Zhan Yu, Zhang Yingqi, Xie Xuetao, Luo Congfeng
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
Department of Orthopaedic Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China.
Ann Transl Med. 2021 Sep;9(17):1364. doi: 10.21037/atm-21-1814.
Multi-fragmentary patella fractures (MFPFs) are common patella fracture type. Low-profile plate fixation seems to be promising advancement in the treatment of such difficult fractures. There is no systematic morphologic study specifically for MFPFs to provide objective reference for the improvement of future implants and biomechanical models. This study aimed to delineate and quantify the location and spatial frequency of fracture lines, comminution zones, and coronal plane fragments in MFPFs using three-dimensional (3D) CT mapping technique.
A total of 187 MFPFs were retrospectively reviewed and analyzed. Fractures were digitally reconstructed from CT data, and fracture lines, comminution zones, and coronal fragments were graphically overlaid onto a 3D patella template. Fracture characteristics were summarized qualitatively based on the fracture maps and quantitatively on the counts and volume of each fragment. Furthermore, according to the classic fracture patterns concerning MFPFs, subgroup analysis was conducted.
On average, we observed 7 fragments in each fracture, 3 of which were <1 cm. Most fractures (81.2%) had coronal fragments on the anterior and/or posterior patella surfaces. We identified three classic patella fracture patterns: transverse with comminution, stellate, and "displaced comminuted" in 104, 54, and 29 knees, respectively. 3D maps demonstrated distinct distribution fracture patterns of fracture lines, comminution zones, and coronal fragments.
Supero-medial corner of the patella was seldomly involved, and might be used as the cornerstone for fixation. Coronal fragments were common on both anterior and posterior patella surfaces, justifying the application of anterior plate osteosynthesis characterized by multi-planar fixation. Comminution areas mainly concentrated in the lower half of the patella, potentially suitable for an implant in combination with sutures or circumferential cerclage wiring. The described 3D features of MFPFs could provide reference for the design of future implants and biomechanical models.
多碎片髌骨骨折（MFPFs）是常见的髌骨骨折类型。低轮廓钢板固定似乎是治疗此类复杂骨折的一项有前景的进展。目前尚无专门针对MFPFs的系统形态学研究，以提供改进未来植入物和生物力学模型的客观参考。本研究旨在使用三维（3D）CT映射技术描绘和量化MFPFs中骨折线、粉碎区域和冠状面碎片的位置及空间频率。
回顾性分析187例MFPFs。骨折由CT数据进行数字重建，骨折线、粉碎区域和冠状面碎片被图形化叠加到3D髌骨模板上。基于骨折图谱对骨折特征进行定性总结，并对每个碎片的数量和体积进行定量分析。此外，根据关于MFPFs的经典骨折模式进行亚组分析。
平均而言，我们在每个骨折中观察到7个碎片，其中3个碎片<1 cm。大多数骨折（81.2%）在髌骨前表面和/或后表面有冠状面碎片。我们确定了三种经典的髌骨骨折模式：横形伴粉碎、星芒状和“移位粉碎”，分别见于104例、54例和29例膝关节。3D图谱显示了骨折线、粉碎区域和冠状面碎片的不同分布骨折模式。
髌骨的上内侧角很少受累，可作为固定的基石。冠状面碎片在髌骨前表面和后表面均很常见，这证明了以多平面固定为特征的前侧钢板接骨术的应用合理性。粉碎区域主要集中在髌骨下半部，可能适合结合缝线或环形钢丝结扎的植入物。所描述的MFPFs的3D特征可为未来植入物的设计和生物力学模型提供参考。
