Abstract
Patellar fractures, which constitute approximately 1% of bone lesions, may lead to severe impairment of the extensor mechanism. When conservative or surgical treatment fails, the patella may develop pseudoarthrosis. Neglect or delayed treatment of this type of injury may lead to significant diastasis between the patellar fragments. There is no consensus regarding the best treatment for such cases. This study is aimed at describing a rare case of patellar pseudoarthrosis in a patient who underwent two-step surgical treatment comprising transskeletal patellar traction followed by osteosynthesis with a tension band. A 17-year-old male patient presented with a left patellar fracture that resulted from a fall from a standing height 8 years ago. He did not undergo any type of surgical treatment during that time, but the fracture was immobilized for only 2 weeks. The two-step surgical treatment with transskeletal patellar traction and patellar osteosynthesis was performed and provided satisfactory functional clinical results in this patient. This two-step surgical treatment can be performed in cases similar to ours with satisfactory results.
Highlights
Patellar pseudoarthrosis, an uncommon entity in developed countries, is not as rare in underdeveloped or developing countries such as India, Brazil, and China [1]
The treatment of patellar pseudoarthrosis with significant diastasis between bone fragments is always challenging, and few studies on this topic have been reported in the literature
After thoroughly cleaning the site with 0.9% physiological saline, we focused on the pseudoarthrosis, an autologous spongy osseous graft from the proximal tibia, and removed it through a small osseous hole made in the anteromedial tibia (Figures 7(a)–7(c))
Summary
An uncommon entity in developed countries, is not as rare in underdeveloped or developing countries such as India, Brazil, and China [1]. Neglect or delayed treatment may lead to significant diastasis among the bone fragments of pseudoarthrosis. The gap between these fragments develops more frequently in transverse fractures. The treatment of patellar pseudoarthrosis with significant diastasis between bone fragments is always challenging, and few studies on this topic have been reported in the literature. Garg et al [1] described a surgical technique for reducing diastasis between bone fragments of pseudoarthrosis. They first performed transskeletal patellar traction in patients with a distance greater than 3 cm between the fragments, followed by osteosynthesis of the patella with a tension band, and they obtained adequate functional results. Between the bone fragments in a patient who underwent two-step surgical treatment based on evidence reported by Garg et al [1]
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