“Is articular cartilage reconstruction feasible in OTA-C2, C3 comminuted patellar fractures?” A prospective study of methodical reduction and fixation

BackgroundComminuted patellar fracture reduction and articular reconstruction is surgically demanding situation to deal with, as patellar articular surface is complex with two diverging facets separated by a median ridge.PurposeThe objective of this study is to evaluate functional outcome of OTA-34 C2, C3 comminuted patellar fractures treated surgically by methodical reduction and fixation.MethodsWe prospectively analyzed 12 patients of OTA-34 C2, C3 patellar fracture operated by our technique in 2 female and 10 male patients. We obtained three dimensional patellar articular facet reconstruction, by direct observation and reduction of articular surface and fixation with mini fragment screws and cerclage wire. The knee outcome survey – Activity of Daily Living Scale (ADLS) was used to assess functional outcome and follow-up X-rays were taken to assess radiological outcome of the fracture fixation.ResultsIn all cases fracture union was achieved at an average of 10.83 weeks (2.49 months). The mean age was 43.58 years, average follow-up was 27.83 months and mean knee outcome survey ADLS – 90.08%. Functional knee range of motion was achieved by the end of 12 weeks (mean ROM – 119.08°). None of the patients had any infection, avascular necrosis of patellar fragments; implant cut out or patellofemoral arthritis. Three patients with associated ipsilateral long bone fracture showed delayed return to work.ConclusionThree dimensional patellar articular reconstruction and restoration of extensor apparatus is possible in comminuted patellar fracture with good clinical outcome by accurate and meticulous surgical reduction and fixation.