Ulus Travma Acil Cerrahi Derg. 2017; 23(2): 150-155 | DOI: 10.5505/tjtes.2016.46402

Repair of comminuted fracture of the lower patellar pole

Elsayed Ibraheem Elsayed Massoud
Department of Orthopaedic, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Egypt

BACKGROUND: Comminuted fracture of the lower patellar pole has characteristics of both patellar fracture and avulsion of the patellar tendon. Therefore, components of both injury types should be considered during treatment. None of the traditional techniques has proven sufficient alone. Currently described is technique that incorporates principles of osteosynthesis as well as repair of the patellar tendon.
METHODS: Total of 23 patients with comminuted fracture of the lower patellar pole were treated surgically and prospectively followed for 24 months.
RESULTS: All patients returned to pre-injury level of activities of daily living at average of fourth postoperative month. Average score on scale described by Böstman et al. was 28.1 points. All fractures united within average of 10 weeks. Patellar height was preserved. Only 4 patients, all post-menopausal, demonstrated increase in degenerative changes in patellofemoral joint.
CONCLUSION: Successful osteosynthesis of the comminuted lower patellar pole using the present technique reduces potential need for partial patellectomy, and preserves original length of the extensor mechanism. Present technique allows for immediate full weight-bearing and early, extensive rehabilitation program.

Keywords: Extensor mechanism, fractured patella, inferior pole of the patella, patellar tendon; patellectomy.

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Patella distal ucu parçalý kýrýðýnýn onarýmý

Elsayed Ibraheem Elsayed Massoud
Sohag Eðitim Hastanesi, Ortopedi Bölümü, Eðitim Hastaneleri ve Enstitüleri, Mýsýr

AMAÇ: Patella distal ucunun parçalý kýrýðý hem patella kýrýðý hem de patella tendonu avülsiyonunun karakteristik özelliklerini taþýr. Bu nedenle travmanýn her iki bileþeni de tedavi sýrasýnda düþünülmelidir. Ancak geleneksel tekniklerin herhangi biri mahzurlarý olmaksýzýn ayrý ayrý iþe yaramaz. Osteosentez ve patella tendonunun eþ zamanlý onarýmýný göz önüne alan bir teknik varsayýmladýk.
GEREÇ VE YÖNTEM: Patella distal ucu parçalýkýrýðý olan 23 hasta cerrahi yöntemle tedavi edilmiþ ve ileriye yönelik olarak 24 ay izlenmiþtir.
BULGULAR: Hastalarýn tümü ortalama ameliyat sonrasý dördüncü ayda travma öncesi günlük aktivite düzeyine geri döndü. Böstman ve ark. skorlamasýna göre hastalar ortalama 28,1 puan aldý. Kýrýklarýn hepsi ortalama 10 haftada kaynadý. Patella yüksekliði muhafaza edilmiþti, ancak dört hastada patellofemoral eklemde dejeneratif deðiþikliklerde artýþ görüldü.
TARTIÞMA: Bu tekniði kullanarak patella distal uç parçalý kýrýðýnda osteosentezin baþarýsý parsiyel patellektomi olma ihtimalini azaltmakta, böylece ekstensör mekanizmanýn fizyolojik uzunlluðu korunmaktadýr. Bu teknik hemen tam olarak aðýrlýk taþýmaya ve erken dönemde yoðun rehabilitasyon programýnýn uygulanmasýna yol açar.

Anahtar Kelimeler: Alt pol, ekstensör mekanizma, kýrýk, patella; patella tendonu; patellektomi.

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