From the Guidelines
Surgery is typically necessary for a fractured patella when the fracture is displaced, multiple fragments exist, or the extensor mechanism of the knee is disrupted. The treatment approach for a fractured patella depends on several factors, including the severity and type of fracture, patient age, activity level, and overall health.
- Displaced fractures, where the bone pieces are separated, often require surgical intervention to restore the extensor mechanism and allow for early mobilization.
- Non-displaced fractures, where the bone pieces remain aligned, may be treated non-surgically with immobilization in a cast or brace for 4-6 weeks.
- Common surgical approaches include tension band wiring, partial patellectomy, or internal fixation with screws or plates, as these methods can effectively reestablish the extensor mechanism and promote healing 1. The goal of treatment, whether surgical or non-surgical, is to restore knee function, allowing for the return of strength and range of motion, with full recovery typically taking 3-6 months.
- Recovery involves physical therapy to regain strength and range of motion.
- Pain management during recovery usually includes prescription pain medications initially, followed by over-the-counter options like acetaminophen or NSAIDs as healing progresses. Note that the provided study 1 discusses treatment of distal radius fractures, which, although different from patella fractures, highlights the importance of proper alignment and stabilization in fracture management, principles that can be applied to the treatment of patella fractures as well.
From the Research
Treatment of Fractured Patella
The treatment of a fractured patella can be either surgical or non-surgical, depending on the severity of the fracture.
- Non-displaced fractures with an intact extensor mechanism can be treated nonoperatively 2.
- 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 Treatment
Surgical treatment options for a fractured patella include:
- Open reduction and internal fixation (ORIF) 3, 4
- Partial patellectomy 3, 4
- Total patellectomy 3
- Tension band fixation 2
- Percutaneous osteosynthesis 5
- Headless compression screws and wiring technique 6
Indications for Surgery
Surgery is generally recommended for:
- Displaced fractures with disruption of the extensor mechanism 4
- Fractures with greater than 2 to 3 mm of step-off and greater than 1 to 4 mm of displacement 2, 3
- Comminuted fractures 6
Complications of Surgery
Common complications of surgical treatment for a fractured patella include: