Department of Orthopedic Surgery, Armed Forces Capital Hospital, Seongnam, Korea.
Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Clin Orthop Surg. 2024 Jun;16(3):357-362. doi: 10.4055/cios23302. Epub 2024 Apr 8.
Treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments is a challenge. To treat this difficult fracture, we perform articular fragment detachment and separate fixation for coronal split articular and inferior pole fragments. We aimed to evaluate the radiological and clinical outcomes of our technique in comminuted patellar fractures at least 1 year after surgery.
Between January 2019 and June 2022, 15 patients diagnosed with comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments based on preoperative computed tomography underwent surgery using the articular detachment technique. The key point of this technique was anatomical reduction and subchondral fixation of the coronal split articular fragment to the superior main fragment after complete detachment of the coronal split fragment from the inferior pole. The remaining inferior pole was fixed using a separate construct. Postoperative articular gap, articular step-off, and complications, including resorption, reduction loss, and avascular necrosis of fixed articular fragments, were evaluated as radiological outcomes. Range of motion and the Lysholm scores were used to evaluate clinical outcomes.
Among the 15 patients, the coronal split articular fragments were fixed using Kirschner wires in 13 patients and headless screws in 2 patients. The inferior poles were fixed using separate vertical wiring in 13 patients and tension-band wiring in 2 patients. A postoperative articular gap was noted in 7 patients, with an average articular gap of 1.0 mm (range, 0.7-1.6 mm). No articular step-off was observed. Bone union and normal range of motion were achieved in all patients. On the 1-year postoperative lateral radiograph, resorption of the articular fracture site was seen in 5 patients. There was no loss of reduction or avascular necrosis of the coronal split articular fragments. The average postoperative Lysholm score at 1 year was 89.3 ± 4.1 (range, 82-95).
The technique would be a reliable and safe option for the surgical treatment of comminuted patellar fractures accompanied by coronal split articular and inferior pole fragments in terms of anatomical reduction and stable fixation of articular fragments without risk of avascular necrosis.
治疗伴有冠状面关节分裂和髌骨下极碎片的粉碎性髌骨骨折是一个挑战。为了治疗这种复杂的骨折，我们对冠状面关节分裂和髌骨下极碎片进行关节片游离和单独固定。我们旨在评估我们的技术在术后至少 1 年治疗粉碎性髌骨骨折的放射学和临床结果。
2019 年 1 月至 2022 年 6 月，根据术前 CT 诊断为伴有冠状面关节分裂和髌骨下极碎片的粉碎性髌骨骨折的 15 例患者采用关节游离技术进行手术。该技术的关键是在完全游离冠状面关节片与髌骨下极后，对冠状面关节片进行解剖复位和软骨下固定至主要上髌骨片。剩余的髌骨下极采用单独的固定方式。术后关节间隙、关节台阶和并发症（包括吸收、复位丢失和固定关节片的缺血性坏死）被评估为放射学结果。关节活动度和 Lysholm 评分用于评估临床结果。
在 15 例患者中，13 例采用克氏针固定冠状面关节片，2 例采用无头螺钉固定。13 例采用单独的垂直布线固定髌骨下极，2 例采用张力带布线固定。7 例患者术后出现关节间隙，平均关节间隙为 1.0mm（范围为 0.7-1.6mm）。未观察到关节台阶。所有患者均获得骨愈合和正常的关节活动度。在术后 1 年的侧位 X 线片上，5 例患者可见关节骨折部位吸收。冠状面关节片无复位丢失或缺血性坏死。术后 1 年平均 Lysholm 评分为 89.3±4.1（范围为 82-95）。
该技术在解剖复位和稳定固定关节片方面是一种可靠和安全的选择，不会导致缺血性坏死，对于治疗伴有冠状面关节分裂和髌骨下极碎片的粉碎性髌骨骨折是一种选择。
