Session V - Femur

Functional Outcome of Patella Fractures following Open Reduction and Internal Fixation

Emil H. Schemitsch, MD, FRCS (C); Jordan Weinberg, BSc; Michael D. McKee, MD, FRCS (C); David J.G. Stephen, MD, FRCS (C); Hans J. Kreder, MD, FRCS (C); James P. Waddell, MD, FRCS (C), Saint Michael's Hospital, Toronto, ON, Canada

Purpose: The purpose of this study was to determine the long-term results of operatively fixed patella fractures according to generic and disease specific health status measures.

Methods: Fifty patients with operatively treated patella fractures, using tension band fixation, and a minimum follow-up of five years were reviewed. Selection criteria for surgery included a displaced patella fracture with a disrupted extensor mechanism. Aspects of care including fracture type, method of injury, concomitant injury, and secondary procedures were documented. Patients were contacted and administered the SF-36 generic health status questionnaire and the WOMAC osteoarthritis index. Scores were analyzed with respect to age at injury, fracture type, and concomitant injury; results were also compared with healthy population norms.

Results: The mean age of the patients at the time of injury was 46 years (range, 16 to 70 years) and the average follow-up period was 8 years (range, 5 to 17 years). There were 33 males and 17 females. Twenty-six patients suffered concomitant injuries. At final follow-up, statistical analysis revealed no significant difference between SF-36 scores of the sample population and healthy population norms. Patient age, fracture type, and concomitant injury had no significant influence on outcome according to both SF-36 and WOMAC scores. 60 percent of patients required hardware removal for relief of irritation/pain. Complications included one wound infection, one septic arthritis, one refracture, and one nonunion. Of patients who were working at the time of injury, 66% were able to return to the same job, 25% returned to modified work or different occupation, and 9% were unable to return to work.

Discussion/Conclusions: Good results of operatively fixed patella fractures have been reported in the literature, but lack outcome measures with proven validity. Our study confirms the efficacy of open reduction and internal fixation of patella fractures with validated outcome measures. Patients who undergo open reduction and internal fixation for patella fractures achieve long-term results equal to healthy population norms. Open reduction and internal fixation of patella fractures restores excellent limb and health status. A high percentage of patients require hardware removal following internal fixation.