DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20182739

Intraoperative mobilisation of knee and its effect on the final functional outcome in patella fractures: a clinical study

Deepak Aher, Ajay Dandotiya, Dharmendra Raghuvanshi, Abhishek Pathak

Abstract


Background: Treatment of patellar fractures depends on its type, integrity of extensor mechanism and fragments size. Operative measures are tension band wiring and partial or total patellectomy. Early weight bearing and then gradual mobilization and finally quadriceps strengthening remains the crux of physiotherapy. Aim of this study was to see for the effect of intraoperative mobilisation of knee on functional outcome of tension band wiring in patella fractures.

Methods: 30 patients were included in this study from January 2016 to February 2018. Tension band wiring was performed in all the patients. Intraoperative mobilisation of knee as allowed was done when patient was under effect of anesthesia. Final functional outcome was assessed as per the modified knee-rating scale of the Hospital for Special Surgery and also range of motion noted. Patients were evaluated at 1 month, 2 month, 6 month and 12 months.

Results: Patients aged from 25-65 years with mean age of 40 years. 26 patients were male and 4 female. In 20 cases, Right knee was involved. All had trauma due to road traffic accident. Mean operation time was 1 hour. At the end of 1 year follow up only 2 patients had range of motion <90, 4 patients had range of motion 90-120 degrees and 24 patients had range of motion >120 degrees. After 1 year, functional outcome was, excellent in 24, good in 4, fair in 1 and poor in 1.

Conclusions: Intraoperative mobilisation of knee after a stable fixation with tension band wiring of patella can prove to a very effective method for increasing postoperative range of motion and improving functional outcome.


Keywords


Patella, Tension band wiring, Intraoperative mobilisation

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References


O’Donoghue DH, Tompkins F, Hays MB. Strength of quadriceps functions after patellectomy. J Surg Gynecol Obstet. 1952;60:159.

Kaufer H. Mechanical functions of the patella. J Bone Joint Surg (Am). 1971:53:1551-60.

Bostrom A. Fracture of the patella. Acta Orthop Scand. 1972;143:1-80.

Nummi J. Fracture of the patella: a clinical study of 170 patellar fractures. Ann Chir Gynaecol Fenn. 1971;60(179):1-85.

Wilson JN. Joint stiffness and traumatic ossification. In: Watson-Jones fracture and joint injuries. 6th ed. Edinburgh: Churchill Livingstone; 1992: 45-75.

Insall JN. Surgery of the knee. New York: Churchill Livingstone; 1984.

Smith ST, Cramer KE, Karges DE, Watson JT, Moed RR. Early complications in the operative treatment of patella fractures. J Orthop Trauma. 1997;11(3);183-7.

Bostrom A. Fracture of the patella. Actga Orthop Scand Suppl. 1972;143:1-80.

Perry CR, McCarthy JA, Karin CC, Pearson RL. Patellar fixation protected with a load-sharing cable: a mechanical and clinical study. J Orthop Trauma. 1988;2:234-40.

Mehdi M, Husson JL. Treatment results of fractures of the patella using pre-patellar tension wiring. Analysis of a series of 203 cases. Acta Orthop Belg. 1999;65(2):188-96.

Nikiforidis P, Babis G, Tsarouchas J, Koudis G, Korres DS. Patellar fractures: contemporary approach to operative treatment, using different types of the tension band principles. Eur J Orthop Surg Traumatol. 1999;9:21–6.

Kim YM, Joo YB. Prognostic factors of arthroscopic adhesiolysis for arthrofibrosis of the knee. Knee Surg Relat Res. 2013;25(4):202–6.

Lotke PA, Ecker ML. Transverse fracture of the patella. Clin Orthopaedics Related Res. 1981;158:235-41.

Hung LK, Chan KM, Chow YN, Leung PC. Fractured patella: operative treatment using the tension band principle. Injury (Br). 1985;16:343-7.

Muller ME, Allgower M, Schneider R, Willenegger H. Technique recommended by the AO group. In: Manual of internal fixation New York: Springer-Verlag; 1991.

Phieffer LS, Kyle RR. Treatment of patellar fractures. Techniques Knee Surg. 2003:2(3):153-9.

Schemitsch Eh, Weinberg J, Mckee MD, Stephen DIG, Kreder HJ, Waddell JP. Functional outcome of patella fractures following open reduction and internal fixation. J Orthop Trauma. 1999;13(4):279.

Gardner MJ, Griffith MH, Lawerence BD, Lorich DG. Complete exposure of the articular surface for fixation of patellar fractures. J Orthop Trauma. 20058;19(2);118-23.