Patella Fractures: Approach to Treatment

Damayea I. Hargett, MD; Brent R. Sanderson, DO; Milton T.M. Little, MD

Disclosures

J Am Acad Orthop Surg. 2021;29(6):244-253. 

In This Article

Nonoperative

Nonoperative management may be indicated for patella fractures with an intact/competent extensor mechanism, <1 to 4 mm of fracture displacement, and less than 2 to 3 mm of articular incongruity or articular step-off.[10] Patient age, functional status, and bone quality must also be considered. Nonsurgical treatment regimens include weight-bearing as tolerated with long leg immobilization (cylinder cast, knee immobilizer, or hinged knee brace) for a duration of 4 to 6 weeks, followed by the initiation of range of motion. Previous evidence supported that nonsurgical management is associated with good-to-excellent outcomes,[10] but recently, Cooper et al[11] reported poor functional outcome scores with minimally displaced fractures. Further long-term clinical trials are needed to define appropriate nonsurgical treatment indications.

Nonoperative treatment for displaced patella fractures is reserved for those with limited functional status or contraindications to surgery. At the 2-year follow-up, Pritchett[12] reported all 18 patients with displaced patella fractures developed a ≥20° extensor lag, but only three patients reported notable limitations in their activities. The natural history, as well as the implications and limitations of nonoperative treatment of nondisplaced and displaced patella fractures, should be discussed with patients.

processing....