Furkan YAPICI, Volkan GÜR, İzzet Özay SUBAŞI, Reşit KARAKÖSE, Nizamettin KOÇKARA

Patella Kırıklarında Gergi Bandı Tekniği: Orta Dönem Radyolojik ve Klinik Sonuçlar

Amaç: Gergi bandı tekniği (GBT) ile tedavi edilen patella kırıklarının orta dönem takibindeki radyolojik ve klinik sonuçlarımızı bildirmek. Yöntem: Bu çalışmaya, bir birinci seviye travma merkezinde, Ocak 2013 ile Haziran 2021 arasında, AO tip 34-A1/C1/C2/C3 patella kırıkları nedeniyle GBT ile cerrahi olarak tedavi edilen hastalar dahil edildi. Radyolojik değerlendirme için rutin takipte alınan radyografiler komplikasyonlar (nonunion, malunion, redüksiyon kaybı, malredüksiyon, patella baja, uzamış patella, implant yetmezliği), Insall Salvati İndeksi (ISI) ve Patellar Morfoloji Oranı (PMO) açısından incelendi. Ağrı, semptomlar, günlük yaşam aktiviteleri (GYA), spor/rekreasyon ve yaşam kalitesi (YK) olmak üzere beş alt ölçek içeren Diz İncinme ve Osteoartrit Sonuç Skoru (KOOS) fonksiyonel değerlendirme için kullanıldı. Klinik değerlendirme ayrıca eklem hareket açıklığını (EHA), uyluk çevresi uzunluğunu (UÇU) ve implant irritasyonu (İİ) gibi komplikasyonları da içeriyordu. Bulgular: Bu çalışmada, ortalama yaşı 42.6 ± 16.1 yıl ve ortalama takip süresi 35.4 ± 24.1 ay olan 42 uygun hasta (10 kadın, 32 erkek) incelendi. En az bir komplikasyonu olan 28 hasta (%66,7) vardı (İİ: %66.7, fleksiyon defisiti: %61.9, malunion: %40.5, uzamış patella/ patella baja: %16.7). İİ kaynaklı yüksek implant çıkarım oranı nedeniyle yeniden ameliyat oranı (%69.1) yüksekti. Opere edilen (O) ve opere edilmeyen kontralateral sağlıklı dizler (S) arasında, ortalama fleksiyon dereceleri (O: 126.2°, S: 135.4°), ortalama ISI (O: 0.9, S: 1.0) ve ortalama PMO (O: 1.5, S: 1.4) ve KOOS alt ölçek puanları (Semptomlar: O: 72.3, S: 89.8; Ağrı: O: 70,4, S: 89.4; GYA: O: 72.1, S: 90; Spor: O: 61.4, S: 84.8; YK: O: 67.9, S: 86.2) açısından istatistiksel olarak anlamlı farklılıklar vardı (tümü p < 0.01). Ortalama ekstansiyon dereceleri ve UÇU açısından fark yoktu (tümü p > 0.05). Tüm kırıklarda kaynama sağlandı. Sonuç: GBT ile tedavi edilen patella kırıklarının orta dönem klinik sonuçları, karşı taraf sağlıklı dizden belirgin ölçüde daha kötüydü. İmplant irritasyonu, diz fleksiyon defisiti, malunion ve patella baja belirgin komplikasyonlardı ve bu sorunları yönetmek için çaba sarf edilmelidir. Patella kırıkları, uzamış patella kaynaklı ilginç vakaların gelişmesine yatkındır.

Tension Band Wiring of Patella Fractures: Mid-Term Radiological and Clinical Results

Objective: We aimed to share our radiological and clinical results with a mid-term follow-up on patella fractures treated with tension band wiring (TBW). Methods: Patients surgically treated with TBW for AO type 34-A1/C1/C2/C3 patella fractures between January 2013 and June 2021 at a level 1 trauma center were included. For radiological evaluation, radiographs obtained at the routine follow-up were analyzed for complications (such as nonunion, malunion, loss of reduction, malreduction, patella baja, elongated patella, implant failure), Insall-Salvati Index (ISI), and Patellar Morphology Ratio (PMR). The Knee Injury and Osteoarthritis Score (KOOS) was utilized for functional evaluation, which includes five subscales: pain, symptoms, activities of daily living (ADL), sports/recreation, and quality of life (QOL). The clinical assessment also included the range of motion (ROM), thigh circumference (TC), and complications such as implant irritation (II). Results: This study reviewed 42 eligible patients (10 females, 32 males) with a mean age of 42.6 ± 16.1 years and a mean follow-up of 35.4 ± 24.1 months. There were 28 patients (66.7%) with at least one complication (II: 66.7%, flexion deficit: 61.9%, malunion: 40.5%, elongated patella/patella baja: 16.7%). The reoperation rate was high at 69.1% due to the high implant removal rate for II. There were statistically significant differences between injured (I) and uninjured contralateral healthy knees (UI) in terms of mean KOOS subscale scores (symptoms: I: 72.3, UI: 89.8; pain: I: 70.4, UI: 89.4; ADL : I: 72.1, UI: 90; sports: I: 61.4, UI: 84.8; QOL: I: 67.9, UI: 86.2), mean flexion degrees (I: 126.2°, UI: 135.4°), mean ISI (I: 0.9, UI: 1.0), and mean PMR (I: 1.5, UI: 1.4) (all p < 0.01). There was no difference in mean extension degrees and TC (all p > 0.05). All fractures achieved union. Conclusion: Firstly, the mid-term clinical results of patellar fractures treated with TBW were significantly worse than the contralateral healthy knee; secondly, implant irritation, knee flexion deficit, malunion, and patella baja were the significant complications, and efforts should be made to manage these problems; thirdly, patellar fractures are susceptible to developing interesting cases of the elongated patella.

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