Executive Editor: Rick Buckley, Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Partial articular, medial sagittal fragmentary fracture

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Glossary

General considerations

These fractures may have implications for instability of the patella. Undisplaced sagittal fractures of the patella are usually stable, do not inhibit extensor function and can be treated nonoperatively. Any significant displacement requires surgical fixation.

Fixation may be technically challenging. Occasionally smaller fracture fragments if significantly displaced may be excised. If it is found that primary fixation is not possible then either a primary salvage procedure, or partial patellectomy, may need to be performed.

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
  • Lateral instability of the patella
  • Displacement of the articular surface
Cerclage wire
Indication summary Skill Equipment
Lateral instability of the patella; surgeon's preference Some specialized surgical experience 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.

Indications

  • Displaced multifragmentary fractures

Contraindications

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

Advantages

  • Restoration of articular surface
  • Restoration of patellar stability 
  • 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
Lateral instability of the patella; 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.

Indications

  • Displaced fractures

Contraindications

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

Advantages

  • Restoration of articular surface
  • Restoration of patellar stability
  • 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