What is the treatment for a patella fracture?

From the Guidelines

Surgery is the usual treatment for patella fractures, with simple immobilization being appropriate for small, nonarticular, or minimally displaced fractures. When considering the treatment for a patella fracture, it's crucial to prioritize the type and severity of the fracture, as this dictates the most appropriate intervention 1.

Key Considerations

• The diagnosis of a patella fracture is based on a history of trauma and focal pain on palpation, confirmed with radiographic studies 1.
• For fractures where the fragments are small, nonarticular, or minimally displaced, simple immobilization is often sufficient 1.
• However, for more complex or displaced fractures, surgical intervention may be necessary to ensure proper alignment and healing of the bone fragments.

Treatment Approaches

• Conservative treatment for non-displaced fractures may include immobilization with a knee brace or cast, pain management with medications, and progressive weight-bearing as tolerated 1.
• Surgical options, such as tension band wiring, screws, or partial/total patellectomy, are considered for displaced fractures or when conservative treatment is not viable 1.
• Regardless of the treatment approach, physical therapy plays a critical role in the rehabilitation process, aiming to restore strength, range of motion, and normal knee function over several months.

Outcome Prioritization

• The primary goal of treatment is to minimize morbidity, reduce mortality risk, and improve the patient's quality of life by restoring knee function and preventing long-term complications such as arthritis or chronic pain 1.
• Given the importance of the patella in knee mechanics, proper treatment is essential to avoid these complications and ensure the best possible outcome for the patient.

From the Research

Treatment Options for Patella Fracture

The treatment for a patella fracture can be either conservative or surgical, depending on the type of fracture and the patient's overall health.

• Non-displaced fractures with an intact extensor mechanism can be treated nonoperatively 2.
• Surgical treatment is recommended for fractures that disrupt the extensor mechanism or have more than 2 to 3 mm of step-off and more than 1 to 4 mm of displacement 2.
• Tension band fixation is the most commonly employed surgical technique 2.
• In cases of comminuted fractures, open reduction and fixation with small fragment screws or new angular stable plates can result in the best outcome 3.
• Additional circular cerclage wiring can increase fixation stability and decrease the risk for re-dislocation 3.

Surgical Techniques

Different surgical techniques can be used to treat patella fractures, including:

• Modified anterior tension band wiring, which can be combined with cannulated screw fixation 3.
• Percutaneous osteosynthesis, which may have similar outcomes to open surgery 4.
• Cable pin system, which may have better outcomes than the tension band technique 4.
• Biodegradable implants, which may have similar outcomes to metallic implants 4.

Rehabilitation and Recovery

Early rehabilitation is recommended to avoid contractures of the knee joint capsule and cartilage degeneration 3.

• Patients can expect to return to their daily life activities without restriction after 6-12 months of rehabilitation 5.
• Full extension and knee flexion can be achieved after 12 months of rehabilitation 5.
• Muscle strength force can return to normal after 12 months of rehabilitation 5.