Current approaches to treatment of patients with closed fractures of the patella

Abstract

Abstract. Introduction Treatment of patients with acute fractures of the patella is the task of the trauma and orthopedic service and should
provide restoration of the integrity of the bone tissue and the extensor apparatus of the knee joint for its early mobilization. There is an opinion
that conservative treatment cannot meet requirements of patients’ quality of life, and therefore, most traumatologists are inclined to surgically
treat patellar fractures. Purpose Based on the available literature data, to determine the most rational way to treat patients with patellar fractures
Materials and methods Available studies published in the last 10 years were analyzed. The databases NCBI Pubmed, Healio Orthopedics, Medline
were searched. Results Such osteosynthesis methods as patella suture, osteosynthesis with plates, special internal devices, external fixation devices,
Kirschner wires and wire cerclage, various screws were covered. The question of clinical application of patellectomy was touched upon; the contribution
of the Department of Traumatology, Orthopedics and Urgent Surgery of the Krasnov Samara State Medical University to the development of operative
techniques of osteosynthesis of the patella, the basic concepts of scientific research, and also the most optimal ways of treating patients with patellar
fractures were described. Conclusion The conservative method of treating patients with patellar fractures is most relevant if there are contraindications
to surgery. It inevitably leads to persistent arthrogenic contracture. The best functional results of treatment have been achieved with surgical treatment
due to the possibility of early mobilization of the knee joint. According to the data of available studies, plates and screws as well as osteosynthesis
with Kirschner wires and wiring cerclage show maximum stability. There is evidence of a direct correlation between the risk of developing infectious
complications and pain in the postoperative period and the number of elements of subcutaneous metal implants. Thus, the most optimal way to treat
closed fractures of the patella is osteosynthesis with the use of wires and wire cerclage according to the tension band principle.