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

Abstract

Background: The neglected patella fracture leading to non-union of the fracture in long term. Non-union patella is therare entity with incidence of 2.4-12.5%. 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 2, 4, 6 and12 months.Results: All patients presented with a mean duration of 9.3 months (7-13months) after the trauma with mean gap betweenthe fracture fragments of 5.2cm (3.8-6.6cm) in maximum flexion and 2.6cm (2.0- 3.0cm) in full passive extension. Themean duration of the radiological union was 5months (3-6months). The average range of motion achieved at the end of12 months ranges from 10o to 110o. The quadriceps power in all patients were 4+ or 5 at 6 and 12months. The meanKnee Society Score was 75 (Range 72-82) and mean Kujala knee score was 73 (Range 70- 82) at the end of 12 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