Davos Courses

Executive Editor: Rick Buckley, Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Complete articular, frontal/coronal wedge fracture

back to skeleton

Glossary

General considerations

These fractures are usually treated operatively, and they may need a combination of fixation techniques, such as screw fixation with tension band wiring, patellar plating, or tension band stitch.

Cerclage wire
Indication summary Skill Equipment
Joint surface reconstructable Highly experienced and skilled surgeon Simple surgical and imaging resources

Cerclage wiring may be used alone, or in combination with tension band wiring, or lag screws, at the discretion of the surgeon, but is mostly used as an adjunct to other types of fixation.

Indications

  • Displaced fractures
  • Impaired extensor function

Contraindications

  • Polytrauma patient in extremis
  • Medically unfit for surgery
  • Local soft-tissue compromise

Advantages

  • Restoration of extensor function
  • Early mobilization of knee joint
  • No prolonged splintage

Disadvantages

  • Caution with knee mobilization is needed, if a single cerclage wire is used
  • Secondary displacement is possible
  • Prominent metalwork after fixation
  • Risk of articular malunion 
  • Risks of open operation
Patellar plating
Indication summary Skill Equipment
Joint surface reconstructable Highly experienced and skilled surgeon Simple surgical and imaging resources

Plating may occasionally be used alone, or in combination with tension band wiring, cerclage wiring and possibly K-wires at the discretion of the surgeon.

Indications

  • Multifragmentary fractures
  • Defective function in the extensor mechanism of the knee

Contraindications

  • Polytrauma patient in extremis
  • Medically unfit for surgery
  • Extensor function preserved

Advantages

  • Early mobilization of knee joint
  • No prolonged splintage

Disadvantages

  • Very prominent metalwork after fixation requiring removal
  • Risk of articular malunion 
  • Risks of open operation
Salvage techniques
Indication summary Skill Equipment
Split fragment cannot be repaired Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

  • Displaced fractures which are associated with inability to actively extend the knee

Contraindications

  • Polytrauma patient in extremis
  • Medically unfit for surgery
  • Local soft-tissue compromise 

Advantages

  • Restoration of extensor mechanism
  • Preservation of most of the patella
  • Early mobilization of knee joint

Disadvantages

  • Prominent metalwork after fixation requiring removal
  • Occasionally weakness will result when the extensor mechanism is shortened
  • Loss of part of the patella
  • Risks of open operation
Tension band stitch
Indication summary Skill Equipment
All displaced frontal/coronal (transverse) fractures in elderly osteoporotic patients Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Impaired extensor function
  • Additional knee injuries

Contraindications

  • Polytrauma, in extremis
  • Medically unfit for surgery
  • Local soft-tissue compromise
  • Undisplaced fractures in the elderly patient 

Advantages

  • Restoration of the extensor mechanism
  • Restoration of articular congruity
  • Early mobilization of knee joint
  • No prolonged splintage
  • Less prominent hardware for later removal

Disadvantages

  • Risk of malunion
  • Risk of nonunion 
  • Risks of open operation
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2019-03-21