Patellofemoral fractures are a common type of injury, accounting for approximately 1% of all fractures in the body, 30% of which require surgical treatment, with a good prognosis based on accurate repositioning and stable fixation. The tension band technique is still a widely accepted treatment modality, and early fixation failure rates of approximately 22-30% have been reported, with one potential factor contributing to failure being inaccurate determination of fracture type. Currently, most staging of patellar fractures relies on radiographic plain films and in turn has limitations in guiding treatment and predicting prognosis. Lionel E. Lazaro and others from the United States studied the staging of patellar fractures by combining plain radiographs with CT, and the results were published in the June issue of JOrthopTrauma. The study reviewed 41 patients who underwent surgery at the unit from 2006 to 2009 for indications of superior or inferior pole displacement of more than 5 mm of the patella or a stepped sign of more than 3 mm of the articular surface. All patients underwent preoperative plain radiographs and CT examinations. 4 orthopaedic trauma surgeons with more than 5 years of clinical practice evaluated all imaging data in two stages: 1. plain radiographs alone; 2. plain radiographs and CT were read 4-6 weeks later, and the fracture staging and treatment plan were requested after the review. fracture staging was performed as shown in Figure 1, and this staging plan included 14 subtypes; the observer The observer was also asked to propose a treatment plan, which was differentiated by another author who was not involved in the imaging evaluation, with the following criteria: 0=no surgery required; 1=incisional internal fixation; 2=incisional internal fixation + patellar tendon repair/strengthening; 3=patellar tendon repair/strengthening; 4=partial or total patellar resection. The influential assessor was not aware of the differentiation criteria for treatment options, and the change was considered significant if the assessor changed the treatment option after reading the CT. 12 months later, the above assessment process was repeated. The results of this study showed that the determination of the treatment plan and the OTA/AO staging were both reliable and reproducible on film alone and with additional CT information; 66% of the staging and 49% of the treatment plans were modified after reference to CT information. This type of fracture is seen in 88% of the injured patients, while about 44% of them do not show up on plain films and, moreover, this type of fracture has no corresponding description in the OTA/AO system. Table 1 Changes in the assessment of treatment options after plain radiographs and additional CT information The authors of this article concluded that CT information helps to describe patellar fractures more accurately and that a careful observation of the lower pole fracture is the basis for the selection of treatment options, therefore, the authors suggested that a staging of patellar fractures based on CT examination should be established. Figure 2A plain film showing transverse patellar fracture (anterior-posterior, oblique, lateral) B CT scan of the same patient suggesting loss of position to observe the comminuted fracture of the lower pole of the patella; the existing AO/OTA staging system does not accurately describe the fracture in this case Figure 3 A 55-year-old female with a fall and left knee landing with a comminuted fracture of the left patella (AO/OTA staging 34-C3.2); CT scan was performed to further clarify the fracture A anteroposterior and lateral views; B axial, coronal, and loss-of-focus CT scan images all suggest a comminuted fracture Figure 4 A 69-year-old female with a fall resulting in a comminuted fracture of the left patella (AO/OTA fraction 34-C3.2). The plain film suggested a complex comminuted fracture with articular surface involvement (A). An incision and reduction of the tension band wire and ring tie wire internal fixation was performed (B). Twelve days after surgery, the patient came back to the clinic with imaging data suggesting loosening of fixation and displacement of the lower pole bone mass (C), and he underwent revision surgery with intraoperative repair and strengthening of the patellar ligament (D), and the postoperative film showed satisfactory repositioning and reliable internal fixation.