From the Guidelines
Surgery is the usual treatment for patella fractures, especially when fracture fragments are large, articular, or significantly displaced. Treatment for a patella fracture depends on the severity and type of fracture, with the goal of minimizing morbidity, mortality, and improving quality of life 1. For non-displaced fractures, conservative treatment involves immobilization with a knee brace or cast for 4-6 weeks, followed by progressive physical therapy to restore strength and range of motion.
- Key considerations in treatment include:
- Fracture severity and displacement
- Patient's overall health and activity level
- Presence of any comorbidities that may affect healing or rehabilitation
- Pain management typically includes acetaminophen or NSAIDs like ibuprofen for 1-2 weeks as needed.
- For displaced fractures, surgical intervention is usually necessary, involving open reduction and internal fixation (ORIF) using screws, wires, or tension band wiring to realign and secure the fragments, as this approach has been shown to improve outcomes in terms of knee function and reduction of complications 1.
- Post-surgery, patients require immobilization and then rehabilitation, with weight-bearing restrictions progressing from non-weight bearing to partial and then full weight bearing over 6-12 weeks.
- Complications of patella fractures include stiffness, weakness, post-traumatic arthritis, and in some cases, partial or complete patellectomy may be required for severely comminuted fractures, highlighting the importance of prompt and appropriate treatment to minimize these risks.
From the Research
Treatment Options for Patella Fractures
- Non-displaced fractures with an intact extensor mechanism can be treated nonoperatively 2, 3, 4
- 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, 4
- Tension band fixation is the most commonly employed surgical technique 2, 3
Surgical Techniques
- Open reduction and internal fixation (ORIF) and partial patellectomy (PP) have similar functional outcomes and complication rates 5
- Anatomic reconstruction of the articular surface is the only way to prevent the development of posttraumatic osteoarthritis 3
- Percutaneous osteosynthesis may give better results than conventional open surgery, with improved knee pain and fewer adverse events 6
Complications and Considerations
- Symptomatic hardware is a frequent complication of surgical fixation 2, 4
- Failure to restore the articular surface contour results in posttraumatic arthritis 3
- Computed tomography of the knee can modify fracture classification and treatment choice by providing a better understanding of the fracture complexity 3
- Operative treatment of comminuted patellar fractures presents a significant challenge to surgeons 3