Patellar Fractures: A Clinical Narrative Review

TL;DR

This review discusses the diagnosis, treatment, and outcomes of patellar fractures, emphasizing the importance of individualized care and modern surgical techniques.

Contribution

The paper provides a comprehensive clinical narrative review of current evidence on patellar fracture management.

Findings

Non-surgical treatment is effective for minimally displaced patellar fractures with good functional recovery.

Surgical fixation is necessary for displaced fractures, with improved outcomes due to advances in imaging and plating technology.

Common complications include hardware irritation, re-operation, and long-term issues like quadriceps weakness and arthritis.

Abstract

Patellar fractures are common knee injuries that can severely compromise the extensor mechanism of the knee. They may result from direct trauma, indirect quadriceps contraction, or high-energy impacts. A sound understanding of their anatomy, biomechanics, and fracture patterns is essential for accurate diagnosis and effective management.

This review summarises the current evidence on patellar fractures, covering anatomy, clinical evaluation, imaging, classification, and treatment. Both conservative and surgical treatments are discussed, such as tension-band wiring, screw fixation, plate osteosynthesis, and patellectomy, along with rehabilitation protocols and outcomes.

Fractures with minimal displacement and an intact extensor mechanism can generally be treated successfully without surgery, with immobilisation and early physiotherapy, and many patients regain good function. Displaced or complex fractures generally require operative fixation, and outcomes have been enhanced by advances in imaging and plating technology. The most frequent complications are hardware irritation and re-operation; quadriceps weakness and post-traumatic arthritis can also affect long-term function.

Optimal management of patellar fractures depends on careful consideration of fracture pattern, extensor mechanism integrity, and patient factors. Individualised treatment and careful follow-up allow most patients to achieve satisfactory functional recovery, although potential complications should be expected and managed.

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