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

Surgical

Common indications for patella fracture fixation includes incompetent extensor mechanism, fracture separation greater than 2 to 4 mm or step-off greater than 2 to 3 mm, and intra-articular loose bodies. Active communication and patient/injury-specific discussions should occur regarding open reduction and internal fixation because of the myriad of treatment options and their associated risks and benefits.

Three common surgical approaches exist to patellar fracture fixation. The most common being a longitudinal midline extensile incision centered over the patella. Direct visualization of the articular surface is difficult and often requires palpation of the articular surface to assess articular reduction. This approach is most useful for the fixation of noncomminuted transverse fractures with large fracture fragments. Accessory fluoroscopic patellar views of 17° of patellar external rotation (range 12°–35°) and 26.5° of patellar internal rotation provide tangential views of the lateral and medial facets, respectively. This aids in confirmation of anatomic articular reduction.[13]

The lateral parapatellar approach allows for visualization of the articular surface for comminuted articular fractures requiring direct reduction (Figure 1). This technique can be done with a midline skin approach or a more lateral skin approach.[14] It preserves the major inferomedial blood supply of the patella while providing extensive visualization of the articular surface.

Figure 1.

Intraoperative image of the lateral parapatellar approach with articular reduction via kirschner wires.

The median parapatellar approach has also been described, but it does include a risk to the inferomedial blood supply of the patella. However, retrospective evaluation of Yoon et al[15] of this approach demonstrated no cases of osteonecrosis or weakening of the extensor mechanism with this approach.

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