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Scientific Articles   |    
Outcomes After Operative Fixation of Complete Articular Patellar Fractures: Assessment of Functional Impairment
Lionel E. Lazaro, MD1; David S. Wellman, MD1; Gina Sauro, PT, DPT2; Nadine C. Pardee, BS1; Marschall B. Berkes, MD1; Milton T.M. Little, MD1; Joseph T. Nguyen, MPH1; David L. Helfet, MD1; Dean G. Lorich, MD1
1 Orthopedic Trauma Service (L.E.L., D.S.W., N.C.P., M.B.B., M.T.M.L., D.L.H., and D.G.L.) and Departments of Epidemiology and Biostatistics Core (J.T.N.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for L.E. Lazaro: lionellazaro@gmail.com
2 New York Presbyterian Hospital, 525 East 68th Street, Box 142, New York, NY 10065
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Investigation performed at the Hospital for Special Surgery and New York Presbyterian Hospital, New York, NY



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always+ provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jul 17;95(14):e96 1-8. doi: 10.2106/JBJS.L.00012
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Abstract

Background: 

Patellar fractures are debilitating injuries that compromise the knee extensor mechanism and are frequently associated with poor outcomes. The purpose of this study was to quantify the functional outcomes of operative treatment of patellar fractures.

Methods: 

Functional outcome data on thirty patients with an isolated unilateral patellar fracture were prospectively obtained at three, six, and twelve months postoperatively.

Results: 

All fractures healed. There were two complications (7%) related to the surgery (wound dehiscence and refracture), and eleven patients (37%) underwent removal of symptomatic implants. The tibial plateau-patella angle demonstrated patella baja in seventeen (57%) of the patients. Anterior knee pain during activities of daily living was experienced by twenty-four (80%) of the patients. Clinical improvement occurred over the first six months. However, functional impairment persisted at twelve months, with objective testing demonstrating that the knee extensor mechanism on the injured side had deficits in strength (−41%), power (−47%), and endurance (−34%) as compared with the uninjured side.

Conclusions: 

Despite advances in surgical protocols and acceptable radiographic outcomes, functional impairment remains common after treatment of patellar fractures. Rehabilitation strategies following surgical stabilization of these injuries will be a fruitful area for future clinical research.

Level of Evidence: 

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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