COMPARISON OF DIFFERENT TREATMENTS FOR PATELLAR FRACTURES

Abstract

Aim: compare the types of surgical treatment for transverse patellar fractures.
Materials and methods: Study design: controlled clinical trial. The study was conducted in 2015-2018 on the clinical
basis of the emergency hospital in Semey. The study included 48 patients with patellar fractures, including 33 men (73.3%)
and 15 women (26.7%) over the age of 18 years (the oldest patient was 77 years old at the time of injury). The average age
in the group was 48.0 ± 4.4 years. Depending on the treatment, all patients were divided into 2 groups: the main group and
the comparison group. The first group included 24 patients - 16 men and 8 women, the second - 17 men and 7 women. The
average age for the selected groups also did not differ significantly - 48.3 ± 4.6 and 47.7 ± 4.3, respectively. In the main
group, treatment was carried out by using an improved method of transosseous osteosynthesis. In the comparison group,
the method of open immersion osteosynthesis was used.
Research results: Complications associated with wound infection were observed only during the implementation of
open surgical osteosynthesis and were observed in 3 patients, including one in whom delayed healing of a postoperative
wound was associated with the development of a deep infection that required re-intervention.
Secondary divergence of fragments took place only in one case in the main group and in two cases in the comparison
group. In both patients of the comparison group, repeated surgery was required.
The incidence of post-traumatic arthritis with severe clinical manifestations was minimal - one case in each group.
However, contractures of the knee joint eventually developed in three patients in the comparison group and only in one in the
main group. The overall complication rate in the main group was 12.5%, in the comparison group - 41.7% (differences by
3.33 times, χ2 = 5.38, p = 0.040). Moreover, these complications developed in two patients of the main group (8.3%) and in
six patients in the comparison group (25.0%). The differences in this indicator were 3-fold (χ2 = 5.03, p = 0.044).
A more significant difference between the groups was revealed in relation to the duration of outpatient treatment (almost
doubled due to the need for patient rehabilitation after removal of the metal device that provided osteosynthesis). Differences
in the duration of inpatient treatment were 71.4% in favor of the main group. In both cases, these differences were
statistically significant (p <0.001).
Statistical analysis was carried out using parametric methods (Student's t test). If the t-criterion is inapplicable due to the
absence of the normal distribution of the variation series, the bootstrap technique was additionally used.
Output: The use of the technique of transosseous osteosynthesis for fractures of the patella in comparison with open
methods of submerged osteosynthesis provides a decrease in the overall frequency of complications.