[Change in the treatment of patellar fractures].

BACKGROUND: Fractures of the patella can lead to substantial functional impairments due to its crucial function in the extensor mechanism of the knee joint. Patellar fractures are associated with a comparatively high complication rate depending on the osteosynthesis procedure used. Despite established diagnostics and various osteosynthesis procedures they are still a therapeutic challenge.
OBJECTIVE: This article gives an overview of the change in the treatment of patellar fractures and highlights the importance of comprehensive diagnostics and fracture-adapted treatment, especially for the increasing fractures in old age.
MATERIAL AND METHODS: Evaluation of the current literature, discussion of biomechanical and clinical studies and expert recommendations (guidelines)
RESULTS: Tension band wiring is still the most commonly used procedure; however, it is associated with a high rate of implant-related complications and failure rates. In particular, multifragmented comminuted fractures can often not be adequately treated by tension band wiring. Anterior locking plates seem to be biomechanically and clinically superior.
CONCLUSION: For a good functional result after a patellar fracture, the fracture morphology must be completely understood and the optimal choice of the osteosynthesis method is crucial. Distal (or proximal) pole fractures and the increasing number of osteoporotic fractures of old patients due to the demographic change, remain a therapeutic challenge and require special consideration in the selection of the osteosynthesis procedure.