Executive Editor: Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Complete articular, frontal/coronal wedge fracture

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Glossary

General considerations

Injuries with a transverse fracture of the body of the patella and an additional vertical fracture of one of the two fragments involve the articular surface and are usually treated operatively.

Cerclage wire
Indication summary Skill Equipment
Joint surface reconstructable Highly experienced and skilled surgeon Simple surgical and imaging resources

Displaced frontal/coronal (transverse) fractures of the body of the patella will interrupt the function of the extensor mechanism and will require operative stabilization.

Cerclage wiring may be used alone, or in combination with tension band wiring, or lag screws, at the discretion of the surgeon, but is mostly used as an adjunct to other types of fixation.

Indications

  • Displaced fractures
  • Impaired extensor function

Contraindications

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

Advantages

  • Restoration of extensor function
  • Early mobilization of knee joint
  • No plaster, or prolonged splintage

Disadvantages

  • Caution with knee mobilization is needed, if a single cerclage wire is used
  • Secondary displacement is possible
  • Prominent metalwork after fixation
  • Risk of articular malunion 
  • Risks of open operation
Salvage techniques
Indication summary Skill Equipment
Split fragment cannot be repaired Highly experienced and skilled surgeon Simple surgical and imaging resources

Displaced frontal/coronal (transverse) fractures of the body of the patella will interrupt the function of the extensor mechanism and will require operative intervention.

When a small, split fragment is not reconstructible, it may be possible to salvage the larger, single fragment.

Indications

  • Displaced fractures which are associated with inability to actively extend the knee
  • Split fragment not reconstructible 

Contraindications

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

Advantages

  • Restoration of extensor mechanism
  • Preservation of the majority of the patella
  • Early mobilization of knee joint

Disadvantages

  • Prominent metalwork after fixation
  • Loss of part of the patella
  • 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