From the Guidelines
Treatment for a fractured patella should prioritize surgery for displaced fractures and immobilization for non-displaced fractures, with a focus on pain management and early physical therapy to optimize outcomes and minimize morbidity, mortality, and impact on quality of life. When considering treatment options, it's essential to evaluate the fracture's severity and displacement. For non-displaced fractures with small, non-articular fragments, simple immobilization may be sufficient, as noted in a study from 1. However, this approach should be taken with caution and under close medical supervision. Key considerations in treating a fractured patella include:
- Immobilization using a knee brace or cast to keep the knee straight during the healing process
- Pain management with medications such as acetaminophen or NSAIDs like ibuprofen for a limited period
- Early initiation of physical therapy, focusing on range of motion exercises, quadriceps strengthening, and gait training, typically starting around 2-6 weeks post-treatment
- For displaced fractures, surgical repair is often necessary, involving techniques like tension band wiring or partial patellectomy, followed by a structured rehabilitation program. Given the potential for chronic complications, such as pain, weakness, and arthritis, if left inadequately treated, it's crucial to seek immediate medical attention for any suspected patella fracture, ensuring proper diagnosis and treatment planning, as supported by the principles outlined in 1.
From the Research
Treatment Options for Fractured Patella
- Non-operative treatment can be used for non-displaced fractures with an intact extensor mechanism 2, 3, 4
- Surgical treatment is recommended for fractures that disrupt the extensor mechanism or have greater than 2 to 3 mm of step-off and greater than 1 to 4 mm of displacement 2, 3, 4
- Tension band fixation is the most commonly employed surgical technique, but it can be technically demanding, especially in multifragmentary fractures 2, 4
Minimally Invasive Techniques
- Minimally invasive techniques, such as Kirschner wires with cerclage, cannulated screw optioning of supplementary cerclage tension banding, external fixation, and combined tension-band braided polyester with a suture button, have been introduced to overcome the problems associated with open reduction and internal fixation 5
- These techniques have been shown to achieve improved knee joint mobility, shorter hospitalization, and more favorable outcomes, with a decreased risk of complications compared to conventional open reduction and fixation 5
Surgical Fixation Methods
- Various surgical fixation methods have been suggested for comminuted patellar fractures, including headless compression screws and wiring technique 6
- A new technique for exposure and stabilization of comminuted patellar fractures using headless compression screws with additional separate vertical wiring has been described, with good clinical outcomes and no loss of reduction or evidence of implant migration or metallic failure 6
Post-Operative Care
- Meticulous handling of the soft-tissue envelope is of the utmost importance, given the patella's tenuous blood supply and limited soft-tissue envelope 3
- Anatomical reconstruction of the articular surface is the only way to prevent the development of posttraumatic osteoarthritis 4
- Post-operative rehabilitation is crucial to improve knee joint mobility and functional outcomes 5