DISCUSSION:
Partial patellectomy is a recommended treatment for a comminuted superior or inferior pole fracture measuring <50% of the patella's height. The area can be excised and a technique of quadriceps tendon (superior pole) or patellar tendon (inferior pole) repair can then be undertaken.
The referenced study by Saltzman et al reported maintenance of range of motion and strength (85% of the contralateral) with partial patellectomy at an average of 8.4 years follow up.
Furthermore, Marder et al showed that change in patellofemoral forces is minimized by attaching the patellar tendon/quad tendon anteriorly on the remaining patella. Their study also showed that by resecting more of the inferior pole that contact stress increased as the size of the discarded portion of the patella increased.
REFERENCES:
1.
Browner BD, Jupiter JB, Levine AM (eds): Skeletal Trauma. Philadelphia, PA, WB Saunders, 1992, pp 1685-1716
2.
Saltzman CL, Goulet JA, McClellan RT, Schneider LA, Matthews LS.: Results of treatment of displaced patella fractures by partial patellectomy. J Bone Joint Surg Am 1991;73:1273-1274
PMID:2229101 (Link to Abstract)
3.
Marder RA, Swanson TV, Sharkey NA, Duwelius PJ. Effects of partial patellectomy and reattachment of the patellar tendon on patellofemoral contact areas and pressures. J Bone Joint Surg Am. 1993 Jan;75(1):35-45
PMID:8419389 (Link to Abstract)
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