Overview
Fractures of the patella account for approximately 1% of all fractures and can be managed surgically or conservatively, depending on the severity and type of fracture 1.Diagnosis
Clinical presentation includes knee pain, swelling, and difficulty in weight-bearing 1.
Radiographic imaging (X-rays) is essential for diagnosis, often supplemented by CT or MRI for complex fractures 1.
Grading systems like the AO/OTA classification help in assessing fracture complexity 1.Management
First-line treatments:
- Conservative management with immobilization using a brace or cast for non-displaced fractures 1.
- Surgical intervention for displaced or comminuted fractures, including various plating techniques 12.
Adjunctive treatments:
- Physical therapy post-immobilization to restore knee function and strength 1.
- Pain management with NSAIDs or opioids as needed for acute pain control 1.Special Populations
Pediatrics: Specific considerations for growth plate involvement may necessitate different surgical approaches 1.
Elderly: Increased risk of complications; conservative treatment may be favored unless displacement warrants surgery 1.
Comorbidities: Presence of conditions like osteoporosis may influence treatment choice towards surgical stabilization to prevent further complications 1.Key Recommendations
For non-displaced patellar fractures, conservative management with immobilization is recommended (Evidence: Moderate 1).
Surgical intervention, including innovative techniques like Hammock plating for complex fractures, should be considered for displaced or comminuted fractures to ensure proper reduction and healing (Evidence: Weak 2).
Early initiation of physical therapy post-immobilization is advised to optimize functional recovery (Evidence: Expert opinion 1).References
1 Sayum Filho J, Lenza M, Tamaoki MJ, Matsunaga FT, Belloti JC. Interventions for treating fractures of the patella in adults. The Cochrane database of systematic reviews 2021. link
2 Jang JH, Cho YJ, Choi YY, Rhee SJ. Hammock plating for comminuted inferior sleeve avulsion fractures of the patella: A surgical technique and clinical results. Orthopaedics & traumatology, surgery & research : OTSR 2021. link