Immobilization Duration for Comminuted Patellar Fracture in an 80-Year-Old
For an 80-year-old patient with a comminuted patellar fracture treated surgically, immobilize the knee in a cast at approximately 10 degrees of flexion for 6 weeks, followed by immediate intensive rehabilitation to restore range of motion. 1
Surgical Treatment is Preferred
Surgical fixation is strongly recommended over conservative treatment for comminuted patellar fractures with disruption of the extensor mechanism in elderly patients, as it yields significantly better functional outcomes and restoration of pre-injury mobility status (82% vs. 50% return to baseline function, p<0.05). 2
In octogenarians specifically, operative treatment with tension band wiring followed by cast immobilization has demonstrated complete fracture union in all cases with good functional recovery. 1
Immobilization Protocol
Cast immobilization should be maintained for 6 weeks with the knee positioned in approximately 10 degrees of flexion. 1
Immediate full weight-bearing is recommended from the start of treatment, even during the immobilization period, to prevent complications associated with prolonged non-weight-bearing in elderly patients. 1
This approach balances fracture stability with the critical need to maintain mobility and independence in octogenarians. 1
Post-Immobilization Rehabilitation is Critical
Intense rehabilitation must begin immediately after cast removal at 6 weeks to address the severe range of motion limitations that develop during immobilization. 1
Before physiotherapy, expect patients to have an active extension lag of 10-20 degrees and maximum flexion limited to approximately 70 degrees. 1
With aggressive rehabilitation, most elderly patients can achieve >100 degrees of flexion, and some may regain full active extension. 1
The rehabilitation program should include muscle strengthening exercises and long-term continuation of hand exercises (applicable to all extremity fractures). 3
Expected Outcomes in Octogenarians
Complete fracture union occurs in all surgically treated cases at a mean of 7 weeks (range 6-10 weeks). 1, 4
86% of octogenarian patients (12 of 14) return to their pre-injury functional level despite the 6-week immobilization period. 1
Minor extension lag (10-30 degrees) may persist in approximately 9% of surgically treated elderly patients, but this rarely prevents return to baseline function. 2
Critical Considerations for the Elderly Population
The 6-week immobilization period, while causing significant initial stiffness, is necessary for fracture healing and does not preclude excellent functional recovery when followed by intensive rehabilitation. 1
Half of elderly patients with patellar fractures have significant background diseases, requiring careful perioperative medical optimization. 2
The majority of patellar fractures in octogenarians (82%) result from simple falls, highlighting the importance of fall prevention strategies and osteoporosis evaluation post-fracture. 2
Do not extend immobilization beyond 6 weeks, as prolonged immobilization in elderly patients increases risks of muscle atrophy, joint stiffness, and loss of independence without improving fracture healing. 1