Management of patellar fractures depends upon the number of fragments the bone has broken into, whether or not any fragments are displaced and also the integrity of the overlying skin.
Page updated July 2023 by Dr Sheila Strover (Clinical Editor)
Fixation with cannulated screws.
Fixation with tension band wiring.
Closed versus open fractures
In a closed fracture the skin has not been broken. In an open fracture the skin has been breached and the potential exists for the introduction of bacteria. The clinician may be reluctant to use metal fixation in the case of an open fracture until the skin is healed and all risk of infection has passed.
Fixation of undisplaced patellar fracture
If the broken bits are not displaced, it may be possible just to immobilise the knee and wait for union of the patellar fragments. The issue, though, is that the joint will be stiff once any plaster has been removed, and regaining range of motion will be challenging.
Instead the surgeon may use cannulated screws and/or modified anterior tension band wiring. Cannulated screws are hollow inside and can be slipped over a guide wire which is drilled through the fragments. Modified anterior tension band wiring comprises two parallel wires, with a figure-of-eight cable wrapped around them.
Securing the fragments of a comminuted fracture
A number of options exist for comminuted fractures, and the surgeon will choose the best for the situation at hand. Choices include small screws, plates or cerclage wire which draw the fragments together.
In really severe situations it may simply be best to remove the patella altogether, and accept a small extension lag.
- Walking too soon + ROM hindered by hardware?
Patients discuss the difficult path of rehabilitation after fixation of a patellar fracture.
Citation: Shea GK, Hoi-Ting So K, Tam KW, Yee DK, Fang C, Leung F. Comparing 3 Different Techniques of Patella Fracture Fixation and Their Complications. Geriatr Orthop Surg Rehabil. 2019 Mar 5;10:2151459319827143. doi: 10.1177/2151459319827143. PMID: 30858993; PMCID: PMC6402069.
Quote: "Implant-related soft tissue irritation resulting in anterior knee pain and subsequent need for implant removal is the most common complication following metal fixation. The prevalence of such sequelae should be discussed with patients in order to temper expectations."
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