Neurobionplus
Home About Journal AHEAD OF PRINT Current Issue Back Issues Instructions Submission Search Subscribe Blog    
Login 

Users Online: 97 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size 
 


 
TRAUMATOLOGY Table of Contents   
Year : 2004  |  Volume : 38  |  Issue : 2  |  Page : 104-106
Evaluation of results of surgical treatment of closed fractures of the patella


Department of Orthopaedics, Nizamís Institute of Medical Sciences, Punjagutta, Hyderabad, India

Click here for correspondence address and email
 

   Abstract 

Background : Management of patellar fractures is controversial.
Methods : Outcome of treatment in thirty two patients of fracture patella was studied. Osteosynthesis with modified TBW of patella was done (10 cases) for non-comminuted fractures of the patella, partial patellectomy (12 cases) for fractures with lower fragment comminution and total patellectomy (10 cases) for severely comminuted fractures of the patella.
Results : Eight out of ten patients who underwent TBW of the patella had minimal or no quadriceps wasting, knee pain or quadriceps power loss and extension lag. In partial patellectomy group eight of 12 patients had minimal or no quadriceps wasting and knee pain with knee range of movement greater than 110 degrees.
Conclusion : It was found that osteosynthesis with modified TBW of patella gives the best results as the normal anatomy is being restored.

Keywords: Comminuted patellar fracture; Patellectomy.

How to cite this article:
Srinivas K, Rao V S, Narendranath L, Rao VP. Evaluation of results of surgical treatment of closed fractures of the patella. Indian J Orthop 2004;38:104-6

How to cite this URL:
Srinivas K, Rao V S, Narendranath L, Rao VP. Evaluation of results of surgical treatment of closed fractures of the patella. Indian J Orthop [serial online] 2004 [cited 2019 Dec 8];38:104-6. Available from: http://www.ijoonline.com/text.asp?2004/38/2/104/40911

   Introduction Top


Fractures of the patella account for 1% of all skeletal injuries. Although patellar fractures appears to be simple injury they do have an important bearing on subsequent knee function. There is no universally accepted treatment for patellar fractures. Treatment options included reconstruction of the entire patella, partial patellectomy & tendon repair or total patellectomy with extensor mechanism repair. Despite advances in surgical techniques, the basic treatment options have not changed significantly and are similar to those available in the early years of patellar fracture surgery.However, the preference is being shifted from patellectomy to reconstruction and preservation of patella and restoration of the extensor mechanism.


   Materials and Methods Top


This study consists of a prospective and retrospective analysis of the results of various methods of surgical treatment of 32 cases of closed fractures of patella, osteosynthesis vs. partial patellectomy vs. total patellectomy. Ten cases were treated by modified tension band wiring, 12 by partial patellectomy and 10 cases by total patellectomy.

The indication for surgery included displacement between the fracture fragments > 2mm and articular surface in congruency of > 2mm. Transverse fractures of the patella in which there was no comminution of the fragment were treated by osteosynthesis using the modified tension band wiring technique [1] .

Transverse fracture of the patella with lower fragment comminution, which was not reconstructable, was treated by lower fragment excision (partial patellectomy) and repair of the patellar tendon to the proximal fragment of the patella by modified Thomson technique. Extremely comminuted fracture of the patella, in which no portion of the patella was reconstructable, was treated by total patellectomy and repair of extensor mechanism.

The results of surgery were evaluated using the Gaur criteria for knee function evaluation [2] based on quadriceps wasting, quadriceps power loss, extension lag, knee range of motion, knee pain and functional status and the results were graded as excellent, good, fair, poor [Table 1].

Quadriceps wasting was measured by measuring the circumference of thigh 15 cm above the knee joint level on both sides and the amount of wasting was noted in centimeters. Quadriceps power was tested by using a spring dynamometer (a strap around the ankle led to a spring balance attached to a lever) with the knee in 90į of flexion and measuring the power of quadriceps by extending the knee against the spring dynamometer [Figure 1]. Quadriceps power of both knees was calculated and the amount of power loss was calculated as the percentage of the quadriceps power loss. Making the patient to actively extend the knee and noting the amount of loss of active extension calculated extension lag. Knee pain and function were evaluated based on subjective symptoms.


   Results Top


The youngest patient was 12 years and oldest 65 years with a mean age of 39.9 years. Male: female ratio was 9:1 and vehicular trauma resulted in 59.7% of patellar fractures. Complications included two cases of irritation from implant with modified TBW patella and one case of DVT in partial patellectomy.

Eight out of ten patients who underwent TBW of the patella had minimal or no quadriceps wasting, knee pain or quadriceps power loss and extension lag. Knee range of motion was greater than 110 deg in nine patients. In Partial patellectomy group eight of 12 patients had minimal or no quadriceps wasting and knee pain with knee range of movement greater than 110 degrees. Good to excellent results are seen in only six out of ten cases with total patellectomy and more than 80% results with preservation of patella.

The detailed results are shown in [Table 2] and final out come in [Table 3].


   Discussion Top


Fractures of the patella occur very frequently. They often require surgical treatment involving one of several methods. Osteosynthesis, partial patellectomy and total patellectomy. The consequences of a patellar fracture as they affect joint function, mobility, muscle power, and development of osteoarthritis can be significant, as the functional role of the patella is needed to obtain a successful result.

There was not much difference in the power of quadriceps muscle in the osteosynthesis and partial patellectomy groups but there is a significant decrease in the power of quadriceps muscle in case of total patellectomy. This emphasizes the fact that patella transmits tensile forces generated by the quadriceps to the patellar ligament and increases the effective lever arm of the knee extensor mechanism from the axis of knee flexion and extension [3] . Partial patellectomy does not significantly compromise the mechanical advantage afforded by the patella and is due to preservation of the near normal patella biomechanics due to preservation of a large fragment.

The decreased range of knee flexion in case of total patellectomy is probably due to change in mechanics of knee motion. Before fracture or in cases of osteosynthesis or partial patellectomy it was smooth cartilage on cartilage articulation between patella and femoral condyle with an added advantage of long extensor moment arm. After total excision of patella these are lost and quadriceps tendon now has to glide over the femoral trochlea with a different coefficient of friction and without the mechanical advantage [4] .

The best results after surgical treatment of patella fracture are obtained by osteosynthesis of the fracture by using modified TBW technique [5],[6] . The results with partial patellectomy are also nearly those of osteosynthesis and where the entire patella could not be salvaged partial patellectomy offers a better alternative [5],[6],[7] . The results of total patellectomy were significantly lower than those of osteosynthesis with TBW of patella (P value < 0.05) and partial patellectomy.

 
   References Top

1.Muller ME, Allgower M, Schneider R, Willenegger H: Manual of Internal Fixation. Techniques recommended by the AO-ASIF Group. 3rd ed. New York; Springer-Verlag.1991.  Back to cited text no. 1    
2.Gaur SC, Verma AN, Kulshreshtha, AK Katiyar, RK Sinha. Late outcome of patellectomy. Ind J Orthop. 1997;33(2):109.  Back to cited text no. 2    
3.Kaufer H. Mechanical function of the patella. J Bone Joint Surg (Am). 1971 ; 53:1551-1560.  Back to cited text no. 3    
4.Das R et al. A comparative study of partial & total patellectomy for comminuted fractures. Ind J Orthop. 2000; 34:  Back to cited text no. 4    
5.Aglietti P, Chambat P. Fractures of the patella. In Insall J, ed: Surgery of the Knee. 1st ed. New York; Churchill Livingstone. 1984.  Back to cited text no. 5    
6.Bostman O, Kiviluoto O, Santavirta S, et al. Fractures of the patella treated by operation. Arch Orthop Trauma Surg. 1983; 102: 778-81.  Back to cited text no. 6    
7.Saltzman G, Goulet J, McClellan R, et al. Results of treatment of displaced patella fractures by partial patellectomy. J Bone Joint Surg (Am). 1990; 72:1279.  Back to cited text no. 7    

Top
Correspondence Address:
V Surya Prakash Rao
1-1-419/e/5/1,íSivapriyaí, Gandhinagar, Hyderabad
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


Rights and PermissionsRights and Permissions


    Figures

  [Figure - 1]
 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]



 

Top
 
 
  Search
 
   
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    References
    Article Figures
    Article Tables
 

 Article Access Statistics
    Viewed2730    
    Printed87    
    Emailed0    
    PDF Downloaded223    
    Comments [Add]    

Recommend this journal