Functional results after patellar fractures in elderly patients.
ABSTRACT Elderly patients tend to fracture the patella because of a simple fall. In this group of patients restoration of primary functional level is crucial. Sixty-eight patients more than 65 years of age with patellar fractures, who were treated in our institution between January 1990 and December 1999 were evaluated. There were 43 females and 25 males. The ages ranged from 65 to 88 years (17 patients>80). We focus on the mechanism, which led to the fracture, the pre-morbid and post-morbid state of the patients and the various aspects of treatment in this group of patients. The majority (82%) had a simple fall. Half of the patients had background diseases. Forty-five patients (66%) had comminuted patellar fracture. In 58 patients (85%) the extensor mechanism was disrupted, which therefore, necessitated an operation (group I). The rest, ten patients, were treated conservatively (group II). Follow-up time ranged between 0.5 and 10.5 years (mean 4.5 years). Minor complications were noted in five patients. Sixty patients (88%) had intact extensor mechanism, while five patients in group I (9%) and three in group II (30%) had extension-lag of 10-30 degrees (P<0.05). None of the patients had non-union, cosmetic disturbances or developed osteoarthritis. Fifty-six patients (82%) (41 patients in group I and five in group II, P<0.05) achieved the same independence mobility status post-fracture. In elderly patients the cause of the fracture is a direct blow by simple fall to the patella causing comminuted fractures; however, with these patients excellent or good results were eventually achieved. Surgical treatment yielded better results than non-surgical.
Article: Compressive screwing of transverse patella fractures provides better resistance to traction than tension band[show abstract] [hide abstract]
ABSTRACT: There are different stabilization methods used in surgical treatment of patellar fractures. The aim of this study was to determine the resistance against the distraction forces by three different and widely used fixation methods of the transverse fractures in calf patella. These fixation methods are as follows: (1) modified tension band (Group 1); (2) Malleolar screw (Group 2), and (3) tension band with Herbert screw (Group 3). Each experimental group had 10 calf patellas. Each patella was placed on a compression-tension testing system, and tension force was applied monotonically up to complete distraction at a loading rate of 15 Newton/second to the one site of the fractured patella. The force that corresponds to 2-mm distraction of the fracture site was accepted as the distraction force that causes the fixation failure. The mean values of the distraction forces were 350.5±81.4 Newton (N) for Group 1; 977.90±345.66N for Group 2, and 957.30±355.94N for Group 3. Results established from each test group were statistically analyzed by using Mann–Whitney U-test. Group 1 was significantly different than Group 2 and Group 3. P values were 0.0013 and 0.0002, respectively. There was no significant difference between Groups 2 and 3 (P=0.6232). As a result, we have concluded that malleolar screw (Group 2) and tension band with Herbert screw (Group 3) were the most stable fixation methods against distraction forces, and there was less resistance against the distraction forces in the modified tension band in Group 1. KeywordsHerbert screw–Internal fixation–Tension band wiring–Fracture of patellaEuropean Journal of Orthopaedic Surgery & Traumatology 04/2012; 21(2):105-110. · 0.10 Impact Factor