What is the treatment for a fracture of the patella (kneecap)?

From the Guidelines

The treatment for a fracture of the patella involves surgical intervention for displaced fractures, while non-displaced fractures can be managed with simple immobilization, as recommended by the american college of foot and ankle surgeons 1. The goal of treatment is to restore the normal anatomy and function of the knee, minimizing morbidity, mortality, and improving quality of life. For non-displaced fractures, where the bone fragments are small, nonarticular, or minimally displaced, conservative treatment is appropriate, including:

• Immobilization with a knee brace or cast for 4-6 weeks
• Pain management with NSAIDs like ibuprofen or acetaminophen
• Progressive weight-bearing as tolerated with crutches initially On the other hand, for displaced fractures, surgical intervention is usually necessary, involving:
• Open reduction and internal fixation (ORIF) with screws, wires, or plates to realign and stabilize the fragments
• Physical therapy to regain strength and range of motion, typically beginning with gentle exercises and progressing to more intensive rehabilitation over 3-6 months It is essential to note that the patella plays a crucial role in knee function, and proper treatment is vital to restore normal knee mechanics and prevent long-term complications like arthritis or chronic pain, as highlighted in the diagnosis and treatment of heel pain study 1. Key considerations in the treatment of patella fractures include:
• The type and severity of the fracture
• The patient's overall health and medical history
• The potential risks and benefits of surgical versus conservative treatment
• The importance of physical therapy in the rehabilitation process By prioritizing the most recent and highest quality evidence, we can ensure that patients receive the most effective treatment for their patella fracture, minimizing morbidity, mortality, and improving quality of life.

From the Research

Treatment for Fracture Patella

The treatment for a fracture of the patella (kneecap) can be either conservative or surgical, depending on the type of fracture.

• Non-displaced fractures with an intact extensor mechanism can be treated nonoperatively 2, 3.
• Surgical treatment is recommended for fractures that either 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.

Surgical Techniques

• Tension band fixation is the most commonly employed surgical technique for treating patella fractures 2, 3.
• Open reduction and internal fixation (ORIF) is also used to treat patella fractures, but it may have complications such as nonunion, infection, posttraumatic arthritis, arthrofibrosis, symptomatic hardware, and extensor mechanism insufficiency 4.
• Partial patellectomy (PP) is another surgical option, which involves removing part of the patella, and has been shown to have similar functional outcomes to ORIF 5.

Post-Operative Care

• After surgical treatment, hardware may need to be removed due to implant-related pain 3.
• A comprehensive rehabilitation program, including cryotherapy, range of motion exercises, strengthening exercises, gait training, balance and proprioception training, can help patients achieve optimal functional outcomes 6.
• Functional outcomes can be assessed using various tools, such as the visual analogue scale, goniometry, manual muscle testing, Berg balance scale, and lower extremity functional scale 6.

Complications

• Complications of patella fracture treatment can include nonunion, infection, posttraumatic arthritis, arthrofibrosis, symptomatic hardware, and extensor mechanism insufficiency 4.
• Functional impairment can persist after operative treatment of patella fractures, regardless of the surgical technique used 5.