Howatt Jonathan, Liew Allan S, Wilkin Geoffrey
Division of Orthopaedic Surgery, The Ottawa Hospital/University of Ottawa, Ottawa, Ontario, Canada.
J Bone Joint Surg Am. 2021 Dec 1;103(23):2237-2246. doi: 10.2106/JBJS.20.01478. Epub 2021 Sep 27.
➤ A preoperative computed tomography scan may be considered to improve surgical planning, as secondary fracture lines are poorly visualized on radiographs.➤ Oblique internal and external rotation fluoroscopic views may be used intraoperatively to fully evaluate the medial and lateral facet articular reduction if direct assessment by visualization or palpation is not completed.➤ Partial patellectomy for inferior pole fractures should be avoided, and bone-preserving procedures are recommended.➤ A lateral arthrotomy may be used for direct visualization of the articular reduction for multifragmentary fractures. An inferomedial arthrotomy should be avoided to protect the dominant blood supply of the patella.➤ Tension band fixation with cannulated screws yields a lower reoperation rate, improved functional outcome scores, and better performance in biomechanical studies than Kirschner wire-based tension band fixation.➤ Preliminary studies of novel plate and screw constructs for osteosynthesis have shown promising results.
➤ 术前计算机断层扫描可考虑用于改善手术规划，因为在X线片上难以清晰显示继发骨折线。
➤ 如果术中未通过直视或触诊完成直接评估，可使用内外旋转透视斜位视图来全面评估内侧和外侧小关节面的复位情况。
➤ 应避免对髌骨下极骨折进行部分髌骨切除术，建议采用保留骨质的手术方法。
➤ 对于多片段骨折，可采用外侧关节切开术直接观察关节面复位情况。应避免采用下内侧关节切开术，以保护髌骨的主要血供。
➤ 与克氏针张力带固定相比，空心螺钉张力带固定的再次手术率更低，功能结局评分更高，在生物力学研究中的表现也更好。
➤ 新型接骨板和螺钉用于骨合成的初步研究已显示出有前景的结果。
