Repair of comminuted fracture of the lower patellar pole.

BACKGROUND: Comminuted fracture of the lower patellar pole has characteristics of both patellar fracture and avulsion of the patellar tendon. Therefore, components of both injury types should be considered during treatment. None of the traditional techniques has proven sufficient alone. Currently described is technique that incorporates principles of osteosynthesis as well as repair of the patellar tendon.

METHODS: Total of 23 patients with comminuted fracture of the lower patellar pole were treated surgically and prospectively followed for 24 months.

RESULTS: All patients returned to pre-injury level of activities of daily living at average of fourth postoperative month. Average score on scale described by Böstman et al. was 28.1 points. All fractures united within average of 10 weeks. Patellar height was preserved. Only 4 patients, all post-menopausal, demonstrated increase in degenerative changes in patellofemoral joint.

CONCLUSION: Successful osteosynthesis of the comminuted lower patellar pole using the present technique reduces potential need for partial patellectomy, and preserves original length of the extensor mechanism. Present technique allows for immediate full weight-bearing and early, extensive rehabilitation program.