Department of Orthopedic Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Department of Orthopedic Surgery, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Injury. 2019 Nov;50(11):2084-2088. doi: 10.1016/j.injury.2019.08.018. Epub 2019 Aug 15.
Tension band wiring is considered the standard treatment for patella fractures. However, it is limited for fractures with marginal involvement, comminution, and osteoporotic bone. Our experience indicates that these limitations can be overcome with the hook plate. We evaluated the radiographic and clinical outcomes in patients with patella fracture treated with hook plating.
We enrolled 30 patients who underwent hook plating for patella fracture at two institutions between 2013 and 2017. Fracture classification and surgical options were reviewed. Postoperative fracture gap and time to union as radiographic measurements, and complications, range of motion, and functional outcome with the Lysholm score as clinical outcomes, were evaluated retrospectively.
Nine fractures were AO/OTA 34A1, three B1, one B2, two C1, nine C2, and six C3. All were closed fractures. There were 3 cases of revision, 4 with lateral or medial marginal fracture, 9 with isolated inferior pole fracture, and 14 with comminuted fracture. The average postoperative fracture gap was 0.4 (range, 0-2.0) mm, and bone union was achieved without additional intervention. The average time to union was 11.6 (range, 7-24) weeks. There were no complications, and no extension lag except in one case (10°). The average flexion was 138.5° (range, 110-145°). For functional outcomes, the average Lysholm score was 89.5 (range, 74-95), with 13 excellent, 14 good, 3 fair, and no poor cases.
This study suggests that hook plating can result in good bone union and restored knee function in marginal or comminuted fractures of the patella.
张力带钢丝固定被认为是治疗髌骨骨折的标准方法。然而，它对于边缘受累、粉碎性和骨质疏松性骨折有限制。我们的经验表明，这些限制可以通过钩钢板克服。我们评估了在两家机构接受钩钢板治疗的髌骨骨折患者的影像学和临床结果。
我们招募了 2013 年至 2017 年间在两家机构接受钩钢板治疗髌骨骨折的 30 名患者。回顾了骨折分类和手术选择。评估术后骨折间隙和愈合时间作为影像学测量，并发症、活动范围和 Lysholm 评分作为临床结果。
9 例骨折为 AO/OTA 34A1，3 例 B1，1 例 B2，2 例 C1，9 例 C2，6 例 C3。均为闭合性骨折。有 3 例翻修，4 例外侧或内侧边缘骨折，9 例孤立的下极骨折，14 例粉碎性骨折。术后平均骨折间隙为 0.4（范围，0-2.0）mm，无需额外干预即可愈合。平均愈合时间为 11.6（范围，7-24）周。无并发症，除 1 例（10°）外无伸展滞后。平均屈曲为 138.5°（范围，110-145°）。在功能结果方面，平均 Lysholm 评分为 89.5（范围，74-95），其中 13 例为优，14 例为良，3 例为可，无差。
本研究表明，钩钢板可使髌骨边缘或粉碎性骨折获得良好的骨愈合和膝关节功能恢复。
