Frontal/coronal fractures are intraarticular and the fracture plane is transverse and therefore perpendicular to the pull of the extensor apparatus. These fractures are usually due to a sudden quadriceps contraction when the weight-bearing knee is held in flexion.
There may be additional impaction of part of the articular surface, adjacent to the fracture line.
If the fragments are separated the extensor mechanism is usually disrupted. Displaced fractures should be fixed surgically.
|Tension band wiring|
|All displaced frontal/coronal (transverse) fractures|
Displaced frontal/coronal (transverse) fractures of the body of the patella interrupt the function of the extensor mechanism and require operative stabilization. These fractures are intraarticular and anatomical reduction of the joint surface, when possible, is important.
- Displaced fractures
- Impaired extensor function
Additional knee injuries
- Polytrauma, in extremis
- Medically unfit for surgery
- Local soft-tissue compromise
- Undisplaced fractures in the elderly patient
- Severe osteoporosis
- Restoration of the extensor mechanism
- Restoration of articular congruity
- Early mobilization of knee joint
- No plaster, or prolonged splintage
- Prominent metalwork after fixation
- Risk of malunion
- Risk of nonunion
- Risks of open operation
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|