[Operative treatment of fractures of the patella (author's transl)]

Relative incongruance and great pressure in the femoro-patella joint are, besides the primary traumatic damage of the cartilage, responsible for frequent posttraumatic arthrosis and posttraumatic chondropathy of the patella after patellafracture. An operative reconstruction with a smooth joint surface of the patella is necessary. The only reliable method to fulfil these demands is the tension wire osteosynthesis by Pauwels, which, according to the type of fracture, can be combined with Kirschner wires and small fragment screws. The best access to the patella is established by diagonal incision. Open fractures must and closed fractures should be operated immediately. In comminuted fractures with devitalised cartilagefragments there is no indication to preserve the patella. Primary patellectomy has better results as late patellectomy. According to stability the after-treatment requires 4 to 6 weeks rest in a plaster cast. Although the operation can be performed with technical skill, arthrosis and chondropathy of the patella cannot always be avoided.