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

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.

[Patalla Fractures]. / Patellafrakturen.

Patella fractures are rare injuries, accounting for 0.5 - 1.5% of all fractures, but they can lead to severe functional limitations if they do not heal properly. In addition to a prompt diagnosis, surgical treatment is usually necessary for multi-fragment fractures. The goals of every treatment are a biomechanically stable joint as well as a congruent restoration of the retropatellar joint surface. These results often remain a challenge, especially in multiple fragment fractures. The surgical treatment strategies have steadily evolved from tension band and screw osteosyntheses in combination with wire cerclages. Currently, angular stable plate systems are increasingly being used. This article gives an overview of the fracture anatomy, the classification and diagnosis of patella fractures and the currently used surgical treatment options.

Good outcome using anatomically pre-formed buttress plates for anteromedial facet fractures of the coronoid-a retrospective study of twenty-four patients.

PURPOSE: The aims of this retrospective study were to describe the characteristics of anteromedial facet fracture of the coronoid (AMFF) and to determine the outcome following surgery using anatomically pre-formed coronoid buttress plates. METHODS: Twenty-four patients underwent surgery for AMFF, using a pre-formed buttress plate, between 2011 and 2017 (20 men, four women), with a mean age of 47.7 years (range, 19-78 years) and a mean post-operative follow-up of 3.7 years (range, 12-86 months). Fracture classification, injury pattern, accompanying injuries, post-operative range of motion, and revision rate were noted. Post-operative radiographs assessed union, arthritic change, and joint articulation. Joint function was quantified using the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), and the Disabilities of the Arm, Shoulder, and Hand (DASH) scores. RESULTS: Eleven cases with subtype 2 and 13 cases with a subtype 3 AMFF could be included, of which 15 had an associated rupture of the lateral collateral ligament (LCL) and nine of the medial collateral ligament (MCL). Post-operatively, all cases went to bone union without secondary elbow instability. The mean post-operative range of motion was 125° (range, 90-140°), mean MEPS was 98, mean OES was 43, and mean DASH score was 7. Five patients required repeat surgery within two years due to a limited range of motion; 90% of patients regained their pre-trauma levels of physical activity. CONCLUSIONS: AMFF are challenging injuries, frequently associated with lesions to the collateral ligament complex. Using anatomically pre-formed coronoid plates, excellent functional outcomes can be achieved.