Patella fracture fixation is an operation to repair a broken kneecap using wires, screws, or plates. The kneecap is an essential part of the knee's extensor mechanism and must be accurately restored to allow straightening of the leg.
An incision is made over the front of the knee. The fracture fragments are realigned and fixed — typically with tension band wiring (two wires and a figure-of-eight wire), screws, or occasionally a plate. If the kneecap is shattered beyond repair (comminuted), partial or total patellectomy (removal) may be necessary. The operation takes one to one and a half hours.
Surgery is recommended for displaced patella fractures that disrupt the extensor mechanism, preventing the patient from actively straightening the knee.
Undisplaced fractures with an intact extensor mechanism can be managed in a cylinder cast or knee brace for four to six weeks.
Standard pre-assessment. Surgery within days of injury.
Restoration of the extensor mechanism allowing active knee extension. Most patients achieve a functional knee, though some loss of full flexion is common.
Wires and plates sit just beneath thin skin over the kneecap. Irritation is very common.
Some loss of full flexion is expected.
Discomfort at the front of the knee with kneeling.
Wires can break or migrate. Metalwork removal is common.
Failure to heal.
Arthritis of the patellofemoral joint may develop.
Wound infection.
The repair may fail if loaded too early.
General or spinal anaesthesia.
Weight-bearing as tolerated in a brace. Range of motion exercises begin early under physiotherapy guidance. Brace removed at six weeks. Metalwork removal is frequently required after healing. Full recovery three to six months.
X-rays at two weeks, six weeks, and three months.
Approximately 50-60% of patients require metalwork removal due to wire prominence or irritation. This is done after the fracture has healed.
Kneeling may remain uncomfortable long-term due to the scar and metalwork. This improves after metalwork removal.