Skip to main content
SpringerLink
Log in

Long-term outcomes after partial patellectomy in comminuted fractures — a clinical study

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to evaluate the long-term clinical and radiographic outcomes of partial patellectomy (PP) in patients with patella comminuted distal pole fractures.

Methods

Seventeen patients who were diagnosed with patella comminuted distal pole fractures and underwent PP procedures were retrospectively included between January 1995 and January 2005. We collected patient demographics and data on the mechanism of injury, time to surgery, fracture type, follow-up time, and post-operative complications (infection, patellofemoral arthritis, and stiffness). At the final follow-up, functional outcome was evaluated by the range of motion (ROM) and the Bostman Scoring System. Quadriceps strength was evaluated by using an isokinetic dynamometer to measure peak torque, and patellar height was evaluated by the Insall-Salvati (IS) ratio in lateral knee radiographs. The average follow-up period was 14.6 years (range, 11–19 years).

Results

We analyzed 17 patients (AO/OTA 34-A1), with an average age of 59.8 years (range, 43–76 years). According to the Bostman grading scales, final functional outcomes were excellent in 11 (64.7%) and good in six (35.3%) patients. All patients had full knee extension, and the average ROM was 125.1° (range, 121.4–129.3°). The average peak torque of the injured knee was 103.2 ± 9.7 Nm, and that of the uninjured opposite side was 108.3 ± 7.6 Nm, with no significant difference (p > 0.05). Furthermore, no postoperative complications, such as infection, posttraumatic osteoarthritis, or stiffness, were observed. Compared to the uninjured knee, the IS ratio of the injured knee was 0.76 ± 0.13, indicating that the patellar height was decreased, which meant patella baja.

Conclusions

The PP procedure for patella comminuted distal pole fractures is a safe, simple, and reliable technique that can provide good long-term clinical outcomes even with decreased patellar height and could be a satisfactory alternative treatment option when anatomical reduction is difficult.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

All the data and material involving this article will be available upon request by sending an e-mail to the first author.

References

  1. Sutton FJ, Thompson CH, Lipke J et al (1976) The effect of patellectomy on knee function. J Bone Joint Surg Am 58(4):537–540

    Article  Google Scholar 

  2. Koval KJ, Kim YH (1997) Patella fractures. Evaluation and treatment. Am J Knee Surg 10(2):101–108

    CAS  PubMed  Google Scholar 

  3. Benjamin J, Bried J, Dohm M et al (1987) Biomechanical evaluation of various forms of fixation of transverse patellar fractures. J Orthop Trauma 1(3):219–222. https://doi.org/10.1097/00005131-198701030-00004

    Article  CAS  PubMed  Google Scholar 

  4. Neumann HS, Winckler S, Strobel M (1993) [Long-term results of surgical management of patellar fractures]. Unfallchirurg 96(6):305–310

    CAS  PubMed  Google Scholar 

  5. Veselko M, Smrkolj V, Tonin M (1996) Comminuted avulsion fractures of the inferior pole of the patella. Unfallchirurg 99(1):71–72

    CAS  PubMed  Google Scholar 

  6. Carpenter JE, Kasman RA, Patel N et al (1997) Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma 11(5):351–356. https://doi.org/10.1097/00005131-199707000-00009

    Article  CAS  PubMed  Google Scholar 

  7. Marya SK, Bhan S, Dave PK (1987) Comparative study of knee function after patellectomy and osteosynthesis with a tension band wire following patellar fractures. Int Surg 72(4):211–213

    CAS  PubMed  Google Scholar 

  8. Kadar A, Sherman H, Drexler M et al (2016) Anchor suture fixation of distal pole fractures of patella: twenty seven cases and comparison to partial patellectomy. Int Orthop 40(1):149–154. https://doi.org/10.1007/s00264-015-2776-9

    Article  PubMed  Google Scholar 

  9. Kastelec M, Veselko M (2004) Inferior patellar pole avulsion fractures: osteosynthesis compared with pole resection. J Bone Joint Surg Am 86(4):696–701. https://doi.org/10.2106/00004623-200404000-00005

    Article  PubMed  Google Scholar 

  10. Zhu W, Xie K, Li X et al (2020) Combination of a miniplate with tension band wiring for inferior patellar pole avulsion fractures. Injury 51(3):764–768. https://doi.org/10.1016/j.injury.2020.01.028

    Article  PubMed  Google Scholar 

  11. Fan M, Wang D, Sun K et al (2020) Study of double button plate fixation in treatment of inferior pole of patella fracture. Injury 51(3):774–778. https://doi.org/10.1016/j.injury.2020.01.031

    Article  PubMed  Google Scholar 

  12. Matejcic A, Puljiz Z, Elabjer E et al (2008) Multifragment fracture of the patellar apex: basket plate osteosynthesis compared with partial patellectomy. Arch Orthop Trauma Surg 128(4):403–408. https://doi.org/10.1007/s00402-008-0572-3

    Article  PubMed  Google Scholar 

  13. Kakazu R, Archdeacon MT (2016) Surgical management of patellar fractures. Orthop Clin North Am 47(1):77–83. https://doi.org/10.1016/j.ocl.2015.08.010

    Article  PubMed  Google Scholar 

  14. Bonnaig NS, Casstevens C, Archdeacon MT et al (2015) Fix it or discard it? A retrospective analysis of functional outcomes after surgically treated patella fractures comparing ORIF with partial patellectomy. J Orthop Trauma 29(2):80–84. https://doi.org/10.1097/BOT.0000000000000201

    Article  PubMed  Google Scholar 

  15. LeBrun CT, Langford JR, Sagi HC (2012) Functional outcomes after operatively treated patella fractures. J Orthop Trauma 26(7):422–426. https://doi.org/10.1097/BOT.0b013e318228c1a1

    Article  PubMed  Google Scholar 

  16. Andrews JR, Hughston JC (1977) Treatment of patellar fractures by partial patellectomy. South Med J 70(7):809–813, 817. https://doi.org/10.1097/00007611-197707000-00014

    Article  CAS  PubMed  Google Scholar 

  17. Saltzman CL, Goulet JA, McClellan RT et al (1990) Results of treatment of displaced patellar fractures by partial patellectomy. J Bone Joint Surg Am 72(9):1279–1285

    Article  CAS  Google Scholar 

  18. Bostman O, Kiviluoto O, Nirhamo J (1981) Comminuted displaced fractures of the patella. Injury 13(3):196–202. https://doi.org/10.1016/0020-1383(81)90238-2

    Article  CAS  PubMed  Google Scholar 

  19. Pincivero DM, Lephart SM, Karunakara RA (1997) Reliability and precision of isokinetic strength and muscular endurance for the quadriceps and hamstrings. Int J Sports Med 18(2):113–117. https://doi.org/10.1055/s-2007-972605

    Article  CAS  PubMed  Google Scholar 

  20. Marsh JL, Slongo TF, Agel J et al (2007) Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee. J Orthop Trauma 21(10 Suppl):S1–S133. https://doi.org/10.1097/00005131-200711101-00001

    Article  CAS  PubMed  Google Scholar 

  21. Insall J, Salvati E (1971) Patella position in the normal knee joint. Radiology 101(1):101–104. https://doi.org/10.1148/101.1.101

    Article  CAS  PubMed  Google Scholar 

  22. Kesemenli CC, Subasi M, Kirkgoz T et al (2001) [The middle period outcome of partial patellectomy for the treatment of comminuted patella fractures]. Ulus Travma Derg 7(2):117–121

    CAS  PubMed  Google Scholar 

  23. Kim KS, Suh DW, Park SE et al (2020) Suture anchor fixation of comminuted inferior pole patella fracture-novel technique: suture bridge anchor fixation technique. Arch Orthop Trauma Surg. https://doi.org/10.1007/s00402-020-03671-5

    Article  PubMed  Google Scholar 

  24. Marsh JL, Buckwalter J, Gelberman R et al (2002) Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am 84(7):1259–1271

    Article  CAS  Google Scholar 

  25. Hung LK, Lee SY, Leung KS et al (1993) Partial patellectomy for patellar fracture: tension band wiring and early mobilization. J Orthop Trauma 7(3):252–260. https://doi.org/10.1097/00005131-199306000-00010

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Xiangtian Deng, Lian Zhu, and Hongzhi Hu contributed equally to this work.

Authors and Affiliations

  1. School of Medicine, Nankai University, Tianjin, 300071, People’s Republic of China

    Xiangtian Deng, Jian Zhu, Zhipeng Ye, Haitao Guan, Boyu Zhang & Yingze Zhang

  2. Department of Orthopaedic Surgery of Hebei Province, Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Xiangtian Deng, Lian Zhu, Qingcheng Song, Xiaodong Cheng, Sifan Yang, Zhipeng Ye, Haitao Guan, Boyu Zhang, Wei Chen & Yingze Zhang

  3. NHC Key Laboratory of Intelligent Orthopaedic Equipment, Third Hospital of Hebei Medical University, Shijiazhuang, 050051, Hebei, People’s Republic of China

    Xiangtian Deng, Lian Zhu, Qingcheng Song, Xiaodong Cheng, Sifan Yang, Zhipeng Ye, Haitao Guan, Boyu Zhang, Wei Chen & Yingze Zhang

  4. Department of Orthopedics, Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China

    Hongzhi Hu & Weijian Liu

Authors
  1. Xiangtian Deng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lian Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hongzhi Hu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Weijian Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Qingcheng Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaodong Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jian Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Sifan Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Zhipeng Ye
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Haitao Guan
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Boyu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Wei Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Yingze Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Yingze Zhang designed the study; Xiangtian Deng, Lian Zhu, Hongzhi Hu, and Weijian Liu searched relevant studies; Qingcheng Song, Xiaodong Cheng, Jian Zhu, Sifan Yang, Zhipeng Ye, Haitao Guan, and Boyu Zhang analyzed and interpreted the data; Xiangtian Deng and Wei Chen wrote the manuscript; and Yingze Zhang approved the final version of the manuscript.

Corresponding author

Correspondence to Yingze Zhang.

Ethics declarations

Ethical approval

This study was approved by the institutional committee of the Third Hospital of Hebei Medical University and complied with the principles of the Declaration of Helsinki.

Consent to participate

All patients provided a written informed consent to the measurement procedures.

Consent for publication

Consent to publish was obtained from each patient.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Deng, X., Zhu, L., Hu, H. et al. Long-term outcomes after partial patellectomy in comminuted fractures — a clinical study. International Orthopaedics (SICOT) 45, 3185–3191 (2021). https://doi.org/10.1007/s00264-021-05127-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-021-05127-w

Keywords

Search

Navigation