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Patellar nonunions: Comparison of various surgical methods of treatment.

Garg P, Sahoo S, Satyakam K, Biswas D, Garg A, Mitra S - Indian J Orthop (2012)

Bottom Line: Many of them have a functional knee joint and only those with a wide gap and failed extensor mechanism need surgery.We compared the results of the treatment in terms of Knee Society Score (KSS), Melbourne patella score, time of union, pain, range of movement, quadriceps power, and ability to do daily activities and complications encountered.Cases with patellectomy showed the next best results but they had a longer period of rehabilitation with ultimately lesser patient satisfaction.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Institute of Post Graduate Medical Education and Research, Kolkata, India.

ABSTRACT

Background: Nonunion of patella is an uncommon entity prevalent more commonly in developing countries. Many of them have a functional knee joint and only those with a wide gap and failed extensor mechanism need surgery. We report an analysis of nonunion of fracture patella treated by 3 surgical method.

Materials and methods: 35 patients of nonunion/delayed union of patella with significant gap and failure of quadriceps mechanism, underwent three different methods surgically: 1) V-Y plasty and tension band wiring (n=10); 2) patellar traction followed by tension band wiring without V-Y plasty (n=15); and 3) patellar traction followed by partial or total patellectomy (n=10). We compared the results of the treatment in terms of Knee Society Score (KSS), Melbourne patella score, time of union, pain, range of movement, quadriceps power, and ability to do daily activities and complications encountered.

Results: The 15 cases of patellar traction followed by tension band wiring showed the best results in terms of time to return to normal activities and complications encountered. Cases with patellectomy showed the next best results but they had a longer period of rehabilitation with ultimately lesser patient satisfaction. V-Y plasty gave the worst results both in complication rate and function return.

Conclusion: Preoperative patellar traction followed by tension band wiring is a good procedure giving better results than either patellectomy or V-Y plasty.

No MeSH data available.


Related in: MedlinePlus

Application of patellar traction: (a) Initial insertion with hand; (b) insertion with drill; (c) after Insertion; (d) with the traction set; (e) X-ray with pin in situ; and (f) on-bed traction
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Figure 2: Application of patellar traction: (a) Initial insertion with hand; (b) insertion with drill; (c) after Insertion; (d) with the traction set; (e) X-ray with pin in situ; and (f) on-bed traction

Mentions: Group 2 (n=15): We applied preoperative patellar traction. A 3.5-mm Steinman pin was inserted with the help of a hand drill very carefully in the mid substance of the upper pole fragment of patella under local anesthesia. This was done under C-Arm guidance or without it in experienced hands. If the upper pole was too small or osteoporotic, the pin could also be given just above and posterior to the upper pole [Figure 2]. Then, 5 lb traction was applied to this pin which was increased gradually up to 10 lb. This was done over 5–21 days during which the patient did active knee bending to increase the quadriceps power. Proper pin tract care was necessary. Average gap of patellar fragments at presentation was 5 cm (range 3–12 cm) which was comparable in all three groups. Traction was removed when the palpable gap between the two fragments, in extension, was less than 1 cm [Figure 3]. The average duration of traction was 8 days (range 5–18 days).


Patellar nonunions: Comparison of various surgical methods of treatment.

Garg P, Sahoo S, Satyakam K, Biswas D, Garg A, Mitra S - Indian J Orthop (2012)

Application of patellar traction: (a) Initial insertion with hand; (b) insertion with drill; (c) after Insertion; (d) with the traction set; (e) X-ray with pin in situ; and (f) on-bed traction
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3377141&req=5

Figure 2: Application of patellar traction: (a) Initial insertion with hand; (b) insertion with drill; (c) after Insertion; (d) with the traction set; (e) X-ray with pin in situ; and (f) on-bed traction
Mentions: Group 2 (n=15): We applied preoperative patellar traction. A 3.5-mm Steinman pin was inserted with the help of a hand drill very carefully in the mid substance of the upper pole fragment of patella under local anesthesia. This was done under C-Arm guidance or without it in experienced hands. If the upper pole was too small or osteoporotic, the pin could also be given just above and posterior to the upper pole [Figure 2]. Then, 5 lb traction was applied to this pin which was increased gradually up to 10 lb. This was done over 5–21 days during which the patient did active knee bending to increase the quadriceps power. Proper pin tract care was necessary. Average gap of patellar fragments at presentation was 5 cm (range 3–12 cm) which was comparable in all three groups. Traction was removed when the palpable gap between the two fragments, in extension, was less than 1 cm [Figure 3]. The average duration of traction was 8 days (range 5–18 days).

Bottom Line: Many of them have a functional knee joint and only those with a wide gap and failed extensor mechanism need surgery.We compared the results of the treatment in terms of Knee Society Score (KSS), Melbourne patella score, time of union, pain, range of movement, quadriceps power, and ability to do daily activities and complications encountered.Cases with patellectomy showed the next best results but they had a longer period of rehabilitation with ultimately lesser patient satisfaction.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Institute of Post Graduate Medical Education and Research, Kolkata, India.

ABSTRACT

Background: Nonunion of patella is an uncommon entity prevalent more commonly in developing countries. Many of them have a functional knee joint and only those with a wide gap and failed extensor mechanism need surgery. We report an analysis of nonunion of fracture patella treated by 3 surgical method.

Materials and methods: 35 patients of nonunion/delayed union of patella with significant gap and failure of quadriceps mechanism, underwent three different methods surgically: 1) V-Y plasty and tension band wiring (n=10); 2) patellar traction followed by tension band wiring without V-Y plasty (n=15); and 3) patellar traction followed by partial or total patellectomy (n=10). We compared the results of the treatment in terms of Knee Society Score (KSS), Melbourne patella score, time of union, pain, range of movement, quadriceps power, and ability to do daily activities and complications encountered.

Results: The 15 cases of patellar traction followed by tension band wiring showed the best results in terms of time to return to normal activities and complications encountered. Cases with patellectomy showed the next best results but they had a longer period of rehabilitation with ultimately lesser patient satisfaction. V-Y plasty gave the worst results both in complication rate and function return.

Conclusion: Preoperative patellar traction followed by tension band wiring is a good procedure giving better results than either patellectomy or V-Y plasty.

No MeSH data available.


Related in: MedlinePlus