A 40-year-old man sustains a transverse patellar fracture after direct trauma. Radiographs show separation of the fragments by 4 mm with a palpable gap in the extensor mechanism and inability to perform a straight leg raise. The most appropriate management is:
- A Cylinder cast immobilisation for 6 weeks
- B Open reduction and internal fixation with tension band wiring ✓
- C Partial Patellectomy
- D Total patellectomy
Correct answer: B. Open reduction and internal fixation with tension band wiring
Explanation
Displacement greater than 3 mm or disruption of the extensor mechanism with loss of active extension is the accepted indication for operative fixation of a patellar fracture. Tension band wiring with Kirschner wires converts the distracting quadriceps force into compression at the fracture site during knee flexion. Conservative treatment is reserved for undisplaced fractures with an intact extensor mechanism, and patellectomy is limited to severely comminuted non-reconstructible fractures.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.