The operative repair of displaced patellar fractures.

Open reduction and internal fixation was used to treat 17 patients with displaced patellar fractures. The fractures were classified as transverse in five patients, transverse with comminuted distal pole in nine, and comminuted in three. The type of the fracture sustained was consistent with the mechanism of injury (eg, a fall, dashboard injury, motorcycle or pedestrian accident). Follow-up averaged 4 years (minimum, 1 year) including clinical and roentgenographic evaluation. Results in 11 patients were categorized as excellent, four as good, and two as unsatisfactory. The primary fixation method was modified tension band, which worked well in transverse fractures and in patients with minimal comminution. When the patella was comminuted, partial excision of the small fragments and internal fixation provided better results than fixation of all the fragments. The roentgenographic analysis did not always correlate with the clinical result. Two patients sustained a medial femoral condylar injury with their patellar fracture and had complicated treatment courses. These concurrent injuries may be predictive of a poor result.