(i) Comminuted patellar fractures

Abstract

Summary Purpose of review This article reviews current best practice for the diagnosis and treatment of comminuted patellar fractures. Recent findings Patellar fractures make up about 1% of all fractures. As a rule, fractures of the patella are caused by direct trauma to the knee. A transverse fracture is the most common fracture type. Open reduction and internal fixation is the treatment of choice for the majority of displaced patellar fractures. Treatment must achieve anatomic reduction of the articular surface and reestablish the continuity of the extensor mechanism. Tension-band wiring, interfragmentary screw fixation and a combination of cerclage wiring and screw fixation are the most accepted techniques for stabilisation. Partial or total patellectomy is generally indicated when the patella is so severely comminuted that an accurate reduction and reconstruction of the retropatellar joint surface cannot be achieved. Summary Different methods of stabilisation for patellar fractures are used, depending mainly on the fracture pattern and the amount of displacement. The aims of operative treatment are basically accurate reduction and stable fixation that allows early mobilisation.