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Patellafrakturen

Fractures of the patella

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Zusammenfassung

Patellafrakturen sind für ca. 1% aller Skelettverletzungen verantwortlich. Die Diagnose wird anhand des Unfallmechanismus, der körperlichen Untersuchung und des radiologischen Befunds gestellt. Die Art der Behandlung der Patellafraktur hängt dabei vom Frakturtyp, der Größe der Fragmente, der Stabilität des Extensorenmechanismus und dem Ausmaß der Kongruenz der Gelenkfläche ab. Unabhängig von der Behandlungsmethode sollte möglichst eine frühe Übungsbehandlung angestrebt werden. Die modifizierte Zuggurtungsosteosynthese ist die am weitesten verbreitete Technik und kann nahezu bei allen Frakturformen angewandt werden. Aufgrund ihrer biomechanischen Überlegenheit ist die kanülierte Schraubenosteosynthese mit Zuggurtung bei der einfachen Patellaquerfraktur inzwischen das Verfahren der Wahl. Bei ausgeprägten Trümmerfrakturen kann man gezwungen sein, eine partielle oder komplette Patellektomie durchzuführen, diese wird aber aufgrund der schlechten funktionellen Ergebnisse als Rettungsoperation angesehen.

Abstract

Fractures of the patella account for approximately 0.5% to 1.5% of all skeletal injuries. The diagnosis is made by means of the mechanism of injury, physical and radiological findings. The kind of treatment of patella fractures depends on the type of fracture, the size of the fragments, the integrity of the extensor mechanism and the congruity of the articular surface. Independent of the kind of treatment an early rehabilitation is recommended. Modified tension band wiring is the most commonly used surgical treatment for patella fractures and can be used for almost every type of fracture. Due the superior stability in biomechanical studies two parallel cannulated lag screws combined with a tension band wiring are the treatment of choice for horizontally displaced two-part fractures. In comminuted fractures a partial or total patellectomy may be necessary. However, since the loss of quadriceps muscle power and the poor outcome total patellectomy should be considered as a salvage procedure.

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  1. Klinik für Unfall- und Handchirurgie, Heinrich Heine Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    M. Wild, J. Windolf & S. Flohé

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  1. M. Wild
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  2. J. Windolf
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  3. S. Flohé
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Correspondence to M. Wild.

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Wild, M., Windolf, J. & Flohé, S. Patellafrakturen. Unfallchirurg 113, 401–412 (2010). https://doi.org/10.1007/s00113-010-1768-x

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