Rehabilitation after knee immobilization in octogenarians with patellar fractures

Between January 1990 and December 1999, 14 octogenarians (8 women and 6 men) underwent surgery for comminuted patellar fracture. Average patient age was 83 years (range: 80-88 years). Follow-up ranged from 1-8 years (mean: 3.5 years). Ten of 14 patients were totally independent, whereas 4 patients used a cane for mobilization. Twelve patients had background diseases. Patients underwent operative treatment with tension band wires followed by cast immobilization (knee in approximately 10 degrees of flexion) for 6 weeks. Immediate full weight bearing was initiated in all patients, and intense rehabilitation was performed after cast removal to increase range of motion. Complete union was noted for all fractures. All patients but 1 had an active extension lag of 10 degrees-20 degrees before physiotherapy and maximum flexion was 70 degrees. After physiotherapy, 4 patients regained full active extension and all patients achieved >100 degrees of flexion. Twelve of 14 patients returned to their pre-injury functional level. A slight deterioration was noted in 2 patients. Although knee immobilization may cause severe limitation in range of motion, its use in elderly patients followed by intense rehabilitation is advocated and showed good results.