Introduction: The patella is a key component of the knee’s extensor system. Fractures of the patella can be treated using a variety of methods. The objective of this study was to describe the epidemiological, anatomical-clinical, therapeutic and evolutionary aspects. Methods: This was a prospective, observational, analytic study conducted from January 2018 to December 2021. It concerned all patients over 15 years of age treated surgically for a patella fracture. The variables to be studied were epidemiological, anatomo-clinical, therapeutic and evolutionary. Statistical analysis was performed using the Chi-square test and Fisher’s exact test. Results: It concerned 51 cases. There were 39 men and 12 women. The average age was 35.13 years. The fracture was caused in 78.5% of cases by a road traffic accident. The main fracture was transverse (49.1%). Tension band technique predominated (92.1%). Complications included superficial suppuration (n = 7) and irritation of the material (n = 7). Mean time to consolidation was 66.39 days. B？sman scores were Excellent (n = 23; 45.10%). Some patients presented osteoarthritic knee symptoms (n = 14; 27.45%), and no pseudarthrosis. Conclusion: Patella fractures are rare. Surgical treatment gives good results, and the choice of method depends essentially on the anatomo-clinical characteristics of the fracture. Kinesitherapy is an essential and important weapon in functional recovery.
References
[1]
Lee, B.H., Xuanrong, M.S., Tzong-Yee, C.W., Huang, Y., Wong, K.L.F., Lin, H., et al. (2021) Radiographic Outcomes Following the Suture Fixation of Mid-Pole Patellar Fractures. Cureus, 13, e20448. https://doi.org/10.7759/cureus.20448
[2]
Atia, R., Atia, M.H., Bensaada, M.C. and Belkadi, A. (2015) Fractures de la patella—Traitement par cerclage au fil—À propos de 247 cas. Revue de Chirurgie Orthopédique et Traumatologique, 101, S163-S164. https://doi.org/10.1016/j.rcot.2015.09.064
[3]
Gnandi-Piou, F., Akondo, H.K.F., Lagnéblé, A., et al. (1995) Les fractures de la patella chez l’adulte. Les fractures de la rotule (fractures sur prothèse exceptées), Cahiers d’enseignement de la SOFCOT Paris. Expansion Scientifique Française, 52, 123-135.
[4]
Agarwala, S., Agrawal, P. and Sobti, A. (2015) A Novel Technique of Patella Fracture Fixation Facilitating Early Mobilization and Reducing Re-Operation Rates. JournalofClinicalOrthopaedicsandTrauma, 6, 207-211. https://doi.org/10.1016/j.jcot.2015.03.009
[5]
Benjamin, J., Bried, J., Dohm, M. and McMurtry, M. (1987) Biomechanical Evaluation of Various Forms of Fixation of Transverse Patellar Fractures. JournalofOrthopaedicTrauma, 1, 219-222. https://doi.org/10.1097/00005131-198701030-00004
[6]
Eggink, K.M. and Jaarsma, R.L. (2010) Mid-Term (2-8 Years) Follow-Up of Open Reduction and Internal Fixation of Patella Fractures: Does the Surgical Technique Influence the Outcome? ArchivesofOrthopaedicandTraumaSurgery, 131, 399-404. https://doi.org/10.1007/s00402-010-1213-1
[7]
Gosal, H.S., Singh, P. and Field, R.E. (2001) Clinical Experience of Patellar Fracture Fixation Using Metal Wire or Non-Absorbable Polyester—A Study of 37 Cases. Injury, 32, 129-135. https://doi.org/10.1016/s0020-1383(00)00170-4
[8]
Egol, K., Howard, D., Monroy, A., et al. (2014) Patella Fracture Fixation with Suture and Wire: You Reap What You Sew. Iowa Orthopedic Journal, 34, 63-67.
[9]
Kakazu, R. and Archdeacon, M.T. (2016) Surgical Management of Patellar Fractures. OrthopedicClinicsofNorthAmerica, 47, 77-83. https://doi.org/10.1016/j.ocl.2015.08.010
[10]
Camarda, L., Morello, S., Balistreri, F., D’Arienzo, A. and D’Arienzo, M. (2016) Non-metallic Implant for Patellar Fracture Fixation: A Systematic Review. Injury, 47, 1613-1617. https://doi.org/10.1016/j.injury.2016.05.039
[11]
Shimi, M., El Ibrahim, A., Dahmani, O., et al. (2013) Haubanage percutané des fractures transversales de la rotule (à propos de 8 cas). Rev Maroc ChirOrthopTraumato, 50, 36-38.
[12]
Akobé, A.J.R., Kouassi, K.J.E., Kouassi, A.A.N., et al. (2022) Fractures de la patella: Aspects épidémiologiques, anatomocliniques et thérapeutiques. Science et Technique, Sciences de la Santé, 45, 115-123.
[13]
Tang, X., Liu, Y., Wu, H., Gong, F., Li, Y., Zeng, H., et al. (2018) Five-pointed Star Lattice Sutures for Fixation of Patella Transverse Fractures: A Clinical Study. EuropeanJournalofOrthopaedicSurgery&Traumatology, 29, 163-168. https://doi.org/10.1007/s00590-018-2272-1
[14]
Neyret, P. (1995) Les fractures de la rotule (fractures sur prothèse exceptées), Ca-hiers d’enseignement de la SOFCOT Paris. Expansion Scientifique Française, 52, 123-135.
[15]
Ibrahim, D.A., Swenson, A., Sassoon, A. and Fernando, N.D. (2017) Classifications in Brief: The Tscherne Classification of Soft Tissue Injury. ClinicalOrthopaedics&RelatedResearch, 475, 560-564. https://doi.org/10.1007/s11999-016-4980-3
[16]
Cauchoix, J., Duparc, J. and Boulez, P. (1957) Traitement des fractures ouvertes de jambe. Memoires. Academie de Chirurgie, 83, 811-822.
[17]
Drolia, N., Sinha, S., Paneru, S.R., Kumar, A., Jameel, J., Kumar, S., et al. (2021) Comparison of Functional and Radiological Outcomes of Transverse Patellar Fractures Fixed with Tension Band Fixation Using Cannulated Screws and Kirschner Wires: A Prospective Randomized Study. IndianJournalofOrthopaedics, 56, 369-376. https://doi.org/10.1007/s43465-021-00498-z
[18]
Al-Obaedi, O., Rthakrar, R., Kundra, R., et al. (2019) Gap Non-Union Patella Fractures: Case Report and Review of the Literature. Journal of Orthopaedic Case Reports, 9, 69-71.
[19]
Mehdi, M., Husson, J.L., Polard, J.L., et al. (1999) Résultats du traitement des fractures de la rotule par haubanage pré-rotulien: Analyse d’une série de 203 cas. Acta Orthopaedica Belgica, 65, 188-196.
[20]
Chiron, P. (2009) Fractures de l’extrémité inférieure du fémur de l’adulte. EMC—Appareillocomoteur, 4, 1-14. https://doi.org/10.1016/s0246-0521(09)43668-4
[21]
Böstman, O., Kiviluoto, O. and Nirhamo, J. (1981) Comminuted Displaced Fractures of the Patella. Injury, 13, 196-202. https://doi.org/10.1016/0020-1383(81)90238-2
[22]
Caton, J. (2008) Diagnostic et traitement des rotules hautes et des rotules basses. E-mémoires de l’Académie Nationale de Chirurgie, 7, 33-39.
[23]
Baran, O., Manisali, M. and Cecen, B. (2008) Anatomical and Biomechanical Evaluation of the Tension Band Technique in Patellar Fractures. InternationalOrthopaedics, 33, 1113-1117. https://doi.org/10.1007/s00264-008-0602-3
[24]
Monaco, E., Saithna, A., Cardarelli, S., Bruni, G., Carrozzo, A., Annibaldi, A., et al. (2022) No Difference in Clinical and Radiological Outcomes Following Fixation of Transverse Patella Fractures with Either Suture Tape or Metallic Cerclage: A Retrospective Comparative Study. Orthopaedics&Traumatology:Surgery&Research, 108, Article ID: 103053. https://doi.org/10.1016/j.otsr.2021.103053
[25]
Gwinner, C., Märdian, S., Schwabe, P., et al. (2016) Current Concepts Review: Fractures of the Patella. GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW, 18, 1-15. https://doi.org/10.3205/iprs000080
[26]
Camara, T., Sidibé, M., Bah, M.L., et al. (2023) Profil épidemio-clinique et prise en charge des blessés d’accidents de moto aux urgences médico-chirurgicales de l’hôpital préfectoral de SIGUIRI. JCSM, 3, 1-9.
[27]
Krah, K.L., Yao, L.B., Sery, B.J.N.L., et al. (2013) Données épidémiologiques des accidents de moto aux urgences de chirurgie du CHU de Bouaké. Revue Internationale des Sciences Médicales d’Abidjan, 15, 161-164.
[28]
Digbeu, O.K.E., Krah, K.L., Sery, B.J.N.L., et al. (2023) Profil épidémiologique des accidents de la voie publique au mois de fin d’année 2018 aux urgences chirurgicales du CHU de Bouaké. Médecine d’Afrique Noire, 70, 20-24.
[29]
Binaté, A., Akobe, A.J.R., Krah, K.L., et al. (2022) Ostéosynthèse de la patella: Analyse de la hauteur de la patella et la fonction du genou d’une série hospitalière. Journal Africain de Chirurgie Orthopédique et Traumatologique, 7, 63-67.
[30]
Heusinkveld, M.H.G., den Hamer, A., Traa, W.A., Oomen, P.J.A. and Maffulli, N. (2013) Treatment of Transverse Patellar Fractures: A Comparison between Metallic and Non-Metallic Implants. BritishMedicalBulletin, 107, 69-85. https://doi.org/10.1093/bmb/ldt013
[31]
Lefaivre, K.A., O’Brien, P.J., Broekhuyse, H.M., Guy, P. and Blachut, P.A. (2010) Modified Tension Band Technique for Patella Fractures. Orthopaedics&Traumatology:Surgery&Research, 96, 579-582. https://doi.org/10.1016/j.otsr.2010.01.014
[32]
Yercan, H.S., Selmi, T.A.S. and Neyret, P. (2005) The Treatment of Patellofemoral Osteoarthritis with Partial Lateral Facetectomy. ClinicalOrthopaedicsandRelatedResearch, 436, 14-19. https://doi.org/10.1097/00003086-200507000-00004
[33]
John, J., Wagner, W.W. and Kuiper, J.H. (2006) Tension-band Wiring of Transverse Fractures of Patella. the Effect of Site of Wire Twists and Orientation of Stainless Steel Wire Loop: A Biomechanical Investigation. InternationalOrthopaedics, 31, 703-707. https://doi.org/10.1007/s00264-006-0238-0
[34]
Nikiforidis, P., Babis, G., Tsarouchas, J., Koudis, G. and Korres, D.S. (1999) Patellar Fractures: Contemporary Approach to Operative Treatment, Using Different Types of the Tension Band Principles. EuropeanJournalofOrthopaedicSurgery&Traumatology, 9, 21-26. https://doi.org/10.1007/bf02427766
[35]
Zhang, Z., Sun, F., Zhang, T. and Wen, L. (2023) Gustilo IIIB, AO/OTA C3 Patella Fracture Treated via Three-Step Strategy: A Case Report. AsianJournalofSurgery, 46, 3336-3337. https://doi.org/10.1016/j.asjsur.2023.03.072
