Patellar fracture is a common injury caused by excessive tension through the extensor mechanism or a direct blow. The intact patella increases the leverage and efficiency of the extensor mechanism and articulates with the femoral trochlea. Patellar fractures can lead to stiffness, extension weakness, and patellofemoral arthritis. Nonsurgical management is indicated for nondisplaced fractures with an intact extensor mechanism. Surgical fixation is recommended for fractures that either disrupt the extensor mechanism or demonstrate >2 to 3 mm step-off and >1 to 4 mm of displacement. Anatomic reduction and fixation with a tension-band technique is associated with the best outcomes; however, symptomatic hardware is a frequent complication. Open fractures are associated with more complications than closed fractures. These complications can be mitigated with timely débridement, irrigation, and internal fixation.
From the Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA.
Dr. Mehta or an immediate family member is a member of a speakers' bureau or has made paid presentations on behalf of AO and Smith & Nephew and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non-research-related funding (such as paid travel) from Wolters Kluwer Health—Lippincott Williams & Wilkins. Neither Dr. Melvin nor any immediate family member has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article.