Patellar fracture nonunion treated without reosteosynthesis: Case report

Area of Science:

• Orthopedic Surgery
• Traumatology
• Biomedical Engineering

Background:

• Patellar fractures are common, frequently treated with open reduction and internal fixation (ORIF).
• Nonunion is a rare but significant complication, with reported incidences ranging from 2.4% to 12.5%.
• Management of patellar nonunion typically involves surgical intervention, often including reosteosynthesis.

Observation:

• A 26-year-old male presented with a comminuted patellar fracture and subsequent nonunion despite preserved knee range of motion and extension strength.
• Persistent knee pain and imaging confirmed the nonunion, indicating a failure of the initial fixation.
• Surgical exploration revealed strong fibrous tissue bridging the fracture fragments, without significant instability of the extensor mechanism.

Findings:

• Surgical removal of existing tension band wiring and cerclage hardware was performed.
• Reosteosynthesis was deemed unnecessary due to the intact extensor mechanism and absence of gross instability.
• The patient experienced complete pain resolution and full functional recovery following hardware removal alone.

Implications:

• This case underscores the importance of individualized treatment strategies for patellar nonunion.
• Hardware removal without reosteosynthesis can be a viable and effective treatment option when the extensor mechanism is functional.
• It challenges the assumption that all patellar nonunions necessitate complex reconstructive procedures.