Executive Editor: Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Partial articular, medial sagittal fragmentary fracture

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Glossary

General considerations

This is a comminuted, partial articular fracture of the medial border of the patella. It may have implications for instability of the patella. Any significant displacement requires surgical fixation.

Long leg cast then hinged knee brace
Indication summary Skill Equipment
Undisplaced fractures Basic surgical experience, no specialized skills Basic equipment only

Undisplaced sagittal fractures of the patella are usually stable, do not inhibit extensor function and can be treated nonoperatively.

Indications

  • Preserved extensor function
  • Local soft-tissue compromise

Contraindications

  • Impairment of extensor function
  • Lateral instability of the patella
  • Displacement of the articular surface
Cerclage wire
Indication summary Skill Equipment
Lateral instability of the patella; surgeon's preference Some specialized surgical experience Simple surgical and imaging resources

Sagittal fractures of the patella with articular displacement require surgical treatment to restore anatomical reduction of the joint surface, when possible.

Some multifragmentary patellar fractures cannot be reduced openly and can only be treated with some form of salvage technique.

Cerclage wiring may be used alone, at the discretion of the surgeon. Cerclage wire is mostly used as an adjunct to other fixations.

Indications

  • Displaced multifragmentary fractures
  • Lateral patellar instability

Contraindications

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

Advantages

  • Restoration of articular surface
  • Restoration of patellar stability 
  • 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
  • Risks of open operation
Lag screws
Indication summary Skill Equipment
Lateral instability of the patella; surgeon's preference Highly experienced and skilled surgeon Simple surgical and imaging resources

Sagittal fractures of the patella with articular displacement require surgical treatment to restore anatomical reduction of the joint surface, when possible.

Lag screw fixation may be used alone, or in combination with cerclage wiring, at the discretion of the surgeon.

Indications

  • Displaced fractures
  • Lateral patellar instability

Contraindications

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

Advantages

  • Restoration of articular surface
  • Restoration of patellar stability
  • Early mobilization of knee joint
  • No plaster, or prolonged splintage

Disadvantages

  • Prominent metalwork after fixation
  • 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