Surgical Management of Non-union Patella Fracture: A Case Series and Review of the Literature

Background: The neglected patella fracture leading to non-union of the fracture in long term. Non-union patella is therare entity with incidence of ۲.۴-۱۲.۵%. The fractured proximal fragment of the patella is retracted proximally leading tofracture gap of various centimetres. Various surgical modalities are described to manage such fracture morphologies.Methods: Ten neglected patella fracture morphology were included in the study. Five patients with transverse fracturewas treated with ORIF with TBW. Two patients with communited fracture was treated with ORIF with TBW (K wires) andcerclage wire. Three patients with inferior pole patella was managed by open reduction and Krachow suture using fibrewire. The results were assessed in terms of time of union, knee range of motion, extension lag, quadriceps power, fracturegap, Knee society score, Kujala knee score and any complications. Follow-up with radiographs was done at ۲, ۴, ۶ and۱۲ months.Results: All patients presented with a mean duration of ۹.۳ months (۷-۱۳months) after the trauma with mean gap betweenthe fracture fragments of ۵.۲cm (۳.۸-۶.۶cm) in maximum flexion and ۲.۶cm (۲.۰- ۳.۰cm) in full passive extension. Themean duration of the radiological union was ۵months (۳-۶months). The average range of motion achieved at the end of۱۲ months ranges from ۱۰o to ۱۱۰o. The quadriceps power in all patients were ۴+ or ۵ at ۶ and ۱۲months. The meanKnee Society Score was ۷۵ (Range ۷۲-۸۲) and mean Kujala knee score was ۷۳ (Range ۷۰- ۸۲) at the end of ۱۲ months.Conclusion: We conclude that in cases of non-union patella ORIF using TBW has the best result. V-Y plasty is rarelyrequired for fracture reduction. The need for bone grafting can be assessed on case to case basis. Partial/total patellectomyshould be avoided and Krackow suture technique is helpful in management of inferior pole patella fractures.Level of evidence: IV

Keywords:

extension lag , Non-union patella , patellectomy , quadriceps mechanism , V-Y plasty