Abstract
BackgroundThe purpose of this study was to evaluate and compare the long-term clinical outcomes between the total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures.MethodsBetween January 1987 and December 2003, this retrospective study included a total of 35 patients (mean age, 51.4±16.8 years) with a minimum of 10 years follow-up period, comprising 29 males and 6 females, who were divided into the total patellectomy group (17 patients) or the open reduction and internal fixation (ORIF) group (18 patients) in the Third Affiliated Hospital of Hebei Medical University. We retrospectively collected patient demographics and data on the type of trauma, fracture type, and postoperative complications. Clinical outcomes including knee range of motion (ROM), 36-Item Short-Form Health Survey (SF-36) score [including physical component score (PCS) and mental component score (MCS)], Knee Injury and Osteoarthritis Outcome Score (KOOS), and Kujala score were evaluated and compared between the two groups. Biodex System dynamometer was used to quantitatively evaluate quadriceps femoris muscle power following measurement of peak torque.ResultsThe mean follow-up periods of the total patellectomy group and the ORIF group were 17.2±5.6 and 16.8±4.9 years, respectively. There were no significant differences between the two groups of patient demographics in terms of the number of patients, age, sex, injury side, time to surgery, type of trauma, and fracture classification (p>0.05). Total patellectomy was comparable to osteosynthesis with tension band wiring in terms of ROM [injured knee: 120.4±3.1° vs 118.6±3.3°; uninjured knee: 126.5±2.8° vs 127.3±1.7°; both p>0.05], peak torque [Injured knee: 96.2±2.3 vs 97.3±2.6, N· m; Uninjured knee: 107.6±2.1 vs 106.3±1.8, N· m; both p>0.05], SF-36 score [PCS: 64.1±18.0 vs 61.5±17.9; MCS: 55.1±13.8 vs 54.3±12.4; both p>0.05], KOOS score [76.3±12.1 vs 73.4±11.7; p>0.05], and Kujala score [67.6±11.8 vs 70.8±11.9; p>0.05] at the final follow-up, while total patellectomy had significantly shorter operation time than ORIF group (47.5±12.1 vs 68.8±22.3, min, p<0.05). In the total patellectomy group, complications occurred in 6 of 17 cases (35.3%), and all occurred with calcification. In the ORIF group, complications occurred in 12 of 18 cases (66.7%), including 2 cases of infection (11.1%), 1 case of non-union (5.6%), 2 cases of implant failure (11.1%), 2 cases of soft tissue irritation (11.1%), and 5 cases of patellofemoral arthritis (27.8%).ConclusionsTotal patellectomy technique was a safe and reliable alternative treatment for treating patients with highly comminuted patella fractures when anatomically reduction and rigid fixation were difficult, although it caused relatively higher rates of calcification.
Highlights
The purpose of this study was to evaluate and compare the long-term clinical outcomes between the total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures
It is undeniable that open reduction and internal fixation (ORIF) have many postoperative complications, including infection, limited range of motion, post-traumatic osteoarthritis, delayed union or nonunion, soft-tissue irritation, and implant-associated problems [5, 6]
Inclusion criteria for this present study were as follows: 1 aged older than 18 years, 2 unilaterally isolated highly comminuted patella fractures, 3 patients treated either by total patellectomy or ORIF with tension band wiring, 4 the postoperative functional scores and complication rates were considered as the comparison, 5 patients with complete follow-up outcomes and with a minimum follow-up time period more than 10 years, and 6 the study was designed as a retrospective comparative study
Summary
The purpose of this study was to evaluate and compare the long-term clinical outcomes between the total patellectomy and osteosynthesis with tension band wiring in patients with highly comminuted patella fractures. Comminuted fractures of the patella comprise about 55% of operatively managed patellar fractures [4], and their treatment depends on the comminution of fracture fragments. Patients with highly comminuted patella fractures often lead to disrupted extensor mechanisms and considerable functional disability. Numerous studies have emphasized the importance on internal fixation of patella comminuted fractures, the optimal surgical management remains controversial. It remains difficult and technically demanding to achieve anatomical reduction and stable fixation in patients with comminuted patella fractures as they are usually along with highly small stellate fragments, and total patellectomy is sometimes inevitable when reduction is felt to be futile
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