Complications of Patellar Fracture Repair: Treatment and Results

Abstract

Open reduction and internal fixation (ORIF) of patellar fractures generally leads to good results; however, the potential for surgical complications exists. Nonunion, infection, posttraumatic arthritis, arthrofibrosis, symptomatic hardware, and extensor mechanism insufficiency have all been described following patellar ORIF, and the risk of their occurrence may be augmented by patient-, injury-, and treatment-related factors. When complications arise, advanced reconstructive techniques are often required for successful management. This review will report the incidence of the aforementioned complications, highlight risk factors contributing to their frequency, discuss treatment options, and present the reported results of selected treatment strategies from available literature.

Keywords

patellar fracture - patellar nonunion - hardware pain - complications

• References

• 1 Hoshino CM, Tran W, Tiberi JV , et al. Complications following tension-band fixation of patellar fractures with cannulated screws compared with Kirschner wires. J Bone Joint Surg Am 2013; 95 (7) 653-659
• 2 Smith ST, Cramer KE, Karges DE, Watson JT, Moed BR. Early complications in the operative treatment of patella fractures. J Orthop Trauma 1997; 11 (3) 183-187
• 3 LeBrun CT, Langford JR, Sagi HC. Functional outcomes after operatively treated patella fractures. J Orthop Trauma 2012; 26 (7) 422-426
• 4 Torchia ME, Lewallen DG. Open fractures of the patella. J Orthop Trauma 1996; 10 (6) 403-409
• 5 Anand S, Hahnel JC, Giannoudis PV. Open patellar fractures: high energy injuries with a poor outcome?. Injury 2008; 39 (4) 480-484
• 6 Carpenter JE, Kasman R, Matthews LS. Fractures of the patella. Instr Course Lect 1994; 43: 97-108
• 7 Catalano JB, Iannacone WM, Marczyk S , et al. Open fractures of the patella: long-term functional outcome. J Trauma 1995; 39 (3) 439-444
• 8 Choi HR, Min KD, Choi SW, Lee BI. Migration to the popliteal fossa of broken wires from a fixed patellar fracture. Knee 2008; 15 (6) 491-493
• 9 Biddau F, Fioriti M, Benelli G. Migration of a broken cerclage wire from the patella into the heart. A case report. J Bone Joint Surg Am 2006; 88 (9) 2057-2059
• 10 Klassen JF, Trousdale RT. Treatment of delayed and nonunion of the patella. J Orthop Trauma 1997; 11 (3) 188-194
• 11 Dy CJ, Little MT, Berkes MB , et al. Meta-analysis of re-operation, nonunion, and infection after open reduction and internal fixation of patella fractures. J Trauma Acute Care Surg 2012; 73 (4) 928-932
• 12 Hung LK, Chan KM, Chow YN, Leung PC. Fractured patella: operative treatment using the tension band principle. Injury 1985; 16 (5) 343-347
• 13 Sorensen KH. The late prognosis after fracture of the patella. Acta Orthop Scand 1964; 34: 198-212
• 14 Mehdi M, Husson JL, Polard JL, Ouahmed A, Poncer R, Lombard J. [Treatment results of fractures of the patella using pre-patellar tension wiring. Analysis of a series of 203 cases]. Acta Orthop Belg 1999; 65 (2) 188-196
• 15 Domby B, Henderson E, Nayak A , et al. Comparison of cannulated screw with tension band wiring versus compressive cannulated locking bolt and nut device (CompresSURE) in patella fractures-a cadaveric biomechanical study. J Orthop Trauma 2012; 26 (12) 678-683
• 16 Sisto DJ, Sarin VK. Patellofemoral arthroplasty with a customized trochlear prosthesis. Orthop Clin North Am 2008; 39 (3) 355-362 , vi–vii vi –vii.