Treatment of Certain Fractures of the Patella
In the literature sufficient attention has not been given to a special type of treatment of transverse and comminuted fractures of the patella in which one large fragment is intact and there are one or more smaller fragments. The only discussion of this subject, to my knowledge, has been that by Thomson at the meeting of the American Medical Association in June, 1934. Much has been written about the importance of insertion of sutures of kangaroo tendon or of fascia to prevent not only the horizontal separation of the fragments, but to prevent also any tilting of one fragment on the other. Practically nothing has been said about the removal of the smaller fragments and the substitution of tendinous and fascial repair for bony union. I have used this procedure for a number of years with such extremely satisfactory results including the elimination of many of the difficulties ordinarily associated with this type of fracture that I feel that a reference to this procedure is warranted at this time.
The keynote of the treatment of injury of the extensor apparatus of the knee is the restoration of the extensor power without impairment of flexion. The patella is simply a sesamoid bone lying at the point of the tendinous insertion of the great extensor muscle of the thigh (the quadriceps). The significance of a fractured patella depends largely on the loss of the continuity of the tendon; and the success or failure of treatment depends on the restoration of the function. . .