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

Background: The neglected patella fracture leading to non-union of the fracture in long term. Non-union patella is the rare entity with incidence of 2.4-12.5%. The fractured proximal fragment of the patella is retracted proximally leading to fracture 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 fracture was treated with ORIF with TBW. Two patients with communited fracture was treated with ORIF with TBW (K wires) and cerclage wire. Three patients with inferior pole patella was managed by open reduction and Krachow suture using fibre wire. The results were assessed in terms of time of union, knee range of motion, extension lag, quadriceps power, fracture gap, Knee society score, Kujala knee score and any complications. Follow-up with radiographs was done at 2, 4, 6 and 12 months.

Results: All patients presented with a mean duration of 9.3 months (7-13months) after the trauma with mean gap between the fracture fragments of 5.2cm (3.8-6.6cm) in maximum flexion and 2.6cm (2.0- 3.0cm) in full passive extension. The mean duration of the radiological union was 5months (3-6months). The average range of motion achieved at the end of 12 months ranges from 10o to 110o. The quadriceps power in all patients were 4+ or 5 at 6 and 12months. The mean Knee 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 rarely required for fracture reduction. The need for bone grafting can be assessed on case to case basis. Partial/total patellectomy should be avoided and Krackow suture technique is helpful in management of inferior pole patella fractures.