Executive Editor: Chris Colton

Authors: Florian Gebhard, Phil Kregor, Chris Oliver

Patella Partial articular, medial sagittal simple fracture

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Glossary

General considerations

This is a noncomminuted, 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
Lag screws
Indication summary Skill Equipment
Articular displacement, lateral instability of the patella Highly experienced and skilled surgeon Simple surgical and imaging resources

The surgeon must bear in mind that sagittal patellar fractures are intraarticular and anatomical reduction of the joint surface is important.

These fractures should be considered for open operative reduction and internal fixation.

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

Indications

  • Displaced fractures
  • Lateral instability of the patella

Contraindications

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

Advantages

  • Restoration of articular surface
  • 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