Functional results after patellar fractures in elderly patients

Elderly patients tend to fracture the patella because of a simple fall. In this group of patients restoration of primary functional level is crucial. Sixty-eight patients more than 65 years of age with patellar fractures, who were treated in our institution between January 1990 and December 1999 were evaluated. There were 43 females and 25 males. The ages ranged from 65 to 88 years (17 patients >80). We focus on the mechanism, which led to the fracture, the pre-morbid and post-morbid state of the patients and the various aspects of treatment in this group of patients. The majority (82%) had a simple fall. Half of the patients had background diseases. Forty-five patients (66%) had comminuted patellar fracture. In 58 patients (85%) the extensor mechanism was disrupted, which therefore, necessitated an operation (group I). The rest, ten patients, were treated conservatively (group II). Follow-up time ranged between 0.5 and 10.5 years (mean 4.5 years). Minor complications were noted in five patients. Sixty patients (88%) had intact extensor mechanism, while five patients in group I (9%) and three in group II (30%) had extension-lag of 10-30° (P<0.05). None of the patients had non-union, cosmetic disturbances or developed osteoarthritis. Fifty-six patients (82%) (41 patients in group I and five in group II, P<0.05) achieved the same independence mobility status post-fracture. In elderly patients the cause of the fracture is a direct blow by simple fall to the patella causing comminuted fractures; however, with these patients excellent or good results were eventually achieved. Surgical treatment yielded better results than non-surgical.