Executive Editor: Rick Buckley, Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Extraarticular avulsion fracture

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Glossary

General considerations

Displaced fractures, especially with patella alta, require surgical fixation. If this avulsion fracture is comminuted, then the surgeon must reattach the proximal end of the patellar tendon back to the patella using heavy stitch salvage techniques.

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

Indications

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

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 splintage

Disadvantages

  • Risks of open operation
Patella tendon repair
Indication summary Skill Equipment
Extraartiuclar tendon injury (avulsion) and distraction with impaired extensor function Some specialized surgical experience Simple surgical and imaging resources

Indications

  • Patella alta

Contraindications

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

Advantages

  • Restoration of extensor function

Disadvantages

  • Risks of open operation
  • Prolonged splintage
Salvage techniques
Indication summary Skill Equipment
Distal fragment too small and fragmented to repair Highly experienced and skilled surgeon Simple surgical and imaging resources

Indications

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

Contraindications

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

Advantages

  • Restoration of extensor function
  • Early mobilization of knee joint

Disadvantages

  • Prominent metalwork after fixation requiring removal
  • Occasionally weakness will result when the extensor mechanism is shortened
  • May need later revision of partial patellectomy to total patellectomy
  • Risk of nonunion
  • Risks of open operation
Sleeve fracture fixation
Indication summary Skill Equipment
Sleeve fracture with impaired extensor function Some specialized surgical experience Simple surgical and imaging resources

Indications

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

Contraindications

  • Polytrauma patient in extremis
  • Medically unfit for surgery
  • Local soft-tissue compromise
  • Severe osteoporosis
  • Too comminuted for screw fixation

Advantages

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

Disadvantages

  • Implant prominence and irritation
  • Cerclage wire to secure sleeve fractures will frequently break once knee has been fully mobilized
  • 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