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Wandel in der Behandlung der Patellafrakturen

Change in the treatment of patellar fractures

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Zusammenfassung

Hintergrund

Frakturen der Patella können aufgrund ihrer entscheidenden Rolle im Streckapparat des Kniegelenks zu erheblichen funktionellen Einschränkungen führen. Sie sind, abhängig vom Osteosyntheseverfahren, mit einer vergleichsweise hohen Komplikationsrate behaftet und stellen trotz etablierter Diagnostik und verschiedener Osteosyntheseverfahren immer noch eine therapeutische Herausforderung dar.

Ziel der Arbeit

Die Arbeit soll eine Übersicht über den Wandel der Behandlung von Patellafrakturen geben sowie die Bedeutung einer umfassenden Diagnostik und frakturangepassten Therapie, v. a. bei zunehmenden Frakturen im höheren Lebensalter, hervorheben.

Material und Methoden

Auswertung der aktuellen Literatur, Diskussion von biomechanischen und klinischen Studienarbeiten sowie Expertenempfehlungen (Leitlinie).

Ergebnisse

Die Zuggurtungsosteosynthese ist weiterhin das am häufigsten angewandte Verfahren; sie ist jedoch mit einer hohen Rate implantatbezogener Komplikationen und hoher Versagensrate assoziiert. Insbesondere mehrfragmentäre Trümmerfrakturen können hiermit oft nicht adäquat versorgt werden. Winkelstabile Platten scheinen biomechanisch und klinisch vorteilhaft zu sein.

Schlussfolgerungen

Für ein gutes funktionelles Ergebnis nach einer Patellafraktur ist die exakte Kenntnis der Frakturmorphologie und des optimalen Osteosyntheseverfahrens entscheidend. Distale (oder proximale) Polfrakturen und die im Rahmen des demografischen Wandels zunehmenden osteoporotischen Frakturen des älteren Menschen bleiben weiterhin eine therapeutische Herausforderung und erfordern eine besondere Berücksichtigung bei der Wahl des Osteosyntheseverfahrens.

Abstract

Background

Fractures of the patella can lead to substantial functional impairments due to its crucial function in the extensor mechanism of the knee joint. Patellar fractures are associated with a comparatively high complication rate depending on the osteosynthesis procedure used. Despite established diagnostics and various osteosynthesis procedures they are still a therapeutic challenge.

Objective

This article gives an overview of the change in the treatment of patellar fractures and highlights the importance of comprehensive diagnostics and fracture-adapted treatment, especially for the increasing fractures in old age.

Material and methods

Evaluation of the current literature, discussion of biomechanical and clinical studies and expert recommendations (guidelines)

Results

Tension band wiring is still the most commonly used procedure; however, it is associated with a high rate of implant-related complications and failure rates. In particular, multifragmented comminuted fractures can often not be adequately treated by tension band wiring. Anterior locking plates seem to be biomechanically and clinically superior.

Conclusion

For a good functional result after a patellar fracture, the fracture morphology must be completely understood and the optimal choice of the osteosynthesis method is crucial. Distal (or proximal) pole fractures and the increasing number of osteoporotic fractures of old patients due to the demographic change, remain a therapeutic challenge and require special consideration in the selection of the osteosynthesis procedure.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland

    Markus T. Berninger &  Karl-Heinz Frosch

  2. Abteilung für Unfallchirurgie, Orthopädie und Sporttraumatologie, BG Klinikum Hamburg, Hamburg, Deutschland

    Karl-Heinz Frosch

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  1. Markus T. Berninger
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Correspondence to Markus T. Berninger.

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Interessenkonflikt

K.-H. Frosch ist als Berater für die Fa. Arthrex (Naples, FL, USA) tätig. M.T. Berninger gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Berninger, M.T., Frosch, KH. Wandel in der Behandlung der Patellafrakturen. Unfallchirurgie 125, 518–526 (2022). https://doi.org/10.1007/s00113-022-01167-y

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