Stellate Patella Fracture Case

Patella fractures are a common injury caused by excessive tension through the extensor mechanism or a direct trauma to the anterior knee. The patella is a vital sesamoid bone that articulates with the femoral trochlea and increases the leverage and efficiency of the extensor mechanism. The following case report is of a 27-year-old male involved in a high energy MVA who sustained a comminuted and displaced patella fracture. The patient was treated with an open reduction and internal fixation with the use of a mesh plate and mini-fragment screws. Fracture exposure was done through an extensile incision with a tibial tubercle osteotomy to facilitate joint visualization. An anatomic reduction and rigid fixation were achieved to allow for early ROM and rehabilitation. In this chapter, the author and commentators review some of the basic principles of patella fractures including injury evaluation and X-rays. They will then cover and give opinions regarding some of the controversies and options in dealing with complex fracture patterns. These include the options for exposure, methods of fixation including tension-band wiring and plating techniques, and also discussing the option of patellectomy. Finally, an appropriate post-operative regimen will be reviewed. Stellate patella fractures are difficult and complex injuries but reliable and reproducible outcomes can be achieved with a thorough understanding of the injury and a thoughtful approach to exposure and fixation.