Plattenosteosynthese bei Patellafrakturen

OBJECTIVE: Anatomic reconstruction of the retropatellar articular surface and repair of the extensor mechanism of the knee joint. The osteosynthesis should allow immediate mobilization as part of an early functional postoperative rehabilitation protocol.

INDICATIONS: Displaced fractures of the patella, especially multifragment and comminuted fractures with a retropatellar incongruity or dislocation of >2 mm.

CONTRAINDICATIONS: Critical local soft tissue because of the risk of postoperative infection.

SURGICAL TECHNIQUE: Median skin incision. For simple (transverse) fractures, preservation of the soft tissue and reduction control via the index finger. For complex fractures, lateral arthrotomy and eversion of the patella. Reconstruction of the articular surface from the joint side with optimal visibility. Temporary fixation with Kirschner wires, osteosynthesis with the fixed angle plate. If necessary, additional screws or wires.

POSTOPERATIVE MANAGEMENT: Immediate mobilization with full weightbearing in full extension with a knee brace. Extension/flexion 0/0/60° for 4 weeks, then 0/0/90° until the 7th week. Active extension after 6 weeks. Climbing stairs after 12 weeks.

RESULTS: Good functional results in combination with a low rate of complications and revisions.