Surgical Management of Patellar Fractures

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Key points

  • The patella is a crucial component of the extensor mechanism.

  • Modern surgical techniques provide good results with proper indications.

  • Management of patella fractures depends on the fracture morphology.

  • Symptomatic implants often lead to additional surgery.

  • New techniques aim to reduce implant complications.

Introduction: nature of the problem

The patella plays a crucial role in the extensor mechanism to increase the mechanical advantage of the quadriceps. Forces up to 5 times the body weight have been recorded from the extensor mechanism; the patella displaces the quadriceps tendon-patellar tendon link away from the axis of knee rotation, effectively increasing the moment arm of the quadriceps.1, 2

Every year, roughly 1 in every 100 fractures will involve the patella.3 Fractures can be classified based on displacement, comminution,

Indications/contraindications

Indications for treatment of patellar fractures are largely determined by the type of fracture encountered. However, the goals of treatment remain the same: (1) restoration of the extensor mechanism and (2) maintenance of a congruous articular surface. Thus, the literature often has focused on treatment type rather than fracture type.

Surgical Indications

Indications for surgery include open fracture, articular step of 2 mm or greater, and loss of knee extension (Fig. 1). Comminuted stellate fractures typically present with intact retinaculum; however, because of the articular incongruity, surgical intervention may be recommended (Fig. 2). Highly comminuted and displaced fractures can present as transverse fractures with massive comminution or stellate fractures with massive diastasis. These injuries are often open.

Preoperative Planning

Standard radiographic views

Summary

  • 1.

    The patella is a crucial component of the extensor mechanism.

  • 2.

    Modern surgical techniques provide good results with proper indications.

  • 3.

    Management of patella fractures depends on the fracture morphology.

  • 4.

    Symptomatic implants often lead to additional surgery.

  • 5.

    New techniques aim to reduce implant complications.

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    Disclosures: No disclosures (R. Kakazu); Consultant: Stryker; Speaker: AO North America, Stryker; Royalties: Stryker, Slack, Inc (M.T. Archdeacon).

    Funding Source: None.

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