Executive Editor: Rick Buckley, Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Complete articular, frontal/coronal simple fracture of the distal third

back to skeleton

Glossary

General considerations

All displaced fractures should be fixed surgically.

Suture repair
Indication summary Skill Equipment
Distraction with impaired extensor function Some specialized surgical experience Simple surgical and imaging resources

Indication

  • 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 function
  • Early mobilization of knee joint
  • No prolonged splint

Disadvantages

  • Risk of malunion
  • Risk of nonunion
  • Risks of open operation
  • Hardware removal required
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
Salvage techniques
Indication summary Skill Equipment
Distal fragment too fragmented to repair Highly experienced and skilled surgeon Simple surgical and imaging resources

Indication

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

Contraindications

  • Polytrauma patient in extremis
  • Medically unfit for surgery

Advantages

  • 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 the lower third of the patella
  • Risks of open operation
Tension band wiring
Indication summary Skill Equipment
Distraction with impaired extensor function Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Displaced fractures
  • Additional knee injuries

Contraindications

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

Advantages

  • Restoration of the extensor mechanism
  • Restoration of articular congruity
  • Early mobilization of knee joint
  • No prolonged splintage

Disadvantages

  • Prominent metalwork after fixation requiring removal
  • 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