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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

Results of patellar traction followed by patellectomy: (a) preoperative X-ray with almost no distal fragment; (b) patellar traction in situ; (c) partial patellectomy by Perry et al.'s technique; (d) postoperative flexion; and (e) extension with extensor lag
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Figure 7: Results of patellar traction followed by patellectomy: (a) preoperative X-ray with almost no distal fragment; (b) patellar traction in situ; (c) partial patellectomy by Perry et al.'s technique; (d) postoperative flexion; and (e) extension with extensor lag

Mentions: Patellar traction followed by patellectomy [Figure 7] (partial and total) was technically not difficult but led to prolonged periods of immobilization and subsequently longer time of rehabilitation (6 months as compared to 1 month for patellar traction group). Therefore, the average period of return to daily activities was six times longer (6 months) as compared to the patellar traction cases(1 month). Also, the postoperative range of movement at 1 year was significantly less (110°) [Figure 5] as compared to the patellar traction group (130°). Other long term complications for patellectomy were persistent pain (20%) and extensor lag (40%), which were significantly higher than patellar traction with TBW group (6.66% for both) [Table 2]. All patients with an extensor lag had quadriceps strength of grade 4, while the rest all had a grade 5 power. We found extensor lag as a better functional measurement of quadriceps function than its power for this study. Since most patients were pain free before the operation, the presence of persistent pain itself was a significant finding for us. All patients with persistent pain rated their pain as annoying to uncomfortable [Visual Analogue Scale (VAS) 2–4], but none rated it as dreadful (VAS 6).


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)

Results of patellar traction followed by patellectomy: (a) preoperative X-ray with almost no distal fragment; (b) patellar traction in situ; (c) partial patellectomy by Perry et al.'s technique; (d) postoperative flexion; and (e) extension with extensor lag
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 7: Results of patellar traction followed by patellectomy: (a) preoperative X-ray with almost no distal fragment; (b) patellar traction in situ; (c) partial patellectomy by Perry et al.'s technique; (d) postoperative flexion; and (e) extension with extensor lag
Mentions: Patellar traction followed by patellectomy [Figure 7] (partial and total) was technically not difficult but led to prolonged periods of immobilization and subsequently longer time of rehabilitation (6 months as compared to 1 month for patellar traction group). Therefore, the average period of return to daily activities was six times longer (6 months) as compared to the patellar traction cases(1 month). Also, the postoperative range of movement at 1 year was significantly less (110°) [Figure 5] as compared to the patellar traction group (130°). Other long term complications for patellectomy were persistent pain (20%) and extensor lag (40%), which were significantly higher than patellar traction with TBW group (6.66% for both) [Table 2]. All patients with an extensor lag had quadriceps strength of grade 4, while the rest all had a grade 5 power. We found extensor lag as a better functional measurement of quadriceps function than its power for this study. Since most patients were pain free before the operation, the presence of persistent pain itself was a significant finding for us. All patients with persistent pain rated their pain as annoying to uncomfortable [Visual Analogue Scale (VAS) 2–4], but none rated it as dreadful (VAS 6).

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