Etiological and epidemiological analysis of patella fractures: evaluation of COVID-19 pandemic and lockdown era effects

Year 2024, , 581 - 586, 27.09.2024

Nezih Ziroğlu , Alican Koluman , Miraçhan Kantarcı , Altuğ Duramaz , Cemal Kural

https://doi.org/10.32322/jhsm.1537719

Abstract

Background: Patella fractures are relatively rare, but significant public health burden with consequences ranging from skin problems to extensor mechanism deficiencies and patellofemoral arthrosis due to their significant effects on pain, functionality, and quality of life. It was aimed to present basic etiological, and epidemiological information about patella fractures and to evaluate the impact of the COVID-19 Pandemic and lockdown era period.
Methods: All patellar fractures admitted to a stage-1 trauma center between 2016 and 2022 were collected retrospectively. Patient's gender, age, side, fracture classification, trauma mechanism, treatment method, admission day and season, accompanying extremity, and non-musculoskeletal/visceral pathologies were recorded and analyzed.
Results: A retrospective evaluation was conducted on 304 patients, with 181 (59.5%) males and 123 (40.5%) females, with an average age of 46±19 years. Most patients were between 30-65 (51.4%) and the most common cause was simple falls (74%). Fractures mostly occurred in the winter (35.2%) and on Sundays (19.7%). 9.9% of the patients were accompanied by extremity traumas and 6.9% by non-musculoskeletal injuries. Regarding the descriptive classification, transverse, distal pole, and proximal pole; and according to the AO/OTA classification, C1 was the most common.
Conclusion: The incidence of patella fractures is increasing. Non-surgical treatment is a priority, and the complication rates of surgical treatment are considerable. The study, which presents etiological and epidemiological data of level-1 trauma center patients, is a suitable sample for Türkiye. The study is unique in showing the potential effects of COVID-19 on the patient profile and treatment management of patella fractures.

Keywords

kneecap, sesamoid bone, knee, genu, incidence, characteristic, patella fractures

Ethical Statement

Disclosure: The authors declare that there are no conflicts of interest and report no potential conflicts of interest or source of funding. The authors have no competing interests to declare. Ethical Declaration: All procedures performed in studies involving human participants followed the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supporting Institution

None

Patella Kırıklarının Etiyolojik ve Epidemiyolojik Analizi: COVID-19 Pandemisi ve Karantina Dönemi Etkilerinin Değerlendirilmesi

Abstract

Arka plan: Patella kırıkları nispeten nadir görülen ancak ağrı, fonksiyonellik ve yaşam kalitesi üzerindeki önemli etkileri nedeniyle cilt problemlerinden ekstansör mekanizma eksikliklerine ve patellofemoral artroza kadar uzanan sonuçlarıyla önemli bir halk sağlığı yüküdür. Patella kırıkları hakkında temel etiyolojik ve epidemiyolojik bilgilerin sunulması ve COVID-19 Pandemisi ve karantina döneminin etkisinin değerlendirilmesi amaçlandı.
Yöntemler: 2016-2022 yılları arasında 1. aşama travma merkezine başvuran tüm patellar kırıkları retrospektif olarak toplandı. Hastaların cinsiyeti, yaşı, tarafı, kırığın sınıflandırılması, travma mekanizması, tedavi yöntemi, başvuru günü ve mevsimi, eşlik eden ekstremite ve kas-iskelet sistemi dışı/iç organ patolojileri kaydedilerek analiz edildi.
Bulgular: Yaş ortalaması 46±19 yıl olan, 181'i (%59,5) erkek, 123'ü (%40,5) kadın olmak üzere 304 hasta retrospektif olarak değerlendirildi. Hastaların çoğu 30-65 yaş aralığındaydı (%51,4) ve en sık neden basit düşmelerdi (%74). Kırıklar en çok kış aylarında (%35,2) ve pazar günleri (%19,7) meydana geldi. Hastaların %9,9'una ekstremite travmaları, %6,9'una kas-iskelet sistemi dışı yaralanmalar eşlik ediyordu. Tanımlayıcı sınıflandırmaya göre transvers, distal ve proksimal kutup kırıkları ve AO/OTA sınıflamasına göre C1 en yaygındı.
Sonuç: Patella kırıklarının görülme sıklığı artmaktadır. Cerrahi dışı tedavi önceliklidir ve cerrahi tedavinin komplikasyon oranları azımsanmayacak düzeydedir. Birinci düzey travma merkezi hastalarının etyolojik ve epidemiyolojik verilerinin sunulduğu çalışma, Türkiye için uygun bir örneklem oluşturmaktadır. Çalışma, COVID-19'un hasta profili ve patella kırıklarının tedavi yönetimi üzerindeki potansiyel etkilerini göstermesi açısından benzersizdir.

Keywords

diz kapağı, sesamoid kemik, diz, genu, insidans, karakteristik, patella kırıkları

References

• Byun SE, Sim JA, Joo YB, et al. Changes in patellar fracture characteristics: a multicenter retrospective analysis of 1596 patellar fracture cases between 2003 and 2017. Injury. 2019; 50(12):2287-2291.
• Graftiaux A, Court-Brown CM, Heckman JD, Mc Queen MM, Ricci WM, Tornetta III P (eds): Rockwood and Green’s Fractures in adults eighth edition: Wolters Kluwer 2015. Eur J Orthop Surg Traumatol. 2015;25(7): 1229-1229.
• Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD. Rockwood and Green’s fractures in adults. Eighth edition. Philadelphia: Wolters Kluwer Health. 2015:815-867.
• Pesch S, Kirchhoff K, Biberthaler P, Kirchhoff C. Patellafrakturen. Unfallchirurg. 2019;122(3):225-237.
• Melvin SJ, Mehta S. Patellar fractures in adults. Am Acad Orthop Surg. 2011;19(4):198-207.
• Boström Å. Fracture of the patella: a study of 422 patellar fractures. Acta Orthop Scand. 1972;43(sup143):1-80.
• Vedel JO, Vistrup S, Larsen P, Elsoe R. Altered long-term health-related quality of life in patients following patella fractures: a long-term follow-up study of 49 patients. Eur J Trauma Emerg Surg. 2018;44(5):707-716.
• Larsen P, Rathleff MS, Østgaard SE, Johansen MB, Elsøe R. Patellar fractures are associated with an increased risk of total knee arthroplasty: a matched cohort study of 6096 patellar fractures with a mean follow-up of 14.3 years. Bone Jt J. 2018; 100(11):1477-1481.
• Kruse M, Wolf O, Mukka S, Brüggemann A. Epidemiology, classification and treatment of patella fractures: an observational study of 3194 fractures from the Swedish fracture register. Eur J Trauma Emerg Surg. 2022;48(6):4727-4734.
• Vesterager JD, Torngren H, Elsoe R, Larsen P. Complications following surgical treatment of patella fractures - a systematic review and proportional meta-analysis. Eur J Trauma Emerg Surg. 2024:1-10. doi: 10.1007/s00068-024-02592-x
• Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32(Suppl 1):S1-170.
• Thompson RC. An Experimental study of surface injury to articular cartilage and enzyme responses within the joint. Clin Orthop. 1975;107:239-248.
• Thompson RC, Oegema TR, Lewis JL, Wallace L. Osteoarthrotic changes after acute transarticular load. An animal model. J Bone Joint Surg Am. 1991;73(7):990-1001.
• LeBrun CT, Langford JR, Sagi HC. Functional outcomes after operatively treated patella fractures. J Orthop Trauma. 2012; 26(7):422-426.
• Bengnér U, Johnell O, Redlund-Johnell I. Increasing incidence of tibia condyle and patella fractures. Acta Orthop Scand. 1986; 57(4):334-336.
• Zhu Y, Liu S, Chen W, Wang L, Zhang X, Zhang Y. Socioeconomic factors and individual lifestyles influencing the incidence of patella fractures: a national population-based survey in China. Int Orthop. 2019;43(3):687-695.
• Larsen P, Court-Brown CM, Vedel JO, Vistrup S, Elsoe R. Incidence and epidemiology of patellar fractures. Orthopedics [Internet]. 2016;39(6):1154-1158.
• Lazaro LE, Wellman DS, Pardee NC, et al. Effect of computerized tomography on classification and treatment plan for patellar fractures. J Orthop Trauma. 2013;27(6):336-344.
• Vestergaard V, Pedersen AB, Tengberg PT, Troelsen A, Schrøder HM. 20-year trends of distal femoral, patellar, and proximal tibial fractures: a Danish nationwide cohort study of 60,823 patients. Acta Orthop. 2020;91(1):109-114.
• Nishizawa M, Nagata K, Adejuyigbe B, Shinozaki T, Yamada K. Trends in inpatient orthopedic surgery during the COVID-19 pandemic in Japan: a nationwide data study. BMC Musculoskelet Disord. 2024;25(1):503.
• Klepacki K, Tomczyk Ł, Miękisiak G, Morasiewicz P. The effect of the COVID-19 pandemic on the epidemiology of ankle joint injuries in adults and children. Ortop Traumatol Rehabil. 2022; 24(6):363-373.
• Rojoa DM, Raheman FJ, Irvine E, Sharma V, Macdonald CR, Cutler L. The impact of COVID-19 on the choice of treatment for hand fractures: a single-centre concordance study. J Hand Surg Asian-Pac Vol. 2022;27(2):261-266.
• Olech J, Ciszewski M, Morasiewicz P. Epidemiology of distal radius fractures in children and adults during the COVID-19 pandemic-a two-center study. BMC Musculoskelet Disord. 2021; 22(1):1-8.
• Demir N, Sayar S, Dokur M, et al. Analysis of increased motorcycle accidents during the COVID-19 pandemic: a single-center study from Turkiye. Turk J Trauma Emerg Surg TJTES. 2024;30(2):114-22.
• Rau Y, Huynh T, Frosch KH, Schultz C, Schulz AP. Developments in the epidemiology and surgical management of patella fractures in Germany. BMC Musculoskelet Disord. 2023;24(1):83.
• Larsen P, Arildsen M, Kristensen K, Lyng KD, Elsoe R. High risk of complications following surgical treatment of patella fractures-a cross-sectional study of 798 patients with mean 6.4 years follow-up. Eur J Trauma Emerg Surg [Internet]. 2024;50(3): 1127-1134.
• Petrie J, Sassoon A, Langford J. Complications of patellar fracture repair: treatment and results. J Knee Surg. 2013;26(05):309-312.
• Mittal S, David VK, Sharma V. Incidence of implant removal in surgically treated patella fractures. Cureus [Internet]. 2022;14(5): e25377.
• Hoshino CM, Tran W, Tiberi JV, et al. complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Jt Surg. 2013;95(7): 653-659.
• Smith ST, Cramer KE, Karges DE, Watson JT, Moed BR. Early complications in the operative treatment of patella fractures. J Orthop Trauma. 1997;11(3):183-187.