The Treatment of Fracture of the Patella

Abstract

In the treatment of fracture of the patella, the most ideal procedure is that which will return the kneejoint to normal range of motion with the minimum of resultant traumatic arthritis. It is also very important that this procedure be accomplished with a minimum of time lost.

The consensus of opinion is that the vast majority of cases of fracture of the patella should be treated by open operation. The operative procedure generally adopted is thorough exploration of the fracture, removing all blood clots, replacing the fragments, and maintaining their position by means of a purse-string suture of silk or wire. This procedure is by no means simple. Even experienced and meticulous surgeons find it wrought with difficulties that often are not sufficiently emphasized. It is very difficult to prevent a certain tipping of one or more fragments, which results in roughness on the undersurface of the patella (Fig. 1 A and B). In the literature there are many suggestions for various methods of insertion of the sutures in an attempt to avoid this complication. The fact that there are so many methods only emphasizes the difficulties encountered. If this roughening occurs, it causes a grating or crepitation of the kneecap when motion is started, which is very annoying to most patients, and definitely prolongs the time of gaining full range of motion in the knee. In some instances where this irregularity is marked, it is often impossible to procure full flexion of the knee-joint even after months of treatment.