Objective: Reconstruction of the extensor apparatus of the knee joint. Open reduction and stable internal fixation of patella fractures. Exact reconstruction of the articular surface of the patellofemoral joint.
Indications: Open and closed fractures. Fractures with an intraarticular incongruity (> 2 mm). Incapability of extension of the knee also in nondisplaced fractures of the patella. In the context of internal fixations of additional periarticular fractures of the knee joint.
Contraindications: Compromised general health status or associated injuries. Compromised local soft-tissue situation (contamination, poor soft-tissue cover). Relative: nondisplaced transverse fractures (no displacement in 40 degrees of flexion). Relative: nondisplaced longitudinal fractures(3). Relative: nondisplaced radiating fractures(3). Relative: nondisplaced fractures of the distal pole without involvement of the joint surface and intact extensor apparatus(3).
Surgical technique: Longitudinal parapatellar incision. Tension band wiring. Lag screw osteosynthesis. Combination of tension band wiring and lag screws. Patellectomy (partial/complete).
Postoperative management: Thrombosis prophylaxis. Early physiotherapy. Knee brace.
Results: 70% good to excellent results. 30% chronic pain and posttraumatic arthritis. Loss of motion (limited extension).