Mohammad Shah Kamal Uddin¹*, Tutul Talukder², Muhammad Amzad Hussain³, Ushahla Marma⁴, AKM Harun-Ar-Rashid⁵, Mohammad Ridowan Tareen⁶ and Md Ayub Ali⁷

¹Senior Consultant of Orthopaedic Surgery, 250 Bed District Sadar Hospital, Cox’s Bazar, Bangladesh
²Junior Consultant of Surgery, 250 Bed District Sadar Hospital, Cox’s Bazar, Bangladesh
³Junior Consultant of Orthopaedic Surgery, Moheshkhali Upazila Health Complex, Cox’s Bazar, Bangladesh
⁴Assistant Registrar of Orthopaedic Surgery, 250 Bed District Sadar Hospital, Cox’s Bazar, Bangladesh
⁵Assistant Professor of Orthopaedic Surgery, Cox's Bazar Medical College, Cox’s Bazar, Bangladesh
⁶Resident Surgeon of General Surgery, 250 Bed District Sadar Hospital, Cox’s Bazar, Bangladesh
⁷Associate Professor of Orthopaedic Surgery, Cox's Bazar Medical College, Cox’s Bazar, Bangladesh

*Corresponding Author: Mohammad Shah Kamal Uddin, Senior Consultant of Orthopaedic Surgery, 250 Bed District Sadar Hospital, Cox’s Bazar, Bangladesh.

Received: June 14, 2023; Published: July 14, 2023

Abstract

Background: The patella is a triangle sesamoid bone located on the anterior part of the knee at the distal portion of the femur. Its principal function is to act as a fulcrum to enhance the moment arm of the quadriceps muscle and thus knee extensive capabilities.

Objective: This study was conducted to evaluate a clinical and functional usefulness of Separate Vertical Wirings for the treatment of Extra-Articular Fractures of the Distal Pole of Patella at National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) from July 2015 to June 2017.

Methods: The study included 40 patients with closed extra-articular fracture of the distal pole of the patella aged 18-70 years, regardless of gender. Patients with pathological fracture, multiple injuries and inability to walk before the fracture were excluded from the study.

Results: They were evaluated by Bostman knee score (ROM, pain, work, atrophy, assistance in walking, effusion, giving way, stair climbing). At final follow-up 31 (77.5%) patients had full extension and ROM 120 degree and 9 (22.5%) patients had ROM 90-120 degree. The main complications was knee stiffness which was 30%. Almost 95% patients had no pain and returned to their original job after 18 weeks of fixation with no significant limitations. The fractures united at a mean of 8 weeks (6 to 10) and no case of non- union was observed. Evaluation of outcome 18 weeks after fixation showed that 60% of the patients had excellent outcome (Bostman Score 28-30) and 40% had good outcome (Bostman Score 20-27).

Conclusion: The majority of patients with extra-articular distal pole patella fractures are farmers in early middle age. For extra-articular patella distal pole fractures, vertical wiring works well. Most patients have resumed pre-injury activities with minor knee restrictions. Larger trials are needed because this study's sample size may skew clinical efficacy assessments.

 Keywords: Extra-Articular Patella Distal Pole Fractures; Vertical Wiring; Unilateral IPFP Diagnosed by Imaging

References

1. Galla M and Lobenhoffer P. “Patella fractures”. Chirurg 76 (2005): 987-997. quiz 998-999.
2. Wong ALY., et al. “The “invisible” wiring technique for displaced fracture patella”. Journal of Orthopaedics, Trauma and Rehabilitation2 (2020): 252-257.
3. Jarraya M., et al. “Imaging of patellar fractures”. Insights Imaging 8 (2017): 49-57.
4. Archdeacon MT and Kakazu R. “Surgical Management of Patellar Fractures”. Orthopedic Clinics of North America 1 (2016): 77-83.
5. Patellar fractures. Physiopedia.
6. Matejci A., et al. “Multifragment fracture of the patellar apex: basket plate osteosyuthesis compared with partial patellectomy”. Archives of Orthopaedic and Trauma Surgery4 (2008): 403-408.
7. Neumann HS., et al. “Long-term results of surgical management of patellar fractures”. Unfallchirurg 6 (1993): 305-310.
8. Kadar A., et al. “Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy”. International Orthopaedics1 (2016): 149-154.
9. Matejcić A., et al. “Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy”. Archives of Orthopaedic and Trauma Surgery4 (2008): 403-408.
10. Zhang Y., et al. “Application of a shape-memory alloy concentrator in displaced patella fractures: technique and long-term results”. Journal of Knee Surgery2 (2017): 166-173.
11. Cho JW., et al. “Comminuted inferior pole fracture of patella can be successfully treated with rim-plateaugmented separate vertical wiring”. Archives of Orthopaedic and Trauma Surgery2 (2018): 195-202.
12. Anand A., et al. “Role of suture anchors in management of fractures of inferior pole of patella”. Indian Journal of Orthopaedic3 (2010): 333-335.
13. Smith ST., et al. “Early complications in the operative treatment of patella fractures”. Journal of Orthopaedic Trauma3 (1997): 183-187.
14. Kim YM., et al. “Separate vertical wirings for the extra-articular fractures of the distal pole of the patella”. Knee Surgery and Related Research4 (2011): 220-226.v
15. Lefaivre KA., et al. “Modified tension band technique for patella fractures”. Orthopaedics and Traumatology: Surgery and Research5 (2010): 579-582.
16. Song HK., et al. “Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella”. Yonsei Medical Journal3 (2014): 785-791.
17. Wilkinson J. “Fracture of the patella treated by total excision. A long-term follow-up”. Journal of Bone and Joint Surgery British 59 (1977): 352-354.
18. Perry CR., et al. “Patellar fixation protected with a load-sharing cable”. Journal of Orthopaedic Trauma3 (1988): 234-240.
19. Huang HC., et al. “Modified basket plate for inferior patellar pole avulsion fractures—a report of three cases”. Kaohsiung Journal of Medical Sciences 28 (2012): 619-623.
20. Mateji A., et al. “The basket plate in the osteosynthesis of comminuted fractures of distal pole of the patella”. Injury-International Journal of the Care of the Injured 37 (2006): 525-530.
21. Kastelec M and Veselko M. “Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection”. Journal of Bone and Joint Surgery American 87 (2005): 113-121.
22. Volgas D and Dreger T. “The use of mesh plates for difficult fractures of the patella”. Journal of Knee Surgery 30 (2017): 200-203.
23. Moore TB., et al. “Fixed angle plate fixation of comminuted patellar fractures”. Injury 49 (2018): 1203-1207.
24. Wild M., et al. “Fixed-angle plates in patella fractures - a pilot cadaver study”. European Journal of Medical Research1 (2011): 41-46.
25. Wild M., et al. “Treating patella fractures with a fixed-angle patella plate—a prospective observational study”. Injury 47 (2016): 1737-1743.
26. He QF., et al. “Novel rim plating technique for treatment of the inferior pole fracture of the patella”. Orthopaedic Surgery 13 (2021): 651-658.
27. Oh HK., et al. “Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing”. Injury 12 (2015): 2512-2515.
28. Xie J., et al. “Anchor and Krackow-“8” suture for the fixation of distal pole fractures of the patella: comparison to Kirschner wire”. Orthopaedic Surgery 14 (2022): 374-382.
29. Zhang ZS., et al. “Comparison of a novel tension band and Patellotibial tubercle Cerclage in the treatment of comminuted fractures of inferior pole of the patella”. Orthopaedic Surgery 12 (2020): 224-232.
30. Yang KH and Byun YS. “Separate vertical wiring for the fixation of comminuted fractures of the inferior pole of the patella”. The Journal of Bone and Joint Surgery. British volume 85 (2003): 1155-1160.
31. Pandey AK., et al. “Results of partial patellectomy”. Archives of Orthopaedic and Trauma Surgery5 (1991): 246-249.
32. Gwinner C., et al. “Current concepts review: fractures of the patella”. GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW 5 (2016): Doc01.
33. Gao Z., et al. “A novel technique for the treatment of inferior pole fractures of the patella: A preliminary report”. Orthopaedic Surgery 11 (2022): 3092-3099.
34. Hung L., et al. “Fractured patella: operative treatment using tension band principle”. Injury5 (1985): 343-347.
35. Chen CH., et al. “Transosseous suturing of patellar fractures with braided polyester—a prospective cohort with a matched historical control study”. Injury10 (2013): 1309-1313.
36. Egol K., et al. “Patella Fracture Fixation with suture and wire: you reap what you sew”. Iowa Orthopaedic Journal 34 (2014): 63-67.
37. Singh RP., et al. “Treatment of inferior patellar pole avulsion fractures with pole resection and Patellotibial cerclage wire”. Nepal Medical College Journal2 (2007): 93-95.
38. Song HK., et al. “Separate vertical wirings for the fixation of comminuted fractures of the inferior pole of the patella”. Yonsei Medical Journal3 (2014): 785-791.
39. Bostman O., et al. “Comminuted displaced fractures of the patella”. Injury 13 (1981): 196-202.
40. Luo TD., et al. “Patella Fractures”. In: Treasure Island (FL);2021.
41. Marder RA., et al. “Effects of partial patellectomy and reattachment of the patellar tendon on patellofemoral contact areas and pressures”. The Journal of Bone and Joint Surgery1 (1993): 35-45.
42. Yang KH and Byun YS. “Separate vertical wiring for the fixation of Comminuted fractures of the inferior pole of the patella”. The Journal of Bone and Joint Surgery 85-B (2003): 1155-1160.

Citation

Citation: Mohammad Shah Kamal Uddin., et al. “A Novel Technique for the Treatment of Patellar Distal Pole Fracture: A Observational Study".Acta Scientific Orthopaedics 6.8 (2023): 21-27.

Copyright

Copyright: © 2023 Mohammad Shah Kamal Uddin., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.