PATELLA FRACTURES: A REVIEW OF CURRENT MANAGEMENT
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Introduction: Patella fractures are not commonly encountered in orthopaedic practice constituting only 1% of all bone fractures. Because of its key role in the knee’s extensor mechanism, fractures affect ambulation negatively. Non- operative treatment is reserved for un-displaced fractures. Surgical treatment options are fast evolving driven by the need to provide more stable and less irritative constructs. The aim was to highlight the current concepts in the clinical diagnosis of patella fractures and discuss the available evidence that can guide current clinical practice.
Methodology: This is a narrative review that discusses relevant studies on patella fractures with emphasis on treatment options, their strengths and weaknesses.
Results: The single most common operative treatment for displaced transverse patella fractures is tension band wiring (TBW). Though favourable outcomes have been reported, irritation of the soft tissue by the subcutaneous implant, wire migration and frequent need for early implant removal are major drawbacks. TWB is also not suitable for comminuted and polar fractures. Newer implants have shown excellent results with comminuted and polar fractures and are less irritative than TBW. The indications for partial or total patellectomy are fast reducing, stimulating the need for more research on patella fractures.
Conclusion: Appropriate patient counselling guided by the severity of the injury, the pattern of fracture, preinjury status, state of the extensor apparatus, available resources, local soft tissue condition and the patient’s preferences are key to successful outcome.
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References
Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg. 2011(4):198-207.
Henrichsen JL, Wilhem SK, Siljander MP, Kalma JJ, Karadsheh MS. Treatment of Patella Fractures. Orthopedics. 2018;41(6):e747-55.
Neumann M.V., Niemeyer P., Südkamp N.P., Strohm P.C. Patellar fractures—A review of classification, genesis, and evaluation of treatment. Acta Chir. Orthop. Traumatol. Cech. 2014;81:303–312. doi: 10.55095/achot2014/041.
Zhu Y, Liu S, Chen W, Wang L, Zhang X, Zhang Y. Socioeconomic factors and individual lifestyles influencing the incidence of patella fractures: a national population-based survey in China. Int Orthop. 2019;43(3):687–95.
Grace JN, Sim FH. Fracture of the patella after total knee arthroplasty. Clin Orthop Relat Res. 1988; S(230):168-75
Torchia ME, Lewallen DG. Open fractures of the patella. J Orthop Trauma. 1996;10(6):403-9.
Anand S, Hahnel JC, Giannoudis PV. Open patellar fractures: high energy injuries with a poor outcome? Injury. 2008 Apr;39(4):480-4.
Gwinner C, Märdian S, Schwabe P, Schaser K-D, Krapohl BD, Jung TM. Current concepts review: Fractures of the patella. GMS Interdiscip Plast Reconstr Surg DGPW. 2016;5:Doc01.
Hoshino CM, Tran W, Tiberi J V., Black MH, Li BH, Gold SM, et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with kirschner wires. J Bone Jt Surg - Ser A. 2013;95(7):653-9.
Smith ST, Cramer KE, Karges DE, Watson JT, Moed BR. Early Complications in the Operative Treatment of Patella Fractures. J Orthop Trauma. 1997 Apr;11(3):183-7.
Eyal S, Blitz E, Shwartz Y, Akiyama H, Schweitzer R, Zelzer E. On the development of the patella. Development. 2015 May 15;142(10):1831-9. doi: 10.1242/dev.121970. Epub 2015 Apr 29. PMID: 25926361.
Byun SE, Sim JA, Joo YB, Kim JW, Choi W, Na YG, Shon OJ. Changes in patellar fracture characteristics: a multicenter retrospective analysis of 1596 patellar fracture cases between 2003 and 2017. Injury. 2019;50(12):2287–91.
Kaufer H. Mechanical function of the patella. J Bone Joint Surg Am. 1971 Dec;53(8):1551-60.
Luo TD, Marino DV, Pilson H. Patella Fractures. 2023 Jul 31. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 30020702.
Scapinelli R. Blood supply to the human patella. Its relation to ischaemic necrosis after fracture. J Bone Joint Surg Br. 1967 Aug;49(3):563-70
Court-Brown CM, Clement ND, Duckworth AD, Biant LC, McQueen MM. The changing epidemiology of fall-related fractures in adults. Injury. 2017;48:819–24.
Kruse, M., Wolf, O., Mukka, S. et al. Epidemiology, classification and treatment of patella fractures: an observational study of 3194 fractures from the Swedish Fracture Register. Eur J Trauma Emerg Surg 48, 4727–4734 (2022). https://doi.org/10.1007/s00068-022-01993-0
Larsen P, Court-Brown CM, Vedel JO, Vistrup S, Elsoe R. Incidence and Epidemiology of Patellar Fractures. Orthopedics. 2016;39:e1154–8.
von Zelewski, A., Kalbitz, M., Pressmar, J. (2021). Epidemiology and Classification of Patella Fractures. In: Hanschen, M., Biberthaler, P., Waddell, J.P. (eds) Knee Fractures. Strategies in Fracture Treatments. Springer, Cham.
Bucholz, Robert W., James D. Heckman, Charles M. CourtBrown, Charles A. Rockwood and DPG. Rockwood and Green’s Fractures in Adults. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.
Court-Brown CM, Biant L, Bugler KE, McQueen MM. Changing epidemiology of adult fractures in Scotland. Scott Med J. 2014;59:30–4.
Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl. 1972;143:1-80.
Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-5.
Ortiguera CJ, Berry DJ. Patellar fracture after total knee arthroplasty. J Bone Joint Surg Am. 2002 Apr;84(4):532-40.
Berry DJ, Rand JA. Isolated patellar component revision of total knee arthroplasty. Clin Orthop Relat Res. 1993 Jan;(286):110-5.
Sheth NP, Pedowitz DI, Lonner JH. Periprosthetic patellar fractures. J Bone Joint Surg Am. 2007 Oct;89(10):2285-96.
Rorabeck CH, Angliss RD, Lewis PL. Fractures of the femur, tibia, and patella after total knee arthroplasty: decision making and principles of management. Instr Course Lect. 1998;47:449-58.
Reuben JD, McDonald CL, Woodard PL, Hennington LJ. Effect of patella thickness on patella strain following total knee arthroplasty. J Arthroplasty. 1991 Sep;6(3):251-8.
Tria AJ, Harwood DA, Alicea JA, Cody RP. Patellar fractures in posterior stabilized knee arthroplasties. Clin Orthop Relat Res. 1994 Feb;(299):131-8.
Figgie HE, Goldberg VM, Figgie MP, Inglis AE, Kelly M, Sobel M. The effect of alignment of the implant on fractures of the patella after condylar total knee arthroplasty. J Bone Joint Surg Am. 1989 Aug;71(7):1031-9.
Petrie J, Sassoon A, Langford J. Complications of patellar fracture repair: treatment and results. J Knee Surg. 2013 Oct;26(5):309-12.
Patella fracture patterns. Available at www. Physica.com.au/patella fractures. Accessed on 10th may 2025.
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018 Jan;32 Suppl 1:S1-S170
Müller ME, Allgöwer M, Schneider R, Willenegger H. Manual of internal fixation: techniques recommended by the AO-ASIF group. Berlin: Springer; 1991.
Konda SR, Davidovitch RI, Egol KA: Computed tomography scan to detect traumatic arthrotomies and identify periarticular wounds not requiring surgical intervention: An improvement over the saline load test. J Orthop Trauma 2013;27:498-504.
Gray SD, Kaplan PA, Dussault RG, et al: Acute knee trauma: How many plain film views are necessary for the initial examination? Skeletal Radiol 1997;26:298-302.
Lazaro LE, Wellman DS, Pardee NC, et al: Effect of computerized tomography on classification and treatment plan for patellar fractures. J Orthop Trauma 2013;27:336-344.
Meng D, Xu P, Shen D, Chen Y, Zhu C, Hou C, et al. A clinical comparison study of three different methods for treatment of transverse patellar fractures. J Orthop Sci. 2019;24(1):142-6.
Benjamin J., Bried J., Dohm M., McMurtry M. Biomechanical evaluation of various forms of fixation of transverse patellar fractures. J. Orthop. Trauma. 1987;1:219–222. doi: 10.1097/00005131-198701030-00004.
Berg E.E. Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws. J. Orthop. Trauma. 1997;11:573–576. doi: 10.1097/00005131-199711000-00005.
Burvant J.G., Thomas K.A., Alexander R., Harris M.B. Evaluation of methods of internal fixation of transverse patella fractures: A biomechanical study. J. Orthop. Trauma. 1994;8:147–153. doi: 10.1097/00005131-199404000-00012.
Lotke P.A., Ecker M.L. Transverse fractures of the patella. Clin. Orthop. Relat. Res. 1981;158:180–184. doi: 10.1097/00003086-198107000-00026.
Posner AD, Zimmerman JP. Surgical Management of Patella Fractures: A Review. Arch Orthop. 2022;3(1):17-21.
Steinmetz S., Brügger A., Chauveau J., Chevalley F., Borens O., Thein E. Practical guidelines for the treatment of patellar fractures in adults. Swiss Med. Wkly. 2020;150:w20165. doi: 10.4414/smw.2020.20165
Wild M., Fischer K., Hilsenbeck F., Hakimi M., Betsch M. Treating patella fractures with a fixed-angle patella plate-A prospective observational study. Injury. 2016;47:1737–1743. doi: 10.1016/j.injury.2016.06.018.
Tian Y., Zhou F., Ji H., Zhang Z., Guo Y. Cannulated screw and cable are superior to modified tension band in the treatment of transverse patella fractures. Clin. Orthop. Relat. Res. 2011;469:3429–3435. doi: 10.1007/s11999-011-1913-z.
Schnabel B., Scharf M., Schwieger K., Windolf M., van der Pol B., Braunstein V., Appelt A. Biomechanical comparison of a new staple technique with tension band wiring for transverse patella fractures. Clin. Biomech. 2009;24:855–859. doi: 10.1016/j.clinbiomech.2009.08.002.
Ha C., Sun J.I. The treatment of patellar fracture with modified tension band wiring, using cannulated screws. J. Korean Fract. Soc. 2004;17:117. doi: 10.12671/jkfs.2004.17.2.117.
Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect. 1994; 43:97-108.
Thelen S, Schneppendahl J, Jopen E, Eichler C, Koebke J, Schönau E, et al. Biomechanical cadaver testing of a fixedangle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury. 2012 Aug;43(8):1290-5.
Zhang Y, Xu Z, Zhong W, Liu F, Tang J. Efficacy of K-wire tension band fixation compared with other alternatives for patella fractures: A meta-analysis. J Orthop Surg Res. 2018;13(1):1-10
Busel G, Barrick B, Auston D, Achor K, Watson D, Maxson B, et al. Patella fractures treated with cannulated lag screws and fiberwire® have a high union rate and low rate of implant removal. Injury. 2020;51(2):473-7.
Wong AL, Wong KK, Wong KK, Wong WC. The “invisible” wiring technique for displaced fracture patella. J Orthop Trauma Rehabil. 2020 Dec 2;27(2):252-7.
Camarda L, La Gattuta A, Butera M, Siragusa F, D’Arienzo M. FiberWire tension band for patellar fractures. J Orthop Traumatol. 2016;17(1):75-80.
Wright PB, Kosmopoulos V, Coté RE, Tayag TJ, Nana AD. FiberWire is superior in strength to stainless steel wire for tension band fixation of transverse patellar fractures. Injury. 2009 Nov;40(11):1200-3.
Dickens AJ, Salas C, Rise L, Murray-Krezan C, Taha MR, DeCoster TA, et al. Titanium mesh as a low-profile alternative for tension-band augmentation in patella fracture fixation: A biomechanical study. Injury. 2015 Jun;46(6):1001-6.
Lorich DG, Warner SJ, Schottel PC, Shaffer AD, Lazaro LE, Helfet DL. Multiplanar Fixation for Patella Fractures Using a Low-Profile Mesh Plate. J Orthop Trauma. 2015 Dec;29(12):e504-10.
Rau Y, Huynh T, Frosch KH, Schultz C, Schulz AP. Developments in the epidemiology and surgical management of patella fractures in Germany. BMC Musculoskelet Disord. 2023 Jan 31;24(1):83. doi: 10.1186/s12891-023-06162-x. PMID: 36721108; PMCID: PMC9887573.
Matejčić A, Ivica M, Jurišić D, Ćuti T, Bakota B, Vidović D. Internal fixation of patellar apex fractures with the basket plate: 25 years of experience. Injury. 2015 Nov;46: S87-90.
Egol K, Howard D, Monroy A, Crespo A, Tejwani N, Davidovitch R. Patella fracture fixation with suture and wire: you reap what you sew. Iowa Orthop J. 2014; 34:63-7.
Kadar A, Sherman H, Drexler M, Katz E, Steinberg EL. Anchor suture fixation of distal pole fractures of patella: twenty-seven cases and comparison to partial patellectomy. Int Orthop. 2016 Jan 26;40(1):149-54
Hung LK, Lee SY, Leung KS, Chan KM, Nicholl LA. Partial patellectomy for patellar fracture: tension band wiring and early mobilization. J Orthop Trauma. 1993;7(3):252-60.
Marder RA, Swanson T V, Sharkey NA, Duwelius PJ. Effects of partial patellectomy and reattachment of the patellar tendon on patellofemoral contact areas and pressures. J Bone Joint Surg Am. 1993 Jan;75(1):35-45