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Patellafrakturen in der Knieendoprothetik

Patella fractures in knee arthroplasty

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Zusammenfassung

Periprothetische Patellfrakturen treten sowohl mit als auch ohne retropatellaren Gelenkersatz auf. Eine konservative Behandlung bringt häufig zufriedenstellende Ergebnisse mit einer geringen Morbidität. Sie findet Anwendung bei minimal dislozierten Frakturen, die eine intakte Patellakomponente und einen intakten Streckmechanismus aufweisen und wird mit einer initialen Immobilisation kombiniert. Die operative Behandlung erbringt relativ schlechte Ergebnisse mit hohen Komplikationsraten. Es fanden sich nur geringe Besserungen der funktionellen Ergebnisse, egal welche operative Technik verwendet wurde. Die operative Intervention ist unverändert erforderlich bei Frakturen mit einer Lockerung der Patellakomponente, erheblicher Dislokationen der Fragmente und Schädigung bzw. Ruptur des Streckapparates. Insbesondere Typ-II-Frakturen erfordern eine Reparatur des Streckapparates, Versorgung der Fraktur oder eine Patellektomie. Typ-III-Frakturen erfordern die Revision oder Resektion der Patellakomponente, Patelloplastie oder totale Patellektomie. Zusätzlich kann die frühe oder späte Rekonstruktion mittels Allograft zur Wiederherstellung des Streckmechanismus im Betracht gezogen werden.

Abstract

Periprosthetic patella fractures occur both with and without retropatellar joint replacement. A non-operative treatment yields satisfactory results with low morbidity. It can be applied in minimally displaced fractures that have an intact retropatellar component and an intact extensor mechanism, combined with an initial immobilization. The surgical treatment is associated with relatively poor results and with high complication rates. There was only minor improvement of functional results, no matter which surgical technique was used. Surgical intervention is still required in fractures with a loosening of the patellar component, considerable dislocations of fragments, and damage to or rupture of the extensor mechanism. In particular, type II fractures require repair of the extensor mechanism and the fracture or patellectomy. Type III fractures require a revision or resection of the patella, a patelloplasty or total patellectomy. In addition, early or late reconstruction using allograft to restore the extensor mechanism can be taken in consideration.

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Authors and Affiliations

  1. Bereich Endoprothetik/Orthopädie, Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, Haus 4, 04103, Leipzig, Deutschland

    A. Roth, M. Ghanem & J. Fakler

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  2. M. Ghanem
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  3. J. Fakler
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Correspondence to A. Roth.

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A. Roth, M. Ghanem und J. Fakler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Roth, A., Ghanem, M. & Fakler, J. Patellafrakturen in der Knieendoprothetik. Orthopäde 45, 416–424 (2016). https://doi.org/10.1007/s00132-016-3254-9

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