Patellar fracture is a common type of fracture that has a very important role to play. Patellar fractures that are unstable and fail to operate in a timely manner have the potential for future lameness. Patella fracture that is unstable needs to be operated as soon as possible. Oriental Hospital Orthopaedics Department uses the latest titanium tour fixation technology, is many patients to achieve anatomical repositioning and restore movement.
Patella fracture The patella is the largest seed bone in the body and a component of the knee joint. After removal of the patella, the quadriceps force can be reduced during knee extension activities, therefore, the patella can play a role in protecting the knee joint, enhancing the quadriceps muscle strength and straightening the knee joint slide. In the treatment, we should try to make the back of the patella a complete articular surface, and its inner and outer sides form the articular surface in front of the femoral inner and outer condyles respectively to restore flatness and reduce the occurrence of patellofemoral arthritis.
Diagnosis】 History of obvious trauma, pain in the affected limb, limited movement. Х radiographs can determine the fracture site and displacement.
Treatment measures】 For fresh patellar fracture, the treatment should restore the smoothness of the joint surface to the maximum extent, give a stronger internal fixation, move the knee joint early, and prevent the occurrence of traumatic arthritis.
（This method is suitable for non-displaced patellar fractures, which do not require manual repositioning, extraction of intra-articular blood, bandaging, and fixation of the affected limb in the extension position for 3-4 weeks with a long-legged cast or tube. Practice quadriceps contraction during cast immobilization and knee extension and flexion after removal of the cast.
（The internal fixation method of patellar fracture is various and can be divided into two categories: one category requires external fixation for a certain period of time after internal fixation; the other category has stronger internal fixation and does not require external fixation.
(1) Indications a transverse patellar fracture; b comminuted patella fracture that can be repositioned.
(2) Surgical method A transverse arc incision is made in front of the patella to reveal the fracture line, and the fracture end is fixed with two 1.5mm diameter Kirschner pins by retrograde penetration from the distal fracture surface. The other pin was fixed in the same way.
(3) Postoperative management No external fixation is needed, and the quadriceps muscle contraction is practiced on the second day after surgery.
(1) Resection of small bones or fracture fragments, attachment of the patellar ligament to the superior patella, or attachment of the quadriceps muscle to the inferior patellar fracture.
(2) Postoperative treatment: Dressing with a large amount of dressing, immobilization of the long-leg cast in the straight position for 3 weeks, and practice of joint movement without weight-bearing after removal of the cast. After 6 weeks, walk gradually with the aid of crutches, and strengthen the joint mobility and quadriceps muscle strength exercise. This method can preserve the role of the patella, heal quickly, and restore the function of the quadriceps, without fracture healing and joint surface unsmoothness.
3.Total patellar resection is suitable for severe comminuted fractures that cannot be repositioned and partially resected. When removing the comminuted fracture, the periosteum and the tendon membrane of the quadriceps muscle should be protected as much as possible. After excision, the torn dilated part and joint capsule are sutured to restore them to normal tightness. Then, the quadriceps tendon is pulled down and sutured to the patellar tendon. If direct suturing is not possible, the quadriceps tendon can be reverted and sutured. A “V” shaped incision is made on the quadriceps tendon and the cut tendon flap is turned down to repair the newly formed defect after removal of the patella. The tendon flap of the lateral femoral and quadriceps tendons can also be turned downward to repair the defect at the patella. Postoperatively, the knee was immobilized in a cast for 4 weeks and knee extension and flexion were practiced.