Patella Fractures

Nonoperative treatment is appropriate for certain types of fractures, particularly when:

• The fracture is nondisplaced or minimally displaced (≤2 mm gap)
• The extensor mechanism is intact
• The patient can straighten the knee against gravity

Treatment Plan:

Immobilization:

• A knee brace or cast keeps the leg straight
• Typically worn for 4–6 weeks

Pain management:

• NSAIDs (e.g., ibuprofen), acetaminophen, or prescribed medications

Limited weight-bearing:

• Use of crutches or a walker

Physical therapy:

• Begins gradually to restore motion and strength
• Active knee motion is usually restricted initially to allow healing

Outcomes:

• Most patients heal in 6–8 weeks
• Long-term results are generally good if alignment and extensor function are preserved
• Risks include knee stiffness, weakness, or patellofemoral pain

Surgery is indicated when:

• Fracture fragments are displaced or separated
• The extensor mechanism is disrupted (can’t perform a straight leg raise)
• Open fractures
• Patient is highly active and needs a stable repair for functional recovery

Surgical Techniques

Open Reduction and Internal Fixation (ORIF)

• Bone fragments are realigned and secured with:
  • Tension band wiring
  • Screws and plates
  • Cables or sutures (especially in comminuted fractures)
• Goal is to restore the extensor mechanism and allow early motion

Partial Patellectomy

If a portion of the patella is too damaged, it may be removed while preserving the rest of the bone and tendon connections

Total Patellectomy (rare)

Removal of the entire patella is a last resort and leads to reduced strength and knee function

Postoperative Care

• Immobilization in a brace or cast for 2–6 weeks
• Early motion is encouraged once the fixation is stable
• Weight-bearing depends on fracture healing and fixation strength
• Physical therapy begins shortly after surgery to prevent stiffness

Both surgical and nonoperative management carry potential risks:

• Loss of knee motion (especially flexion)
• Chronic anterior knee pain
• Nonunion or delayed healing
• Hardware irritation (may require removal)
• Post-traumatic arthritis
• Infection (especially in open fractures)

Phase 1 (0–6 weeks)

• Immobilization
• Full weightbearing
• Gradual range-of-motion exercises
• Pain control and edema management

Phase 2 (6–12 weeks)

• Quadriceps and hamstring strengthening
• Continued mobility exercises

Phase 3 (3–6 months)

• Functional training and return to daily activities
• Brace discontinued pending progress
• Return to work or sports depending on physical demands

Full Recovery

• Usually achieved in 4–6 months, but it can take longer in complex fractures
• High-impact sports may be limited permanently in some cases

The prognosis depends on the type and severity of the fracture and the treatment method:

• Nondisplaced fractures treated nonoperatively often heal well with minimal long-term problems
• Displaced or comminuted fractures treated surgically can also do well, but may result in some degree of anterior knee pain or motion limitation
• Functional outcomes are generally good with proper rehabilitation
• Return to work or sports depends on occupation, sport type, and recovery progress

See a doctor if you experience:

• A fall or blow to the knee with immediate pain and swelling
• Inability to straighten the knee or perform a straight leg raise
• Significant swelling, bruising, or deformity
• Open wound over the kneecap
• Persistent or worsening pain despite rest and medication