Результаты хирургического лечения переломов надколенника

V.Kh Khidzhazin,M.A Abdulkhabirov,E.I Solod

doi:10.18019/1028-4427-2020-26-1-13-17

Abstract

Introduction Patella fractures account for one percent of all fractures. Arthritis, non-union and other complications which affect the function of the lower limb may develop in the long term. The aim was to develop the most optimal osteosynthesis techniques for patella fractures. Methods We analyzed longterm treatment results of 78 patients with patella fractures treated from 2017 to 2018 using the KOOS (The Knee Injury and Osteoarthritis Outcome Score) scale, clinical examinations and knee joint X-rays. Based on the methods of surgical treatment for patella fractures, we divided the patients into 5 groups: Weber tension band wiring for two-fragment fractures; cross-like osteosynthesis and other methods of patella osteosynthesis using K-wires and wire loops for multifragmental fractures of the patella; combined osteosynthesis (tension band wiring with an additional screw or cerclage around patella); partial patellectomy and the inferior pole osteosynthesis. Results A comparative analysis of patients’ groups after surgical treatment of patella fractures using the KOOS scale showed the best results after Weber tension band wiring for transversal fractures (72 %). The results of patients with multifragmental fractures of the patella using K-wires and wire loops were positive in 64 %; after the restoration of the inferior pole in 68 %, after partial patellectomy in 57 %. Conclusion For transversal fractures of the patella, tension band wiring is the method of choice. With multifragmental patella fractures, good results are achieved by cross-like osteosynthesis and other methods using K-wires and wire bands. The use of patellectomy followed by wire loop locking should be avoided for all types of patella fractures. In fractures of the inferior pole of the patella, it is preferable to fix it to the main patella fragment.

Highlights

Patella fractures account for one percent of all fractures
Based on the facts that various methods of surgical treatment for patella fractures were used and depended on the fracture type as well as due to a small number of patients in some groups and for facilitating the statistical analysis, we divided the patients into the following groups: Weber tension band wiring for two-fragment fractures; cross-like osteosynthesis and other similar methods of patella osteosynthesis using K-wires and wire bands for multifragmental fractures of the patella; combined osteosynthesis; partial patellectomy in comminution of the distal patellar pole; inferior pole osteosynthesis with double suture and partial reinforcement of the patellar ligament from both sides
If the inferior pole of the patella was fixed to its main fragment by transosseous suture with partial reinforcement of the patellar ligament on both sides there was no need for repeated surgical interventions to remove them due to the absence of metal fixators, which is a great advantage in the treatment of patients with this type of fracture

Summary

Introduction

Patella fractures account for one percent of all fractures. Arthritis, non-union and other complications which affect the function of the lower limb may develop in the long term. Methods We analyzed long-term treatment results of 78 patients with patella fractures treated from 2017 to 2018 using the KOOS (The Knee Injury and Osteoarthritis Outcome Score) scale, clinical examinations and knee joint X-rays. The results of patients with multifragmental fractures of the patella using K-wires and wire loops were positive in 64 %; after the restoration of the inferior pole in 68 %, after partial patellectomy in 57 %. Good results are achieved by cross-like osteosynthesis and other methods using K-wires and wire bands. Surgical treatment methods are applied in patients with patella fractures when fragments are shifted from one to 4 mm and articular surface incongruency of more than 2 mm [4, 5, 7].

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Discussion

Conclusion