Surgery of patellar fractures using a medial parapatellar approach

Abstract

Purpose: The general surgical approach for patellar fractures has a significant weakness, in that the articular facet is invisible because the fixation is performed using radiation amplifiers after exposing the fracture site through vertical or transverse dissection on the anterior patella. We report excellent outcomes in the surgical treatment of patellar fractures, using a medial parapatellar approach. Methods: This study evaluated 20 patients who underwent surgery between August 2008 and April 2014 to correct patellar fractures with comminution or with displacement of the articular facet of ≥2 mm and who had ≥1 year of follow-up. Surgery was performed using anatomical reduction with direct exposure of the articular facet of the patella via a medial parapatellar approach. Bone union, severity of displacement, range of motion (ROM) of the patella, and complications were evaluated after surgery, and patellar function was evaluated using the Lysholm knee score. Results: Bone union was achieved in all cases, and average displacement of the articular facet decreased from 3.2 mm (range: 1.2–7.3 mm) preoperatively to 0.2 mm (range: 0–0.5 mm) postoperatively. No particular postsurgical complication was observed. All cases had a normal ROM, and the average Lysholm score at final follow-up was 96.2 points. Conclusion: Anatomical fixation of the articular facet via a medial parapatellar approach appears to be suitable for patellar fractures, which are intra-articular.