Clinical application of anatomical locking plate in treatment of Rockwood type <b>Ⅰ</b>-<b>Ⅲ</b>patella fractures_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Yi ¹ , Alimujiang·Abulaiti ¹ , Maimaitiming·Saiyiti ¹ , CHENG Erlin ¹ ,  Aihemaitijiang·Yusufu ^1,2 , LI Yi ¹ , Alimujiang·Abulaiti ¹ , Maimaitiming·Saiyiti ¹ , CHENG Erlin ¹ ,  Aihemaitijiang·Yusufu ^1,2

1. Department of Microsurgical Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China;
2. Key Laboratory of Trauma Repair and Reconstruction in Xinjiang Uygur Autonomous Region, Urumqi Xinjiang, 830054, P. R. China;

Corresponding author：

Aihemaitijiang·Yusufu, Email: ahmatjang@163.com; Aihemaitijiang·Yusufu, Email: ahmatjang@163.com

Keywords：

Patella fracture; Rockwood typeⅠ-Ⅲ fractures; anatomical locking plate; internal fixation

DOI：

10.7507/1002-1892.202401113

Video：

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Objective To investigate the effectiveness of anatomical locking plate in the treatment of Rockwood type Ⅰ-Ⅲ patella fractures. Methods The clinical data of 16 patients with patella fractures who were admitted between November 2021 and January 2023 and met the selection criteria was retrospectively analyzed. There were 14 males and 2 females, with an average age of 44.5 years (range, 19-72 years). Causes of injuries included tumble in 12 cases and traffic accident in 4 cases. The fractures were rated as type Ⅰ in 2 cases, type Ⅱ in 9 cases, and type Ⅲ in 5 cases according to Rockwood classification criteria. The time from injury to operation ranged from 6 to 15 days, with an average of 9 days. After fracture reduction, an appropriate anatomical locking plate was selected for internal fixation. The operation time, intraoperative blood loss, and incision healing were recorded; the Lysholm score, Böstman patella fracture efficacy score, knee joint mobility, and pain visual analogue scale (VAS) score were used to evaluate the knee joint function and pain degree; X-ray films were used to review the fracture reduction and healing. Results The operation time was 65-100 minutes (mean, 75.3 minutes); the intraoperative blood loss was 10-35 mL (mean, 25.6 mL). All incisions healed by first intention after operation. All patients were followed up 11-26 months (mean, 19.7 months). X-ray films showed that the fractures were reduced satisfactorily, and all achieved bony healing with healing time of 3-5 months. At last follow-up, the Lysholm score was 90-95 (mean, 93.0); the Böstman patella fracture efficacy score was 27-30 (mean, 28.8), of which 12 cases were excellent and 4 were good; the VAS score was 0-1 (mean, 0.3). There was no significant difference in the range of motion of the knee joint between the healthy and affected sides [145° (140°, 150°) vs 145° (140°, 145°); Z=1.890, P=0.059]. Conclusion Choosing anatomical locking plates for Rockwood typeⅠ-Ⅲ patella fractures can achieve strong fixation with minimal surgical trauma, rapid recovery of knee joint function, and mild pain after operation.

Citation： LI Yi, Alimujiang·Abulaiti, Maimaitiming·Saiyiti, CHENG Erlin, Aihemaitijiang·Yusufu. Clinical application of anatomical locking plate in treatment of Rockwood type Ⅰ-Ⅲpatella fractures. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(4): 422-425. doi: 10.7507/1002-1892.202401113 Copy

1.	Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl, 1972, 143: 1-80.
2.	Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl, 1972, 143: 1-80.
3.	Wiss DA, Wstson JT, Johson EE. Fractures of the knee//Rockwood CA Jr, Green DP, Bucholz RW, et al. Rockwood and Green’s fractures in adults. 4th ed. Philadephia: Lippincott-Raven Publisher, 1996: 1025-1026.
4.	Wiss DA, Wstson JT, Johson EE. Fractures of the knee//Rockwood CA Jr, Green DP, Bucholz RW, et al. Rockwood and Green’s fractures in adults. 4th ed. Philadephia: Lippincott-Raven Publisher, 1996: 1025-1026.
5.	Galla M, Lobenhoffer P. Patella fractures. Chirurg, 2005, 76(10): 987-999.
6.	Galla M, Lobenhoffer P. Patella fractures. Chirurg, 2005, 76(10): 987-999.
7.	Wurm S, Bühren V, Augat P. Treating patella fractures with a locking patella plate-first clinical results. Injury, 2018, 49 Suppl 1: S51-S55.
8.	Wurm S, Bühren V, Augat P. Treating patella fractures with a locking patella plate-first clinical results. Injury, 2018, 49 Suppl 1: S51-S55.
9.	Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect, 1994, 43: 97-108.
10.	Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect, 1994, 43: 97-108.
11.	Cramer KE, Moed BR. Patellar fractures: Contemporary approach to treatment. J Am Acad Orthop Surg, 1997, 5(6): 323-331.
12.	Cramer KE, Moed BR. Patellar fractures: Contemporary approach to treatment. J Am Acad Orthop Surg, 1997, 5(6): 323-331.
13.	Müller ME, Allgöwer M, Schneider R, et al. Manual of internal fixation techniques recommended by the AO-ASIF group//Manual of Internal Fixation Techniques Recommended by the AO-ASIF Group. Berlin: Springer, 1979: 248-253.
14.	Müller ME, Allgöwer M, Schneider R, et al. Manual of internal fixation techniques recommended by the AO-ASIF group//Manual of Internal Fixation Techniques Recommended by the AO-ASIF Group. Berlin: Springer, 1979: 248-253.
15.	Matthews B, Hazratwala K, Barroso-Rosa S. Comminuted patella fracture in elderly patients: A systematic review and case report. Geriatr Orthop Surg Rehabil, 2017, 8(3): 135-144.
16.	Matthews B, Hazratwala K, Barroso-Rosa S. Comminuted patella fracture in elderly patients: A systematic review and case report. Geriatr Orthop Surg Rehabil, 2017, 8(3): 135-144.
17.	Wild M, Windolf J, Flohé S. Fractures of the patella. Unfallchirurg, 2010, 113(5): 401-411.
18.	Wild M, Windolf J, Flohé S. Fractures of the patella. Unfallchirurg, 2010, 113(5): 401-411.
19.	Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma, 1997, 11(5): 351-356.
20.	Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma, 1997, 11(5): 351-356.
21.	Kakazu R, Archdeacon MT. Surgical management of patellar fractures. Orthop Clin North Am, 2016, 47(1): 77-83.
22.	Kakazu R, Archdeacon MT. Surgical management of patellar fractures. Orthop Clin North Am, 2016, 47(1): 77-83.
23.	Labitzke R. Proper and improper tension band fixation exemplified by patellar fracture. Chirurg, 1997, 68(6): 638-642.
24.	Labitzke R. Proper and improper tension band fixation exemplified by patellar fracture. Chirurg, 1997, 68(6): 638-642.
25.	Hada S, Ishijima M, Tomita Y. A case report of patellar fracture treated by percutaneous strong suture technique. Ann Med Surg (Lond), 2021, 69: 102810. doi: 10.1016/j.amsu.2021.102810.
26.	Hada S, Ishijima M, Tomita Y. A case report of patellar fracture treated by percutaneous strong suture technique. Ann Med Surg (Lond), 2021, 69: 102810. doi: 10.1016/j.amsu.2021.102810.
27.	Adjal J, Ban I. Patella fractures treated with suture tension band fixation. J Orthop Surg Res, 2021, 16(1): 179. doi: 10.1186/s13018-021-02309-5.
28.	Adjal J, Ban I. Patella fractures treated with suture tension band fixation. J Orthop Surg Res, 2021, 16(1): 179. doi: 10.1186/s13018-021-02309-5.
29.	张伟, 程安源, 夏平, 等. 带线锚钉“8”字缝合固定髌骨下极骨折. 中国矫形外科杂志, 2022, 30(2): 167-170.
30.	张伟, 程安源, 夏平, 等. 带线锚钉“8”字缝合固定髌骨下极骨折. 中国矫形外科杂志, 2022, 30(2): 167-170.
31.	Wagner FC, Neumann MV, Wolf S, et al. Biomechanical comparison of a 3.5 mm anterior locking plate to cannulated screws with anterior tension band wiring in comminuted patellar fractures. Injury, 2020, 51(6): 1281-1287.
32.	Wagner FC, Neumann MV, Wolf S, et al. Biomechanical comparison of a 3.5 mm anterior locking plate to cannulated screws with anterior tension band wiring in comminuted patellar fractures. Injury, 2020, 51(6): 1281-1287.
33.	Thelen S, Schneppendahl J, Jopen E, et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury, 2012, 43(8): 1290-1295.
34.	Thelen S, Schneppendahl J, Jopen E, et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury, 2012, 43(8): 1290-1295.
35.	Dickens AJ, Salas C, Rise L, et al. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury, 2015, 46(6): 1001-1006.
36.	Dickens AJ, Salas C, Rise L, et al. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury, 2015, 46(6): 1001-1006.
37.	Checketts JX, Scott J, Fishbeck K, et al. Reoperation and complication rates following patellar fracture repair with plates: a retrospective analysis with patient-reported outcomes at more than 1 year of follow-up. JBJS Open Access, 2022, 7(2): e22.00012. doi: 10.2106/JBJS.OA.22.00012.
38.	Checketts JX, Scott J, Fishbeck K, et al. Reoperation and complication rates following patellar fracture repair with plates: a retrospective analysis with patient-reported outcomes at more than 1 year of follow-up. JBJS Open Access, 2022, 7(2): e22.00012. doi: 10.2106/JBJS.OA.22.00012.
39.	Howatt J, Lieu AS, Wilkin G. Current concepts review: patellar fractures. J Bone J Surg, 2021, 103: 2237-2246.
40.	Howatt J, Lieu AS, Wilkin G. Current concepts review: patellar fractures. J Bone J Surg, 2021, 103: 2237-2246.
41.	Hargett DI, Sanderson BR, Little MTM. Patella fractures: approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
42.	Hargett DI, Sanderson BR, Little MTM. Patella fractures: approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
43.	Wurm S, Augat P, Bühren V. Biomechanical assessment of locked plating for the fixation of patella fractures. J Orthop Trauma, 2015, 29(9): e305-308.
44.	Wurm S, Augat P, Bühren V. Biomechanical assessment of locked plating for the fixation of patella fractures. J Orthop Trauma, 2015, 29(9): e305-308.
45.	Wild M, Fischer K, Hilsenbeck F, et al. Treating patella fractures with a fixed-angle patella plate-A prospective observational study. Injury, 2016, 47(8): 1737-1743.
46.	Wild M, Fischer K, Hilsenbeck F, et al. Treating patella fractures with a fixed-angle patella plate-A prospective observational study. Injury, 2016, 47(8): 1737-1743.
47.	Shymon SJ, Jansson H, Schneiderman BA, et al. Functional outcomes of patella fractures treated with anterior plate osteosynthesis at one year. J Orthop Trauma, 2021, 35(1): e1-e6.
48.	Shymon SJ, Jansson H, Schneiderman BA, et al. Functional outcomes of patella fractures treated with anterior plate osteosynthesis at one year. J Orthop Trauma, 2021, 35(1): e1-e6.
49.	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
50.	Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
51.	Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
52.	Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.

1. Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl, 1972, 143: 1-80.
2. Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl, 1972, 143: 1-80.
3. Wiss DA, Wstson JT, Johson EE. Fractures of the knee//Rockwood CA Jr, Green DP, Bucholz RW, et al. Rockwood and Green’s fractures in adults. 4th ed. Philadephia: Lippincott-Raven Publisher, 1996: 1025-1026.
4. Wiss DA, Wstson JT, Johson EE. Fractures of the knee//Rockwood CA Jr, Green DP, Bucholz RW, et al. Rockwood and Green’s fractures in adults. 4th ed. Philadephia: Lippincott-Raven Publisher, 1996: 1025-1026.
5. Galla M, Lobenhoffer P. Patella fractures. Chirurg, 2005, 76(10): 987-999.
6. Galla M, Lobenhoffer P. Patella fractures. Chirurg, 2005, 76(10): 987-999.
7. Wurm S, Bühren V, Augat P. Treating patella fractures with a locking patella plate-first clinical results. Injury, 2018, 49 Suppl 1: S51-S55.
8. Wurm S, Bühren V, Augat P. Treating patella fractures with a locking patella plate-first clinical results. Injury, 2018, 49 Suppl 1: S51-S55.
9. Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect, 1994, 43: 97-108.
10. Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect, 1994, 43: 97-108.
11. Cramer KE, Moed BR. Patellar fractures: Contemporary approach to treatment. J Am Acad Orthop Surg, 1997, 5(6): 323-331.
12. Cramer KE, Moed BR. Patellar fractures: Contemporary approach to treatment. J Am Acad Orthop Surg, 1997, 5(6): 323-331.
13. Müller ME, Allgöwer M, Schneider R, et al. Manual of internal fixation techniques recommended by the AO-ASIF group//Manual of Internal Fixation Techniques Recommended by the AO-ASIF Group. Berlin: Springer, 1979: 248-253.
14. Müller ME, Allgöwer M, Schneider R, et al. Manual of internal fixation techniques recommended by the AO-ASIF group//Manual of Internal Fixation Techniques Recommended by the AO-ASIF Group. Berlin: Springer, 1979: 248-253.
15. Matthews B, Hazratwala K, Barroso-Rosa S. Comminuted patella fracture in elderly patients: A systematic review and case report. Geriatr Orthop Surg Rehabil, 2017, 8(3): 135-144.
16. Matthews B, Hazratwala K, Barroso-Rosa S. Comminuted patella fracture in elderly patients: A systematic review and case report. Geriatr Orthop Surg Rehabil, 2017, 8(3): 135-144.
17. Wild M, Windolf J, Flohé S. Fractures of the patella. Unfallchirurg, 2010, 113(5): 401-411.
18. Wild M, Windolf J, Flohé S. Fractures of the patella. Unfallchirurg, 2010, 113(5): 401-411.
19. Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma, 1997, 11(5): 351-356.
20. Carpenter JE, Kasman RA, Patel N, et al. Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma, 1997, 11(5): 351-356.
21. Kakazu R, Archdeacon MT. Surgical management of patellar fractures. Orthop Clin North Am, 2016, 47(1): 77-83.
22. Kakazu R, Archdeacon MT. Surgical management of patellar fractures. Orthop Clin North Am, 2016, 47(1): 77-83.
23. Labitzke R. Proper and improper tension band fixation exemplified by patellar fracture. Chirurg, 1997, 68(6): 638-642.
24. Labitzke R. Proper and improper tension band fixation exemplified by patellar fracture. Chirurg, 1997, 68(6): 638-642.
25. Hada S, Ishijima M, Tomita Y. A case report of patellar fracture treated by percutaneous strong suture technique. Ann Med Surg (Lond), 2021, 69: 102810. doi: 10.1016/j.amsu.2021.102810.
26. Hada S, Ishijima M, Tomita Y. A case report of patellar fracture treated by percutaneous strong suture technique. Ann Med Surg (Lond), 2021, 69: 102810. doi: 10.1016/j.amsu.2021.102810.
27. Adjal J, Ban I. Patella fractures treated with suture tension band fixation. J Orthop Surg Res, 2021, 16(1): 179. doi: 10.1186/s13018-021-02309-5.
28. Adjal J, Ban I. Patella fractures treated with suture tension band fixation. J Orthop Surg Res, 2021, 16(1): 179. doi: 10.1186/s13018-021-02309-5.
29. 张伟, 程安源, 夏平, 等. 带线锚钉“8”字缝合固定髌骨下极骨折. 中国矫形外科杂志, 2022, 30(2): 167-170.
30. 张伟, 程安源, 夏平, 等. 带线锚钉“8”字缝合固定髌骨下极骨折. 中国矫形外科杂志, 2022, 30(2): 167-170.
31. Wagner FC, Neumann MV, Wolf S, et al. Biomechanical comparison of a 3.5 mm anterior locking plate to cannulated screws with anterior tension band wiring in comminuted patellar fractures. Injury, 2020, 51(6): 1281-1287.
32. Wagner FC, Neumann MV, Wolf S, et al. Biomechanical comparison of a 3.5 mm anterior locking plate to cannulated screws with anterior tension band wiring in comminuted patellar fractures. Injury, 2020, 51(6): 1281-1287.
33. Thelen S, Schneppendahl J, Jopen E, et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury, 2012, 43(8): 1290-1295.
34. Thelen S, Schneppendahl J, Jopen E, et al. Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury, 2012, 43(8): 1290-1295.
35. Dickens AJ, Salas C, Rise L, et al. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury, 2015, 46(6): 1001-1006.
36. Dickens AJ, Salas C, Rise L, et al. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury, 2015, 46(6): 1001-1006.
37. Checketts JX, Scott J, Fishbeck K, et al. Reoperation and complication rates following patellar fracture repair with plates: a retrospective analysis with patient-reported outcomes at more than 1 year of follow-up. JBJS Open Access, 2022, 7(2): e22.00012. doi: 10.2106/JBJS.OA.22.00012.
38. Checketts JX, Scott J, Fishbeck K, et al. Reoperation and complication rates following patellar fracture repair with plates: a retrospective analysis with patient-reported outcomes at more than 1 year of follow-up. JBJS Open Access, 2022, 7(2): e22.00012. doi: 10.2106/JBJS.OA.22.00012.
39. Howatt J, Lieu AS, Wilkin G. Current concepts review: patellar fractures. J Bone J Surg, 2021, 103: 2237-2246.
40. Howatt J, Lieu AS, Wilkin G. Current concepts review: patellar fractures. J Bone J Surg, 2021, 103: 2237-2246.
41. Hargett DI, Sanderson BR, Little MTM. Patella fractures: approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
42. Hargett DI, Sanderson BR, Little MTM. Patella fractures: approach to treatment. J Am Acad Orthop Surg, 2021, 29(6): 244-253.
43. Wurm S, Augat P, Bühren V. Biomechanical assessment of locked plating for the fixation of patella fractures. J Orthop Trauma, 2015, 29(9): e305-308.
44. Wurm S, Augat P, Bühren V. Biomechanical assessment of locked plating for the fixation of patella fractures. J Orthop Trauma, 2015, 29(9): e305-308.
45. Wild M, Fischer K, Hilsenbeck F, et al. Treating patella fractures with a fixed-angle patella plate-A prospective observational study. Injury, 2016, 47(8): 1737-1743.
46. Wild M, Fischer K, Hilsenbeck F, et al. Treating patella fractures with a fixed-angle patella plate-A prospective observational study. Injury, 2016, 47(8): 1737-1743.
47. Shymon SJ, Jansson H, Schneiderman BA, et al. Functional outcomes of patella fractures treated with anterior plate osteosynthesis at one year. J Orthop Trauma, 2021, 35(1): e1-e6.
48. Shymon SJ, Jansson H, Schneiderman BA, et al. Functional outcomes of patella fractures treated with anterior plate osteosynthesis at one year. J Orthop Trauma, 2021, 35(1): e1-e6.
49. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
50. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
51. Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.
52. Böstman O, Kiviluoto O, Nirhamo J. Comminuted displaced fractures of the patella. Injury, 1981, 13(3): 196-202.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical application of anatomical locking plate in treatment of Rockwood type Ⅰ-Ⅲpatella fractures

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