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Operative Orthopadie Und Traumatologie Dec 2017Anatomic reconstruction of the retropatellar articular surface and repair of the extensor mechanism of the knee joint. The osteosynthesis should allow immediate... (Review)
Review
OBJECTIVE
Anatomic reconstruction of the retropatellar articular surface and repair of the extensor mechanism of the knee joint. The osteosynthesis should allow immediate mobilization as part of an early functional postoperative rehabilitation protocol.
INDICATIONS
Displaced fractures of the patella, especially multifragment and comminuted fractures with a retropatellar incongruity or dislocation of >2 mm.
CONTRAINDICATIONS
Critical local soft tissue because of the risk of postoperative infection.
SURGICAL TECHNIQUE
Median skin incision. For simple (transverse) fractures, preservation of the soft tissue and reduction control via the index finger. For complex fractures, lateral arthrotomy and eversion of the patella. Reconstruction of the articular surface from the joint side with optimal visibility. Temporary fixation with Kirschner wires, osteosynthesis with the fixed angle plate. If necessary, additional screws or wires.
POSTOPERATIVE MANAGEMENT
Immediate mobilization with full weightbearing in full extension with a knee brace. Extension/flexion 0/0/60° for 4 weeks, then 0/0/90° until the 7th week. Active extension after 6 weeks. Climbing stairs after 12 weeks.
RESULTS
Good functional results in combination with a low rate of complications and revisions.
Topics: Bone Plates; Braces; Combined Modality Therapy; Female; Fracture Fixation, Internal; Fractures, Comminuted; Humans; Imaging, Three-Dimensional; Knee Injuries; Magnetic Resonance Imaging; Middle Aged; Patella; Postoperative Care; Postoperative Complications; Resistance Training
PubMed: 29071377
DOI: 10.1007/s00064-017-0522-8 -
The Journal of the American Osteopathic... Dec 2016
Topics: Adult; Female; Humans; Patella; Radiography
PubMed: 27893149
DOI: 10.7556/jaoa.2016.158 -
The Orthopedic Clinics of North America Jan 2016The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Fractures can be classified based on displacement,... (Review)
Review
The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Fractures can be classified based on displacement, comminution, and fracture pattern, which often guide treatment. Modern treatment options include internal fixation using tension bands with Kirschner wires or cannulated screws, lag screw fixation, partial patellectomy, and rarely total patellectomy. Nondisplaced, closed patellar fractures or fractures with less than 2-mm articular steps can be successfully treated conservatively. Open fractures, articular step of 2 mm or greater, and loss of knee extension are indications for surgical intervention.
Topics: Fracture Fixation, Internal; Fractures, Bone; Fractures, Comminuted; Humans; Patella; Postoperative Care; Radiography; Treatment Outcome; Wound Healing
PubMed: 26614923
DOI: 10.1016/j.ocl.2015.08.010 -
Journal of Orthopaedic Trauma Jun 2023To compare anterior hook plating with established fixation constructs biomechanically and report outcomes and complications in a cohort of patella fractures treated with... (Review)
Review
OBJECTIVES
To compare anterior hook plating with established fixation constructs biomechanically and report outcomes and complications in a cohort of patella fractures treated with the technique.
DESIGN
Laboratory-based biomechanical study and clinical multicenter retrospective cohort study.
SETTING
2 US Level 1 trauma centers.
PATIENTS/PARTICIPANTS
51 patients (28 M and 23 F) with 30 simple transverse and 21 comminuted patella fractures. Thirty-six cadaveric patellae were used for the biomechanical study.
INTERVENTION
Biomechanical-dorsal plating was compared with cerclage wiring and modified tension band cable fixation in a comminuted patella fracture model in 36 cadaveric patellae. Constructs were tested at 0° and 45 degrees of flexion. Clinical-we reviewed a consecutive series of patella fractures in 2 centers for outcome and complications.
MAIN OUTCOME MEASUREMENTS
Biomechanical-construct stiffness. Clinical-reduction, union, complications, and range of motion.
RESULTS
Stiffness was greatest in dorsal plating at both 0° and 45 degrees. Dorsal plating (976 N, 1643 N) > modified tension band (317 N, 297 N) > cerclage (89.8 N, 150.3 N) at 0 and 45 degrees, respectively. 51 patients with patella fractures had them fixed with dorsal 2.7-mm mini fragment plates including a distal to proximal lag screw through the plate from the nose of the patella. 9 cases were small distal fragments not easily managed with screws and cables. All patients were followed up to union. There were 2 infections (1 superficial and 1 deep with nonunion), and 5 had implant removal (9.8%).
CONCLUSIONS
Dorsal plating is biomechanically and clinically superior to modified tension band and cerclage techniques in comminuted patella fractures. This method allows for fixation of small distal pole fractures.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics: Humans; Retrospective Studies; Patella Fracture; Bone Wires; Fractures, Bone; Fracture Fixation, Internal; Patella; Knee Injuries; Cadaver; Biomechanical Phenomena; Fractures, Comminuted; Multicenter Studies as Topic
PubMed: 36728234
DOI: 10.1097/BOT.0000000000002565 -
Der Orthopade May 2016Periprosthetic patella fractures occur both with and without retropatellar joint replacement. A non-operative treatment yields satisfactory results with low morbidity.... (Review)
Review
Periprosthetic patella fractures occur both with and without retropatellar joint replacement. A non-operative treatment yields satisfactory results with low morbidity. It can be applied in minimally displaced fractures that have an intact retropatellar component and an intact extensor mechanism, combined with an initial immobilization. The surgical treatment is associated with relatively poor results and with high complication rates. There was only minor improvement of functional results, no matter which surgical technique was used. Surgical intervention is still required in fractures with a loosening of the patellar component, considerable dislocations of fragments, and damage to or rupture of the extensor mechanism. In particular, type II fractures require repair of the extensor mechanism and the fracture or patellectomy. Type III fractures require a revision or resection of the patella, a patelloplasty or total patellectomy. In addition, early or late reconstruction using allograft to restore the extensor mechanism can be taken in consideration.
Topics: Arthroplasty, Replacement, Knee; Combined Modality Therapy; Evidence-Based Medicine; Fracture Fixation, Internal; Fractures, Bone; Humans; Patella; Plastic Surgery Procedures; Treatment Outcome
PubMed: 27125233
DOI: 10.1007/s00132-016-3254-9 -
Orthopaedics & Traumatology, Surgery &... Feb 2023Good patellar tracking is needed for functionally successful total knee arthroplasty (TKA), and depends on several factors. The aim of the present Instructional Lecture... (Review)
Review
Good patellar tracking is needed for functionally successful total knee arthroplasty (TKA), and depends on several factors. The aim of the present Instructional Lecture is to identify the main factors and how to control them so as to optimize patellar tracking: more or less "patella-friendly" prosthetic trochlea design, requiring precise assessment and choice of model; patellar component design; type of tibial implant; surgical approach and management of peripatellar structures, and any lateral release; distal and posterior femoral bone cuts, determining femorotibial alignment, femoral component rotation and patellar height; tibial implant rotation with respect to the anterior tibial tubercle; patellar cut characteristics in resurfacing. In case of instability or patellar maltracking despite correct implant positioning, there are 2 main surgical techniques: medial patellofemoral ligament reconstruction, and anterior tibial tubercle medialization. To obtain optimal patellar tracking, correction of other factors should be associated: trochlear component design, distal and posterior femoral bone cuts, tibial implant positioning, patellar component shape and positioning, etc.
Topics: Humans; Arthroplasty, Replacement, Knee; Patella; Knee Joint; Femur; Tibia
PubMed: 36302447
DOI: 10.1016/j.otsr.2022.103458 -
Orthopedics Jun 2015Patella fractures can be caused by excessive tension through the extensor mechanism or a direct impact. Non-displaced fractures with an intact extensor mechanism can be... (Review)
Review
Patella fractures can be caused by excessive tension through the extensor mechanism or a direct impact. Non-displaced fractures with an intact extensor mechanism can be treated nonoperatively. Surgical treatment is recommended for fractures that either disrupt the extensor mechanism or have greater than 2 to 3 mm of step-off and greater than 1 to 4 mm of displacement. Tension band fixation is the most commonly employed surgical technique; however, this can be technically demanding, especially in multifragmentary fractures. Symptomatic hardware is the most common complication following operative treatment. Functional impairment remains common after treatment of patella fractures. The purpose of this article is to review current treatment strategies to help optimize the management of patients with such patella fractures.
Topics: Bone Wires; Fracture Fixation, Internal; Fractures, Bone; Humans; Patella
PubMed: 26091213
DOI: 10.3928/01477447-20150603-05 -
Open Veterinary Journal 2021Patellar luxation (PL) is a common orthopedic affection among farm and pet animals with mostly congenital (environmental and/or genetic) background.
BACKGROUND
Patellar luxation (PL) is a common orthopedic affection among farm and pet animals with mostly congenital (environmental and/or genetic) background.
AIM
We report here the first observation of lateral PL in Hejazi goats bred in Libya.
METHODS
Five Hejazi goats aged between 4 months and 2 years with severe hind limb lameness were admitted to Al-Sorouh veterinary clinic in Tripoli during the period from 2016 to 2018. The goats were thoroughly examined clinically and radiographically. Two goats were surgically treated, and the other three cases were not because of either the cost limitation or expected poor prognosis. The surgical intervention involved femoral trochlear sulcoplasty, medial joint capsule imbrication, and tibial tuberosity transposition.
RESULTS
The clinical examination showed grade III-IV lateral PL. Radiologically, there were unilateral or bilateral, ventrocaudal, and dorsal PLs. Two cases were referred to surgical correction. One case almost restored the normal movement of stifle joint together with a good general status 1 year postsurgery. However, the surgical treatment was not effective in correcting the luxated patella in the second case.
CONCLUSION
Lateral PL is common among orthopedic affections in Hejazi goats in Libya, and its surgical treatment provided a quite convenient approach. An association between inbreeding and the PL was suggested in those cases.
Topics: Animals; Goats; Patella; Patellar Dislocation; Stifle; Tibia
PubMed: 34307087
DOI: 10.5455/OVJ.2021.v11.i2.14 -
Orthopedics 2022The purpose of this study was to evaluate the readability, content, and authorship of websites related to patella instability. A search was performed using three search... (Review)
Review
The purpose of this study was to evaluate the readability, content, and authorship of websites related to patella instability. A search was performed using three search engines and four terms related to patella dislocation. Thirty-seven unique websites were identified. Seventeen of 37 (46%) websites disclosed the authorship credentials. The mean Flesch-Kincaid grade was 10.8±3.5, and the mean Flesch reading ease score was 47.6±18. Only 8 of 37 (22%) websites had a third-party Health On the Net seal. The information presented online about patella dislocation can be unreliable and misleading for patients. [. 2022;45(2):e62-e66.].
Topics: Comprehension; Humans; Internet; Patella; Reading; Search Engine
PubMed: 35021028
DOI: 10.3928/01477447-20220105-09 -
Journal of Exposure Science &... Feb 2021Lead is a ubiquitous toxicant following three compartment kinetics with the longest half-life found in bones. Patella and tibia lead levels-validated measures of...
BACKGROUND
Lead is a ubiquitous toxicant following three compartment kinetics with the longest half-life found in bones. Patella and tibia lead levels-validated measures of cumulative exposure-require specialized X-ray-fluorescence-spectroscopy available only in a few centers worldwide. We developed minimally invasive biomarkers reflecting individual cumulative lead exposure using blood DNA methylation profiles-obtainable via Illumina 450K or IlluminaEPIC bead-chip assays.
METHODS
We developed and tested two methylation-based biomarkers from 348 Normative Aging Study (NAS) elderly men. We selected methylation sites with strong associations with bone lead levels via robust regressions analysis and constructed the biomarkers using elastic nets. Results were validated in a NAS subset, reporting specificity, and sensitivity.
FINDINGS
Participants were 73 years old on average (standard deviation, SD = 6), with moderate lead levels of (mean ± SD patella: 27 ± 18 µg/g; tibia:21 ± 13 µg/g). Methylation-based biomarkers for lead in patella and tibia included 59 and 138 DNA methylation sites, respectively. Estimated lead levels were significantly correlated with actual measured values, (r = 0.62 patella, r = 0.59 tibia) and had low mean square error (MSE) (MSE = 0.68 patella, MSE = 0.53 tibia). Means and distributions of the estimated and actual lead levels were not significantly different across patella and tibia bones (p > 0.05). Methylation-based biomarkers discriminated participants highly exposed (>median) to lead with a specificity of 74 and 73% for patella and tibia lead levels, respectively, with 70% sensitivity.
INTERPRETATION
DNA methylation-based lead biomarkers are novel tools that can be used to reconstruct decades' worth of individual cumulative lead exposure using only blood DNA methylation profiles and may help identify the consequences of cumulative exposure.
Topics: Adult; Aged; Aging; DNA Methylation; Environmental Exposure; Humans; Lead; Male; Patella; Tibia
PubMed: 31636367
DOI: 10.1038/s41370-019-0183-9