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

Document Type : RESEARCH PAPER


Orthopaedics Maulana Azad Medical College, New Delhi, India


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.
Level of evidence: IV


1. Gwinner C, Märdian S, Schwabe P, Schaser KD, Krapohl
BD, Jung TM. Current concepts review: Fractures
of the patella. GMS Interdisciplinary plastic and
reconstructive surgery DGPW. 2016; 5:Doc01.
2. Uvaraj NR, Vahanan NM, Sivaseelam A, Sameer MM,
Basha IM. Surgical management of neglected fractures
of the patella. Injury. 2007;38(8):979-83.
3. Klassen JF, Trousdale RT. Treatment of Delayed
and Nonunion of the Patella. J Orthop Trauma.
1997;11(3):188 94.
4. Kaufer H. Mechanical function of the patella. J Bone
Joint Surg Am. 1971;53(8):1551 60.
5. Singhal V, Mittal D, Lal H, Khare R, Sharma S. Gap non
union patella: A treatment dilemma Pb. J Orthop.
2010;12(1):8 11.
6. Dhar SA, Mir MR. Use of the Illizarov method to reduce
quadriceps lag in the management of neglected non
union of a patellar fracture. J Orthop. 2007;4(1):12.
7. Nathan ST, Fisher BE, Roberts CS, Giannoudis PV. The
management of nonunion and delayed of union of
patella fractures: A systematic review of the literature.
Int Orthop. 2011;35(6):791 5.
8. Satku K, Kumar VP. Surgical management of non
union of neglected fractures of the patella. Injury.
1991;22(2):108 10.
9. Garg P, Sahoo S, Satyakam K, Biswas D, Garg A,
Mitra S. Patellar nonunions: Comparison of various
surgical methods of treatment. Indian J Orthop.
10. Bhimani R, Singh P, Bhimani F. Double-Tension
Wire Management of Nonunion Patella with Severe
Quadriceps Contracture. Case reports in orthopedics.
11. Sutton S Jr, Thompson C, Lipke J, Kettelkamp D. The
effect of patellectomy on knee function. J Bone Joint
Surg Am. 1976;58(4):537 40.
12. Lennox IA, Cobb AG, Knowles J, Bentley G. Knee
function after patellectomy a 12 to 48 year follow up.
J Bone Joint Surg Br. 1994;76(3):485 7.
Volume 9, Issue 5
September and October 2021
Pages 554-558
  • Receive Date: 20 June 2020
  • Revise Date: 30 November 2020
  • Accept Date: 02 December 2020