Executive Editor: Rick Buckley, Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Partial articular, lateral sagittal fragmentary fracture

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Glossary

General considerations

Sagittal fractures of the patella with articular displacement require surgical treatment. These patellar fractures are intraarticular and the need for anatomical reduction of the joint surface, when possible, is important.

Fixation of these fracture types is technically challenging. Smaller fracture fragments may be excised. If primary fixation is not possible then primary salvage procedures may need to be performed.

Undisplaced sagittal fractures of the patella are usually stable, do not inhibit the function of the extensor mechanism and can be treated nonoperatively.

The choice between surgical techniques is based on surgeon's experience and preference.

Bracing
Indication summary Skill Equipment
Undisplaced fractures Basic surgical experience, no specialized skills Basic equipment only

Indications

  • Preserved extensor function
  • Local soft-tissue compromise

Contraindications

  • Impairment of extensor function
  • Displacement of the articular surface
Cerclage wire
Indication summary Skill Equipment
Displaced fractures; surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources

Cerclage wiring may be used alone, at the discretion of the surgeon. Cerclage wire is mostly used as an adjunct to other fixations.

Contraindications

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

Advantages

  • Restoration of articular surface
  • 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
  • Risks of open operation
Suture anchors
Indication summary Skill Equipment
Displaced fractures; surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources

Anchor stitches may be used alone, or in combination with cerclage wiring

Indications

  • Displaced fractures
  • Inability to actively extend the knee

Contraindications

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

Advantages

  • Restoration of articular surface
  • Early mobilization of knee joint
  • No prolonged splintage

Disadvantages

  • Possible prominent metalwork after fixation
  • Risks of open operation
Lag screws
Indication summary Skill Equipment
Displaced fractures; surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources

Lag screw fixation may be used alone, or in combination with cerclage wiring, at the discretion of the surgeon.

Contraindications

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

Advantages

  • Restoration of articular surface
  • Early mobilization of knee joint
  • No prolonged splintage

Disadvantages

  • Prominent metalwork after fixation
  • 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