements)

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“…The comminution, a difficulty to achieve anatomic reduction and stability of osteosynthesis, as well as the need to use circular and double tension bands, likely contribute to the fact that C3 fractures and these types of osteosynthesis present higher levels of osteosynthesis removal and residual pain, which leads to a worse prognosis of these fractures. Although consolidation is achieved in most cases, allowing for reasonable clinical and functional outcome, the surgical treatment of patellar fractures leads to high levels of residual pain, atrophy, muscle strength deficit, and other complications, which is in agreement with the literature 10, 11, 12, 13. In the present study, osteosynthesis removal and thigh atrophy in patellar fractures were more common in younger individuals, probably due to the higher functional level of this age group and more intensive demand on the extensor apparatus.…”

Section: Discussionsupporting

confidence: 89%

Total ruptures of the extensor apparatus of the knee

Moura

Fonseca

2016

Revista Brasileira de Ortopedia (English Edition)

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ObjectiveThis was a retrospective case-control study on total ruptures of the extensor apparatus of the knee, aimed to compare patella fractures with tendinous ruptures.MethodsThe sample included 190 patients and 198 total ruptures of the knee extensor apparatus. All patients were evaluated by the same examiner after a minimum one-year follow-up.ResultsTendinous ruptures occurred most frequently in men, in younger patients, and had better clinical and functional outcomes when compared with patella fractures; however, the former presented higher levels of thigh atrophy. Patella fractures occurred most frequently in women and in older patients and caused most frequently caused residual pain, muscle weakness, and limitations in daily activities. Comminuted fractures were related to high-energy trauma, lower clinical and functional outcomes, and higher levels of residual pain and osteosynthesis failure. Early removal of osteosynthesis material was related to better outcomes. Regarding the tendinous ruptures, over half of the patients presented risk conditions for tendinous degeneration; a longer delay until surgery was related to lower Kujala scores.ConclusionThe surgical repair of bilateral ruptures of the knee extensor apparatus resulted in satisfactory clinical and functional outcomes, which were better for tendinous ruptures when compared with patella fractures. However, these lesions are associated with non-negligible levels of residual pain, muscle weakness, atrophy, and other complications.

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Section: Discussionsupporting

confidence: 89%

Total ruptures of the extensor apparatus of the knee

Moura

Fonseca

2016

Revista Brasileira de Ortopedia (English Edition)

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“…The literature does not describe complications after surgery in children, and therefore the complication rates in adults are presented. Lazaro and colleagues10 reported 11 out of 30 (37%) patients requiring removal of symptomatic hardware. LeBrun and colleagues reported11 14 out of 27 (52%) requiring secondary surgery due to symptomatic implant and 5 of 13 (38%) with retained implants reporting anterior knee pain, an average in these three studies is 42%.…”

Section: Discussionmentioning

confidence: 99%

Screw osteosynthesis of transverse fracture of the patella in children

Mortensen

Stausholm

Thorninger

2019

World Jnl Ped Surgery

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ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified superior technique for children. The aim of this study is to assess the functional outcome after screw fixation of transverse patella fractures in children.MethodsTwo boys at 11 years of age were presented with a transverse fracture of the patella within the same week. Open reduction and fixation of the fractured patella with periost sutures and a 4.0 mm titanium screw inserted from the distal fragment. Afterward, the quadriceps expansion was meticulously repaired with sutures.ResultsThe patients could fully weight bear immediately on a fully extended knee in an orthosis. After 4 weeks, radiological healing was obtained. At the 8-week and 6-month follow-up, the modified Hospital of Special Surgery knee score was 100 points in both patients.ConclusionSingle screw fixation provides an excellent outcome after 8 weeks with a full range of motion and full weight bearing, providing a faster recovery.

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Section: Introductionunclassified

“…Согласно публикациям, посвященным как открытым, так и артроскопическим методам хи-рургического лечения, консолидация перелома наступала через 6-7 недель независимо от мето-да лечения [11][12][13]. Что касается восстановления функции сустава, в публикациях, посвященных открытым методикам, авторы отмечают сохра-няющиеся функциональные нарушения на про-тяжении 8-12 недель [13], а в ряде случаев -до 12 месяцев [12]. В то же время другие авторы от-мечают, что применение артроскопии позволяет сократить сроки реабилитационного периода до 6 недель, признавая артроскопическую внутрен-нюю фиксацию допустимой альтернативой для лечения при переломах надколенника со смеще-нием [8,11].…”

Section: Introductionunclassified

Arthroscopic treatement of patella fractures in children

Timofeev¹,

Викторович²,

Dyakonova³

et al. 2017

Pediatr Traum Orthop Reconstr Surg

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ФГАУ «Научный центр здоровья детей» Минздрава России, МоскваВведение. По литературным данным, частота переломов надколенника составляет примерно от 0,5 до 1,5 % от всех повреждений скелета. По характеру перелома можно выделить авульзивные, поперечные, оскольчатые и продольные. При смещении фрагментов более 2-3 мм и повреждении сухожильного растяжения четырехгла-вой мышцы предпочтительна открытая репозиция с восстановлением конгруэнтности суставной поверхности и стабильным остеосинтезом. В случаях продольных переломов артроскопия может рассматриваться как вы-сокоэффективный метод хирургического лечения. Материалы и методы. С применением артроскопии нами были прооперированы 4 пациента с продольным переломом надколенника. Возрастной диапазон пострадавших варьировал от 14 до 17 лет. Из них 3 мальчика и 1 девочка. Все больные получили травму во время занятий спортом. Поскольку при продольных переломах надколенника боковой разгибательный аппарат четырехглавой мышцы бедра оставался неповрежденным, объем оперативного вмешательства в этих случаях заключался в артроскопически ассистированной закрытой репозиции фрагментов и чрескожной диафиксации спи-цами без наложения проволочного шва. Результаты и обсуждение. Малоинвазивность, возможность визуального контроля за качеством восстанов-ления геометрии суставной поверхности надколенника и надежностью фиксации фрагментов, существенное сокращение сроков последующей реабилитации делают артроскопию высокоэффективным методом хирурги-ческого лечения переломов надколенника.Ключевые слова: коленный сустав, перелом, надколенник, артроскопия, подростки. ARTHROSCOPIC TREATEMENT OF PATELLA FRACTURES IN CHILDREN © I.V. Timofeev, E.Y. Dyakonova, A.A. Gusev, E.A. Romanova, P.V. KhrolenkoScientific Centre of Children Health, Moscow, RussiaIntroduction. The frequency of patellar fractures is approximately 0.5% to 1.5% of all skeletal injuries. The following types of fractures can be distinguished: avulsive, transverse, longitudinal, and comminuted. In cases of displacement of more than 2-3 mm and quadriceps tendon injuries open reduction and internal fixation with the restoration of the articular surface is more preferable. In cases of longitudinal fractures, arthroscopy is regarded as a highly effective method of surgical treatment. Materials and methods. Using arthroscopy, we have operated on 4 patients with longitudinal fracture of the patella. The average age of the injured persons was 15.4 years (14-17). These were 3 males and 1 female. All patients had sport-related injuries. Because of the longitudinal fracture of the patella, the lateral knee extensor mechanism remained intact, and arthrosopy-assisted surgical intervention with closed reposition of fragments and transcutaneous wire fixation was performed without wire suturing. Results and discussion. Minimal invasiveness, the possibility of visual control over the recovery quality of patellar surface, the reliability of fragment fixation, and a significant reduction in the subsequent rehabilitation make arthroscopy a highly effective ...

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Outcomes After Operative Fixation of Complete Articular Patellar Fractures: Assessment of Functional Impairment

Abstract: Despite advances in surgical protocols and acceptable radiographic outcomes, functional impairment remains common after treatment of patellar fractures. Rehabilitation strategies following surgical stabilization of these injuries will be a fruitful area for future clinical research.

Cited by 83 publications

References 1 publication

Total ruptures of the extensor apparatus of the knee

Total ruptures of the extensor apparatus of the knee

Screw osteosynthesis of transverse fracture of the patella in children

Arthroscopic treatement of patella fractures in children

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