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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

Patellar traction + TBW group (a) Preoperative X-ray shows nonunion of patella (b) postoperative X-rays after TBW and (c) after union with implant removal at followup (d) clinical photograph shows scar (e) extension; (f) flexion; (g) squatting; (h) crossed leg sitting
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Figure 6: Patellar traction + TBW group (a) Preoperative X-ray shows nonunion of patella (b) postoperative X-rays after TBW and (c) after union with implant removal at followup (d) clinical photograph shows scar (e) extension; (f) flexion; (g) squatting; (h) crossed leg sitting

Mentions: The 15 cases of patellar traction followed by tension band wiring showed better results in terms of range of motion (130°) and time to return to normal activities (1 month)than the other 2 groups [Table 1, Figure 6]. The operative difficulty was also very less (Grade I) as compared to V-Y Plasty (Grade III), as this required no extra soft tissue release other than fracture site clearance. There were two cases of nonunion in the V–Y plasty group and none in the patellar traction group. The exact cause of the nonunion could not be determined as there was infection as a confounding factor in both these cases. The average time of union (excluding the cases of nonunion) was almost similar in both the techniques (5.5 months for V- Y plasty and 5.3 for patellar traction group).


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)

Patellar traction + TBW group (a) Preoperative X-ray shows nonunion of patella (b) postoperative X-rays after TBW and (c) after union with implant removal at followup (d) clinical photograph shows scar (e) extension; (f) flexion; (g) squatting; (h) crossed leg sitting
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 6: Patellar traction + TBW group (a) Preoperative X-ray shows nonunion of patella (b) postoperative X-rays after TBW and (c) after union with implant removal at followup (d) clinical photograph shows scar (e) extension; (f) flexion; (g) squatting; (h) crossed leg sitting
Mentions: The 15 cases of patellar traction followed by tension band wiring showed better results in terms of range of motion (130°) and time to return to normal activities (1 month)than the other 2 groups [Table 1, Figure 6]. The operative difficulty was also very less (Grade I) as compared to V-Y Plasty (Grade III), as this required no extra soft tissue release other than fracture site clearance. There were two cases of nonunion in the V–Y plasty group and none in the patellar traction group. The exact cause of the nonunion could not be determined as there was infection as a confounding factor in both these cases. The average time of union (excluding the cases of nonunion) was almost similar in both the techniques (5.5 months for V- Y plasty and 5.3 for patellar traction group).

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