Executive Editor: Rick Buckley, Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Complete articular, frontal/coronal simple fracture of the middle and proximal third

back to skeleton

Glossary

General considerations

All displaced fractures should be fixed surgically. The choice between surgical techniques is based on surgeon's experience and preference.

Tension band wiring
Indication summary Skill Equipment
All displaced frontal/coronal (transverse) fractures Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Displaced fractures
  • Impaired extensor function
  • 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
  • Risk of malunion
  • Risk of nonunion 
  • 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