Sat., 10/10/09 Knee/Tibia, Paper #84, 4:20 pm OTA-2009
Long-Term Functional Outcomes following Operatively Treated Patella Fractures
Christopher R. LeBrun, MD (n); Joshua R. Langford MD (n); H. Claude Sagi, MD (7-Synthes);
Orthopaedic Trauma Service, Tampa General Hospital, Tampa, Florida, USA
Purpose: Our objective was to evaluate the long-term functional outcomes of patients with isolated operatively treated patella fractures.
Methods: We identified 241 patients who underwent operative intervention for a displaced patella fracture from our institution’s prospectively enrolled orthopaedic trauma registry between 1991 and 2007. A total of 39 patients with isolated, unilateral, operatively treated patella fractures with minimum 1-year follow-up agreed to participate in this study and return for functional testing. Mean follow-up was 6.5 years (range, 1.25-17 years). All enrolled patients were evaluated with the Short Form-36 (SF-36) and an injury-specific questionnaire (Knee Injury and Osteoarthritis Outcome Score [KOOS]) and asked to self-report symptomatic hardware. Patients were evaluated by physical examination, which included range-of-motion assessments and Biodex bilateral quadriceps isometric and isokinetic comparisons.
Results: The mean normalized SF-36 physical component summary (PCS) score (40.9) and the mean normalized KOOS subscale scores (pain, 71.7; symptoms, 66.3; activities of daily living [ADL], 75.1; sport/recreation, 45.2; quality of life [QOL], 49.6) were statistically significantly different (P <0.05) from reference population norms. Implant removal was required in 46.8% of patients treated with osteosynthesis. Of those with retained implants at latest follow-up, 33.3% self-reported pain from the hardware at least some of the time. Eight patients (20.5%) had an extensor lag greater than 5°. A restricted range of flexion of greater than 5° was noted in 15 patients (38.4%) and restricted extension of greater than 5° in 6 patients (15.3%). Biodex dynamometric testing revealed a mean isometric extension deficit of 25.5% between the uninvolved and involved sides for peak torque. Extension power was also tested with an angular velocity of 90 deg/s and 180 deg/s, and mean deficits of 31.0% and 28.9%, respectively, were noted when compared to the contralateral extremity.
Conclusion: At a mean of 6.5 years after operative treatment for patella fractures, significant symptomatic complaints and functional deficits persist based on validated outcome measures as well as objective physical evaluations. This study fills a void in the literature regarding the long-term functional outcomes of these patients. It also underscores the complexity associated with treating this common fracture and should help guide surgeons to better counsel patients on the expected long-term function after operative treatment of patella fractures.
Disclosure: (n=Respondent answered 'No' to all items indicating no conflicts; 1=Board member/owner/officer/committee appointments; 2=Medical/Orthopaedic Publications; 3=Royalties; 4=Speakers bureau/paid presentations; 5A=Paid consultant or employee; 5B=Unpaid consultant; 6=Research or institutional support from a publisher; 7=Research or institutional support from a company or supplier; 8=Stock or Stock Options; 9=Other financial/material support from a publisher; 10=Other financial/material support from a company or supplier).
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant