Patellar Fractures: Anatomy, Mechanics, and Surgical Management.

Abstract

A preoperative computed tomography scan may be considered to improve surgical planning, as secondary fracture lines are poorly visualized on radiographs. Oblique internal and external rotation fluoroscopic views may be used intraoperatively to fully evaluate the medial and lateral facet articular reduction if direct assessment by visualization or palpation is not completed. Partial patellectomy for inferior pole fractures should be avoided, and bone-preserving procedures are recommended. A lateral arthrotomy may be used for direct visualization of the articular reduction for multifragmentary fractures. An inferomedial arthrotomy should be avoided to protect the dominant blood supply of the patella. Tension band fixation with cannulated screws yields a lower reoperation rate, improved functional outcome scores, and better performance in biomechanical studies than Kirschner wire-based tension band fixation. Preliminary studies of novel plate and screw constructs for osteosynthesis have shown promising results.