Fehske Kai, Berninger Markus T, Alm Lena, Hoffmann Reinhard, Zellner Johannes, Kösters Clemens, Barzen Stefan, Raschke Michael J, Izadpanah Kaywan, Herbst Elmar, Domnick Christoph, Schüttrumpf Jan Philipp, Krause Matthias
Klinik und Poliklinik für Unfall‑, Hand‑, Plastische- und Wiederherstellungschirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
Unfallchirurg. 2021 Oct;124(10):832-838. doi: 10.1007/s00113-020-00939-8. Epub 2020 Dec 17.
The treatment of patella fractures is technically demanding. Although the radiological results are mostly satisfactory, this often does not correspond to the subjective assessment of the patients. The classical treatment with tension band wiring with K‑wires has several complications. Fixed-angle plate osteosynthesis seems to be biomechanically advantageous.
Who is treating patella fractures in Germany? What is the current standard of treatment? Have modern forms of osteosynthesis become established? What are the most important complications?
The members of the German Society for Orthopedics and Trauma Surgery and the German Knee Society were asked to participate in an online survey.
A total of 511 completed questionnaires were evaluated. Most of the respondents are specialized in trauma surgery (51.5%), have many years of professional experience and work in trauma centers. Of the surgeons 50% treat ≤5 patella fractures annually. In almost 40% of the cases preoperative imaging is supplemented by computed tomography. The classical tension band wiring with K‑wires is still the preferred form of osteosynthesis for all types of fractures (transverse fractures 52%, comminuted fractures 40%). In the case of comminuted fractures 30% of the surgeons choose fixed-angle plate osteosynthesis. If the inferior pole is involved a McLaughlin cerclage is used for additional protection in 60% of the cases.
The standard of care for patella fractures in Germany largely corresponds to the updated S2e guidelines. Tension band wiring is still the treatment of choice. Further (long-term) clinical studies are needed to verify the advantages of fixed-angle plates.
髌骨骨折的治疗对技术要求很高。尽管放射学结果大多令人满意，但这往往与患者的主观评估不符。经典的克氏针张力带钢丝固定治疗存在多种并发症。角度固定钢板内固定在生物力学上似乎更具优势。
在德国，谁在治疗髌骨骨折？当前的治疗标准是什么？现代内固定形式是否已确立？最重要的并发症有哪些？
邀请德国骨科与创伤外科学会以及德国膝关节学会的成员参与一项在线调查。
共评估了511份完整问卷。大多数受访者专长于创伤外科（51.5%），拥有多年专业经验且在创伤中心工作。50%的外科医生每年治疗≤5例髌骨骨折。在近40%的病例中，术前影像学检查通过计算机断层扫描进行补充。经典的克氏针张力带钢丝固定仍然是所有类型骨折（横行骨折52%，粉碎性骨折40%）首选的内固定形式。对于粉碎性骨折，30%的外科医生选择角度固定钢板内固定。如果下极受累，60%的病例会使用麦克劳克林环扎术进行额外保护。
德国髌骨骨折的护理标准在很大程度上符合最新的S2e指南。张力带钢丝固定仍然是首选治疗方法。需要进一步的（长期）临床研究来验证角度固定钢板的优势。
