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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 V–Y plasty + TBW: (a) Pre-op X-ray; (b) post-op X-ray after TBW; (c) X-ray after union and implant removal; (d) scar with discharging sinus; (e) flexion; (f) extension
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Figure 8: Results of V–Y plasty + TBW: (a) Pre-op X-ray; (b) post-op X-ray after TBW; (c) X-ray after union and implant removal; (d) scar with discharging sinus; (e) flexion; (f) extension

Mentions: Tension band wiring with V–Y plasty was the most difficult operation primarily because bringing the fragment together without preoperative traction was tedious and unpredictable [Figure 8]. This led to increased operative time and soft tissue damage, and complications like wound dehiscence, exposing the quadriceps in 50% cases [Figure 6], and persistent nonunion in 20% cases [Table 2]. The postoperative ROM (80°) and time for return to ADL (4.2 months) were also poor although the time of union (5.5 months) was similar to that of the patellar traction group (5.3 months), although this time was more than double of a fresh fracture (2.5 months) [Table 1, Figure 5]. There was also persistent pain (50%) and extensor lag (40%) in a significant number of these cases which may again be attributed to infection in most cases [Table 2]. The increase in the KSS and Melbourne patella score at 1 year postoperative was also consistent with other findings. The KSS increased by an average of 52 points for the patellar traction group, while the increase was only 30 and 42 points for the V–Y plasty and patellectomy group, respectively. Similarly the average Melbourne patellar score increased by 24 points, 12 points, and 18 points for the three groups, respectively.


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 V–Y plasty + TBW: (a) Pre-op X-ray; (b) post-op X-ray after TBW; (c) X-ray after union and implant removal; (d) scar with discharging sinus; (e) flexion; (f) extension
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 8: Results of V–Y plasty + TBW: (a) Pre-op X-ray; (b) post-op X-ray after TBW; (c) X-ray after union and implant removal; (d) scar with discharging sinus; (e) flexion; (f) extension
Mentions: Tension band wiring with V–Y plasty was the most difficult operation primarily because bringing the fragment together without preoperative traction was tedious and unpredictable [Figure 8]. This led to increased operative time and soft tissue damage, and complications like wound dehiscence, exposing the quadriceps in 50% cases [Figure 6], and persistent nonunion in 20% cases [Table 2]. The postoperative ROM (80°) and time for return to ADL (4.2 months) were also poor although the time of union (5.5 months) was similar to that of the patellar traction group (5.3 months), although this time was more than double of a fresh fracture (2.5 months) [Table 1, Figure 5]. There was also persistent pain (50%) and extensor lag (40%) in a significant number of these cases which may again be attributed to infection in most cases [Table 2]. The increase in the KSS and Melbourne patella score at 1 year postoperative was also consistent with other findings. The KSS increased by an average of 52 points for the patellar traction group, while the increase was only 30 and 42 points for the V–Y plasty and patellectomy group, respectively. Similarly the average Melbourne patellar score increased by 24 points, 12 points, and 18 points for the three groups, respectively.

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