Managing Complications of Patellar Fracture Hardware Removal

A simple surgical procedure is not without the risk of complications and when removing hardware from the bone, such as a previous patella fracture hardware, the surgeon must be well aware of this potential. Here we present the case of a 71-year-old male who presented for removal of retained hardware of united right patella fracture with overlying skin complications. Surgical intervention was uneventful. On post-operative day 1, the patient suffered a fall while using the restroom unassisted with a subsequent large amount of bleeding from the incision site. X-rays demonstrated a new displaced inferior pole patellar fracture. The patient returned to the operating room for debridement and repair of this new patellar fracture with primary closure. Intraoperative cultures of initial operative site were positive for Corynebacterium and Staphylococcus epidermidis. The patient was then started on intravenous Vancomycin based on culture sensitivities. The patella fixation/repair was protected with a knee immobilizer as there was increased risk of falls due to his age/underlying medical condition. This case discusses recommendations and guidelines for preventing and managing these various postoperative complications.