Overview
The patella is the kneecap — a sesamoid bone embedded in the quadriceps and patellar tendons. A displaced patella fracture disconnects the mechanism that straightens the knee, which makes it impossible to actively extend the leg against gravity.
Operative fixation is indicated for displaced fractures, any fracture with loss of active extension, and most comminuted patterns. Non-displaced fractures with an intact extensor mechanism can usually be treated in a brace.
Why it's done
Patella ORIF is typically considered when imaging and the clinical picture together indicate that the fracture will not reliably heal or function without surgical stabilization. Common indications include:
Loss of active knee extension
The key clinical indication for surgery.
Displacement greater than about 3 mm
Displacement continues under quadriceps pull.
Articular step-off
The back of the patella is a joint surface.
Open fracture
Urgent debridement and fixation.
How it works
Simple transverse fractures are typically fixed with two cannulated screws and a figure-of-eight suture or wire tension band. This converts the pull of the quadriceps into compression across the fracture.
Comminuted fractures are fixed with a combination of screws, plates, and cerclage constructs through an anterior midline incision. The goal is a congruent articular surface on the back of the patella.
Recovery
The knee is protected in a brace locked in extension for walking during early recovery. Toe-touch or protected weight-bearing is used initially. Passive and active-assisted knee flexion begins early to prevent stiffness. Active extension against resistance is delayed until the fracture is healed. Full recovery is gradual, with milestones your surgeon will discuss at follow-up. Hardware irritation is common and removal is sometimes needed later.
Contact
For questions about this procedure or to schedule an evaluation, call the office at (830) 625-0009 or request an appointment online.
Weight-Bearing After Repair
Controlled load is part of how bone heals. Once the fracture is stabilized with hardware, gentle weight through the limb stimulates the biology that builds callus and remodels bone — completely offloading a fixed fracture for too long can actually slow healing and stiffen the joint above and below. Full body weight right away, however, can overload the construct before bone has caught up. The right answer sits in between: a partial weight-bearing progression decided by your surgeon based on your fracture pattern, the strength of the fixation, your bone quality, and how the repair looks on post-op imaging. We tell you exactly how much weight the limb can take, when to advance, and what to watch for.
Risks & Why We Still Recommend It
Every operation carries risk. The reason we offer this procedure is that the condition, left untreated, causes an extensor mechanism that cannot actively straighten the knee — walking, stairs, and standing all depend on it. That is the trade we are managing — not eliminating risk, but choosing the smaller of two unfavorable trajectories.
The risks we discuss with patients before patella orif include:
- bleeding and infection
- anesthesia risk
- stiffness
- hardware irritation (kneeling is often symptomatic until the hardware is removed)
- non-union
- post-traumatic patellofemoral arthritis
- blood clot (DVT/PE)
The indication to proceed is a displaced patella fracture with loss of active knee extension. Patients who don't need this operation don't get it.
Further Reading
External patient-education references and related OSI pages for additional background: