Zusammenfassung
Die Patellafraktur ist eine seltene Fraktur, deren suffiziente Behandlung mit Erhalt des Streckapparats eine wichtige Voraussetzung für die Kniefunktion darstellt. Der demografische Wandel und die damit einhergehend zunehmend komplexeren Frakturmuster, häufigeren Komplikationen und der größere Funktionsanspruch auch im hohen Patientenalter werden zu einer Veränderung bestehender Versorgungskonzepte führen. Die isolierte Drahtcerclage wird an Bedeutung verlieren. Vielmehr werden in Kombination mit Zusatzverfahren alternative Osteosynthesetechniken wie Schrauben- und/oder winkelstabile Plattensysteme weiteren Einzug in die Standards finden. Gerade der distale Patellapol, welcher oft bei mehrfragmentären Patellafrakturen betroffen ist, ist ein häufiger Risikofaktor für einen sekundären Repositionsverlust. Die CT stellt den neuen Goldstandard in der präoperativen Diagnostik und Festlegung der Operationsstrategie dar. Bei Beteiligung des distalen Pols, welcher häufig mehrfragmentär frakturiert ist, können zusätzliche Cerclagetechniken wie eine modifizierte transpatelläre Naht nach Krackow oder patellotibiale Cerclage nach McLaughlin für eine Entlastung der Zugspannung am distalen Patellapol sorgen.
Abstract
The patella fracture is a rare fracture whose adequate treatment with preservation of the extensor apparatus is an important prerequisite for knee function. Demographic change and the associated increasingly complex fracture patterns, more frequent complications and greater functional demands, even in older patients, will lead to a change in existing treatment concepts. The isolated wire cerclage will become less important. Rather, in combination with additional procedures, alternative osteosynthesis techniques such as screw and/or angle-stable plate systems will continue to find their way into the standards. Especially the distal pole of the patella, which is often affected in multifragmentary patellar fractures, represents a frequent risk factor for secondary loss of reduction. Computed tomography (CT) represents the new gold standard in preoperative diagnostics and determination of the surgical strategy. If the distal pole is involved, which is often fractured into multiple fragments, additional cerclage techniques such as a modified transpatellar suture according to Krackow or patellotibial cerclage according to McLaughlin can relieve the tension on the distal pole of the patella.
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M. Krause, K.-H. Frosch, M.T. Berninger und J. Frings geben an, dass kein Interessenkonflikt besteht.
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Matthias Krause, Hamburg
Kai Fehske, Würzburg
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Krause, M., Frosch, KH., Berninger, M.T. et al. Der distale Patellapol – „lessons learned?“. Knie J. 5, 91–97 (2023). https://doi.org/10.1007/s43205-023-00201-2
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DOI: https://doi.org/10.1007/s43205-023-00201-2