Patellar Fractures Must Not Be Taken Lightly: Inadequate Management of a Simple Fracture Can Lead to Failure

Case Presentation

A patient presented with a comminuted patellar fracture, classified as AO type 34-C3.3.

Initial Treatment

The initial surgical strategy, based on the degree of comminution and displacement, consisted of interfragmentary screw fixation for the transverse fracture component and additional screw fixation for the supplementary sagittal fracture fragments.

Postoperative Radiographs

Early Postoperative Course

The patient had sutures removed and was discharged 2 weeks after surgery. At that time, the knee was maintained in full extension with a brace and was allowed to bear weight. This was followed by catastrophic failure, with redisplacement of the fracture.

Cause of Failure

1. Underestimation of the coronal-plane comminution of the main distal fracture fragment. Although suture reinforcement was used intraoperatively, the primary fixation relied on vertically oriented cannulated screws. Once the distal fragment split, these screws lost their anchoring efficacy.

Revision Surgery

After reduction, a titanium mesh plate was applied to the dorsal surface for fixation. A tendon suture was passed through the patellar tendon and secured to the titanium plate to augment fixation at the inferior pole of the patella.

Postoperative Status