Executive Editor: 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

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

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.

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 plaster, or prolonged splintage

Disadvantages

  • Prominent metalwork after fixation
  • 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

v1.0 2008-12-03