Skip to main content

Advertisement

SpringerLink
Log in

Comminuted AO-C3 fractures of the patella: good outcome using anatomically contoured locking plate fixation

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

Abstract

Purpose

The treatment of comminuted patellar fractures remains a challenge for orthopedic surgeons. The aim of this study was to assess the clinical, functional, and radiological outcome after treatment of comminuted patellar fractures using an anatomically contoured plating system.

Methods

Between January 2015 and December 2019 (5 years), 29 patients with complex C3 fractures according to AO classification (18 female, 11 male; mean age: 53 years) were treated using an anatomically contoured plating system (patella SuturePlate™, Arthrex®, Naples, USA). Indication for surgery was based on instability and/or initial fragment dislocation (> 2 mm). After a minimum follow-up of 12 months, patients were examined using a standardized clinical examination and functional outcome was assessed using specific knee scores (Lysholm, WOMAC, IKDC, Kujala, and Tegner score). In addition, complications were recorded and all available radiographs were evaluated regarding osteoarthritis and reduction quality.

Results

All patients returned for follow-up investigation after an average of 19 months (range: 12–48 months). A mean range of motion (ROM) of 131° (range: 100–150) was recorded. Overall good functional outcome parameters could be reported, with a mean Lysholm score of 84.7 (range: 100–45), a WOMAC of 5.1 (range: 0–19.2), a Kujala scale of 85.5 (range: 100–48), an IKDC of 76.6 (range: 100–44.8), and a Tegner score of 4.3 (range: 10–3) with a difference of 0.62 to pre-operative. Patient satisfaction was rated 8.4 (range: 4–10) using a VAS. No loss of reduction, mechanical failure, or implant complications were detected. Radiological follow-up showed no evidence of relevant post-traumatic retropatellar osteoarthritis. In 7 cases, implants were removed due to subjective mechanical irritation.

Conclusion

Anatomically contoured patellar plates allow secure fixation of the fracture fragments even in comminuted cases. Especially when tension-band wiring is prone to early failure, locking plate fixation represents a viable option leading to good functional results and low complication rates.

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
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

References

  1. Boström Å (1972) Fracture of the patella: a study of 422 patellar fractures. Acta Orthop Scand 43:1–80. https://doi.org/10.3109/ort.1972.43.suppl-143.01

    Article  Google Scholar 

  2. Müller EC, Frosch K-H (2019) Patellafrakturen Chir 90:243–254. https://doi.org/10.1007/s00104-019-0797-4

    Article  Google Scholar 

  3. Larsen P, Court-Brown CM, Vedel JO et al (2016) Incidence and epidemiology of patellar fractures. Orthopedics 39(6):e1154–e1158. https://doi.org/10.3928/01477447-20160811-01

  4. Yang N-P, Chan C-L, Yu I-L et al (2010) Estimated prevalence of orthopaedic fractures in Taiwan—a cross-sectional study based on nationwide insurance data. Injury 41:1266–1272. https://doi.org/10.1016/j.injury.2010.05.025

    Article  PubMed  Google Scholar 

  5. Court-Brown CM, Caesar B (2006) Epidemiology of adult fractures: a review. Injury 37:691–697. https://doi.org/10.1016/j.injury.2006.04.130

    Article  PubMed  Google Scholar 

  6. Schüttrumpf JP, Piatek S, Stürmer KM (2019) Patellafraktur. Leitlinien Unfallchirurgie. AWMF-Nr. 012-017

  7. Levack B, Flannagan J, Hobbs S (1985) Results of surgical treatment of patellar fractures. J Bone Joint Surg Br 67-B:416–419. https://doi.org/10.1302/0301-620X.67B3.3997951

  8. Fehske K, Berninger MT, Alm L et al (2021) Current treatment standard for patella fractures in Germany. Unfallchirurg 124(10): 832–838. https://doi.org/10.1007/s00113-020-00939-8

  9. Müller ME, Allgöwer M, Schneider R, et al. (1990) Manual der Osteosynthese, 3rd edn. Springer Verlag, Berlin, Heidelberg, New York

  10. Smith ST, Cramer KE, Karges DE et al (1997) Early complications in the operative treatment of patella fractures. J Orthop Trauma 11:183–187. https://doi.org/10.1097/00005131-199704000-00008

    Article  CAS  PubMed  Google Scholar 

  11. Zderic I, Stoffel K, Sommer C et al (2017) Biomechanical evaluation of the tension band wiring principle. A comparison between two different techniques for transverse patella fracture fixation. Injury 48:1749–1757. https://doi.org/10.1016/j.injury.2017.05.037

    Article  PubMed  Google Scholar 

  12. Wurm S, Augat P, Bühren V (2015) Biomechanical assessment of locked plating for the fixation of patella fractures. J Orthop Trauma 29:e305. https://doi.org/10.1097/BOT.0000000000000309

    Article  PubMed  Google Scholar 

  13. Ellwein A, Lill H, DeyHazra R-O et al (2019) Outcomes after locked plating of displaced patella fractures: a prospective case series. Int Orthop 43:2807–2815. https://doi.org/10.1007/s00264-019-04337-7

    Article  PubMed  Google Scholar 

  14. Moore TB, Sampathi BR, Zamorano DP et al (2018) Fixed angle plate fixation of comminuted patellar fractures. Injury 49:1203–1207. https://doi.org/10.1016/j.injury.2018.03.030

    Article  PubMed  Google Scholar 

  15. Wild M, Fischer K, Hilsenbeck F et al (2016) Treating patella fractures with a fixed-angle patella plate—a prospective observational study. Injury 47:1737–1743. https://doi.org/10.1016/j.injury.2016.06.018

    Article  PubMed  Google Scholar 

  16. Meinberg EG, Agel J, Roberts CS et al (2018) Fracture and dislocation classification compendium-2018. J Orthop Trauma 32(Suppl 1):S1–S170. https://doi.org/10.1097/BOT.0000000000001063

    Article  PubMed  Google Scholar 

  17. Tegner Y, Lysholm J (1985) Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 198:43–49

  18. Lysholm J, Gillquist J (1982) Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 10:150–154. https://doi.org/10.1177/036354658201000306

    Article  CAS  PubMed  Google Scholar 

  19. Kujala UM, Jaakkola LH, Koskinen SK et al (1993) Scoring of patellofemoral disorders. Arthrosc J Arthrosc Relat Surg Off Publ Arthrosc Assoc N Am Int Arthrosc Assoc 9:159–163. https://doi.org/10.1016/s0749-8063(05)80366-4

    Article  CAS  Google Scholar 

  20. Bellamy N (2005) The WOMAC knee and hip osteoarthritis indices: development, validation, globalization and influence on the development of the AUSCAN hand osteoarthritis indices. Clin Exp Rheumatol 23:S148-153

    CAS  PubMed  Google Scholar 

  21. Hefti F, Müller W, Jakob RP, Stäubli HU (1993) Evaluation of knee ligament injuries with the IKDC form. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 1:226–234. https://doi.org/10.1007/BF01560215

    Article  CAS  Google Scholar 

  22. Kellgren JH, Lawrence JS (1957) Radiological assessment of osteo-arthrosis. Ann Rheum Dis 16:494–502. https://doi.org/10.1136/ard.16.4.494

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Dy CJ, Little MTM, Berkes MB et al (2012) Meta-analysis of re-operation, nonunion, and infection after open reduction and internal fixation of patella fractures. J Trauma Acute Care Surg 73:928–932. https://doi.org/10.1097/TA.0b013e31825168b6

    Article  PubMed  Google Scholar 

  24. Mao N, Liu D, Ni H et al (2013) Comparison of the cable pin system with conventional open surgery for transverse patella fractures. Clin Orthop 471:2361–2366. https://doi.org/10.1007/s11999-013-2932-8

    Article  PubMed  PubMed Central  Google Scholar 

  25. Luna-Pizarro D, Amato D, Arellano F et al (2006) Comparison of a technique using a new percutaneous osteosynthesis device with conventional open surgery for displaced patella fractures in a randomized controlled trial. J Orthop Trauma 20:529–535. https://doi.org/10.1097/01.bot.0000244994.67998.1b

    Article  PubMed  Google Scholar 

  26. Mao N, Liu D, Ni H et al (2013) Comparison of the cable pin system with conventional open surgery for transverse patella fractures. Clin Orthop Relat Res 471:2361–2366. https://doi.org/10.1007/s11999-013-2932-8

    Article  PubMed  PubMed Central  Google Scholar 

  27. Thelen S, Betsch M, Schneppendahl J et al (2013) Fixation of multifragmentary patella fractures using a bilateral fixed-angle plate. Orthopedics 36:e1437-1443. https://doi.org/10.3928/01477447-20131021-29

    Article  PubMed  Google Scholar 

  28. Thelen S, Schneppendahl J, Jopen E et al (2012) Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury 43:1290–1295. https://doi.org/10.1016/j.injury.2012.04.020

    Article  PubMed  Google Scholar 

  29. Wurm S, Augat P, Bühren V (2012) Winkelstabile Plattenosteosynthese der Patella: Neue Therapieoption. Trauma Berufskrankh 14:147–151. https://doi.org/10.1007/s10039-011-1815-z

    Article  Google Scholar 

  30. Siljander M, Koueiter D, Gandhi S et al (2018) Outcomes following low-profile mesh plate osteosynthesis of patella fractures. J Knee Surg 31:919–926. https://doi.org/10.1055/s-0038-1625958

    Article  PubMed  Google Scholar 

  31. Wurm S, Bühren V, Augat P (2018) Treating patella fractures with a locking patella plate - first clinical results. Injury 49:S51–S55. https://doi.org/10.1016/S0020-1383(18)30304-8

    Article  PubMed  Google Scholar 

  32. Ellwein A, Katthagen J, Jensen G (2017) Plate osteosynthesis after patellar fracture: 1-year results of a prospective study. Orthopaedic Journal of Sports Medicine 5(4_suppl4):2325967117S0013–. https://doi.org/10.1177/2325967117S00138

  33. Copay AG, Eyberg B, Chung AS et al (2018) Minimum clinically important difference: current trends in the orthopaedic literature, part II: lower extremity: a systematic review. JBJS Rev 6:e2–e2. https://doi.org/10.2106/JBJS.RVW.17.00160

    Article  PubMed  Google Scholar 

  34. Lazaro LE, Wellman DS, Pardee NC et al (2013) Effect of computerized tomography on classification and treatment plan for patellar fractures. J Orthop Trauma 27:336–344. https://doi.org/10.1097/BOT.0b013e318270dfe7

    Article  PubMed  Google Scholar 

  35. Tengler MB, Lill H, Wente M, Ellwein A (2021) Anterior locking plate osteosynthesis of patellar factures – analysis of complications and functional outcome. Z Für Orthop Unfallchirurgie. https://doi.org/10.1055/a-1403-3681

    Article  Google Scholar 

  36. McLAUGHLIN HL (1947) Repair of major tendon ruptures by buried removable suture. Am J Surg 74:758–764. https://doi.org/10.1016/0002-9610(47)90233-x

    Article  CAS  PubMed  Google Scholar 

  37. Wild M, Fischer K, Hilsenbeck F et al (2016) Treating patella fractures with a fixed-angle patella plate-a prospective observational study. Injury 47:1737–1743. https://doi.org/10.1016/j.injury.2016.06.018

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Zentrum Für Unfallchirurgie Und Orthopädische Chirurgie, BG Unfallklinik Frankfurt Am Main, Friedberger Landstrasse 430, 60389, Frankfurt am Main, Germany

    Stefan Buschbeck, Kristina Götz, Alexander Klug, Stefan Barzen, Yves Gramlich & Reinhard Hoffmann

Authors
  1. Stefan Buschbeck
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kristina Götz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander Klug
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Barzen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yves Gramlich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reinhard Hoffmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

S. Buschbeck: conceptualized and designed the study, examined the patients, analyzed and interpreted the data, wrote and revised the manuscript.

K. Götz: examined the patients, analyzed the data, wrote the manuscript.

A. Klug: revised and proofread the manuscript, made statistical analysis.

S. Barzen: analyzed the data, proofread the manuscript.

Y. Gramlich: analyzed the data, proofread the manuscript.

R. Hoffmann: proofread the manuscript, provided administrative, technical, and material support.

Corresponding author

Correspondence to Stefan Buschbeck.

Ethics declarations

Ethics approval

This study was approved by the local ethics committee of the Regional Medical Board of Hesse, Germany (FF24/2019).

Conflict of interest

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.

Level of evidence: III, retrospective cohort study

Stefan Buschbeck and Kristina Götz This authors contributed equally to this publication.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buschbeck, S., Götz, K., Klug, A. et al. Comminuted AO-C3 fractures of the patella: good outcome using anatomically contoured locking plate fixation. International Orthopaedics (SICOT) 46, 1395–1403 (2022). https://doi.org/10.1007/s00264-022-05374-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-022-05374-5

Keywords

Search

Navigation