“Is articular cartilage reconstruction feasible in OTA-C2, C3 comminuted patellar fractures?” A prospective study of methodical reduction and fixation

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• 作者：Ramakanth Rajagopalakrishnan^a ; ^{ramjesh64@yahoo.co.in" class="auth_mail" title="E-mail the corresponding author} ; Prasad Soraganvi^b ; Balaji Douraiswami^a ; ^{balaji7@jipmer.net" class="auth_mail" title="E-mail the corresponding author} ; P. Velmurugesan^c ; S. Muthukumar^d
• 关键词：Comminuted patellar fracture ; OTA-C2 ; C3 fractures ; Patellar articular cartilage reconstruction ; Tension band wire ; Mini fragment fixation
• 刊名：Journal of Arthroscopy and Joint Surgery
• 出版年：2016
• 出版时间：May-August 2016
• 年：2016
• 卷：3
• 期：2
• 页码：66-70
• 全文大小：912 K

文摘

Comminuted patellar fracture reduction and articular reconstruction is surgically demanding situation to deal with, as patellar articular surface is complex with two diverging facets separated by a median ridge.

Purpose

The objective of this study is to evaluate functional outcome of OTA-34 C2, C3 comminuted patellar fractures treated surgically by methodical reduction and fixation.

Methods

We prospectively analyzed 12 patients of OTA-34 C2, C3 patellar fracture operated by our technique in 2 female and 10 male patients. We obtained three dimensional patellar articular facet reconstruction, by direct observation and reduction of articular surface and fixation with mini fragment screws and cerclage wire. The knee outcome survey – Activity of Daily Living Scale (ADLS) was used to assess functional outcome and follow-up X-rays were taken to assess radiological outcome of the fracture fixation.

Results

In all cases fracture union was achieved at an average of 10.83 weeks (2.49 months). The mean age was 43.58 years, average follow-up was 27.83 months and mean knee outcome survey ADLS – 90.08%. Functional knee range of motion was achieved by the end of 12 weeks (mean ROM – 119.08°). None of the patients had any infection, avascular necrosis of patellar fragments; implant cut out or patellofemoral arthritis. Three patients with associated ipsilateral long bone fracture showed delayed return to work.

Conclusion

Three dimensional patellar articular reconstruction and restoration of extensor apparatus is possible in comminuted patellar fracture with good clinical outcome by accurate and meticulous surgical reduction and fixation.