Abstract
OBJECTIVE Reconstruction of the extensor apparatus of the knee joint. Open reduction and stable internal fixation of patella fractures. Exact reconstruction of the articular surface of the patellofemoral joint. INDICATIONS Open and closed fractures. Fractures with an intraarticular incongruity (> 2 mm). Incapability of extension of the knee also in nondisplaced fractures of the patella. In the context of internal fixations of additional periarticular fractures of the knee joint. CONTRAINDICATIONS Compromised general health status or associated injuries. Compromised local soft-tissue situation (contamination, poor soft-tissue cover). Relative: nondisplaced transverse fractures (no displacement in 40 degrees of flexion). Relative: nondisplaced longitudinal fractures(3). Relative: nondisplaced radiating fractures(3). Relative: nondisplaced fractures of the distal pole without involvement of the joint surface and intact extensor apparatus(3). SURGICAL TECHNIQUE Longitudinal parapatellar incision. Tension band wiring. Lag screw osteosynthesis. Combination of tension band wiring and lag screws. Patellectomy (partial/complete). POSTOPERATIVE MANAGEMENT Thrombosis prophylaxis. Early physiotherapy. Knee brace. RESULTS 70% good to excellent results. 30% chronic pain and posttraumatic arthritis. Loss of motion (limited extension).
