Egol Kenneth, Howard Daniel, Monroy Alexa, Crespo Alexander, Tejwani Nirmal, Davidovitch Roy
Hospital for Joint Diseases NYU Langone Medical Center New York, N.Y.
Iowa Orthop J. 2014;34:63-7.
Operative fixation of displaced inferior pole patella fractures has now become the standard of care. This study aims to quantify clinical, radiographic and functional outcomes, as well as identify complications in a cohort of patients treated with non-absorbable braided suture fixation for inferior pole patellar fractures. These patients were then compared to a control group of patients treated for mid-pole fractures with K-wires or cannulated screws with tension band wiring.
In this IRB approved study, we identified a cohort of patients who were diagnosed and treated surgically for a displaced patella fracture. Demographic, injury, and surgical information were recorded. All patients were treated with a standard surgical technique utilizing non-absorbable braided suture woven through the patellar tendon and placed through drill holes to achieve reduction and fracture fixation. All patients were treated with a similar post-operative protocol and followed up at standard intervals. Data were collected concurrently at follow up visits. For purpose of comparison, we identified a control cohort with middle third patella fractures treated with either k-wires or cannulated screws and tension band technique. Patients were followed by the treating surgeon at regular follow-up intervals. Outcomes included self-reported function and knee range of motion compared to the uninjured side.
Forty-nine patients with 49 patella fractures identified retrospectively were treated over 9 years. This cohort consisted of 31 females (63.3%) and 18 males (36.7%) with an average age of 57.1 years (range 26-88 years). Patients had an average BMI of 26.48 (range 19-44.08). Thirteen patients with inferior pole fractures underwent suture fixation and 36 patients with mid-pole fractures underwent tension band fixation (K-wire or cannulated screws with tension band). In the suture cohort, one fracture failed open repair (7.6%), which was revised again with sutures and progressed to union. Of the 36 fractures repaired with a tension band fixation, 11 underwent secondary surgery due to hardware pain or fixation failure (30.6%). At one year, no difference was seen in knee range of motion between cohorts. All fractures healed radiographically. Those patients who required reoperation or removal of hardware had significantly diminished range of motion about their injured knee (p > 0.005).
Patients who sustain inferior pole patella fractures have limited options for fracture fixation. Suture repair is clinically acceptable, yielding similar results to patella fractures repaired with metal implants. Importantly, patients undergoing suture repair appear to have fewer hardware related postoperative complications than those receiving wire fixation for midpole fractures.
移位的髌骨下极骨折的手术固定现已成为治疗的标准方法。本研究旨在量化临床、影像学和功能结果，并确定一组接受不可吸收编织缝线固定治疗髌骨下极骨折患者的并发症。然后将这些患者与一组接受克氏针或空心螺钉张力带固定治疗髌骨中极骨折的对照组患者进行比较。
在这项经机构审查委员会批准的研究中，我们确定了一组经手术诊断和治疗的移位髌骨骨折患者。记录了人口统计学、损伤和手术信息。所有患者均采用标准手术技术治疗，即通过髌腱编织不可吸收编织缝线，并通过钻孔置入以实现复位和骨折固定。所有患者均采用类似的术后方案，并按标准间隔进行随访。随访时同时收集数据。为了进行比较，我们确定了一组采用克氏针或空心螺钉张力带技术治疗髌骨中1/3骨折的对照队列。治疗医生定期对患者进行随访。结果包括与未受伤侧相比的自我报告功能和膝关节活动范围。
回顾性确定的49例髌骨骨折患者在9年期间接受了治疗。该队列包括31名女性（63.3%）和18名男性（36.7%），平均年龄57.1岁（范围26 - 88岁）。患者的平均体重指数为26.48（范围19 - 44.08）。13例髌骨下极骨折患者接受了缝线固定，36例髌骨中极骨折患者接受了张力带固定（克氏针或空心螺钉张力带）。在缝线固定组中，1例骨折开放修复失败（7.6%），再次用缝线修复并愈合。在36例采用张力带固定修复的骨折中，11例因内固定疼痛或固定失败接受了二次手术（30.6%）。1年后，两组间膝关节活动范围无差异。所有骨折在影像学上均愈合。那些需要再次手术或取出内固定的患者，其受伤膝关节的活动范围明显减小（p > 0.005）。
髌骨下极骨折患者的骨折固定选择有限。缝线修复在临床上是可以接受的，其结果与用金属植入物修复的髌骨骨折相似。重要的是，接受缝线修复的患者术后与内固定相关的并发症似乎比接受中极骨折钢丝固定的患者少。
