title: Outcomes after operative fixation of complete articular patellar fractures: assessment of functional impairment.
abstract: BACKGROUND
  Patellar fractures are debilitating injuries that compromise the knee extensor mechanism and are frequently associated with poor outcomes. The purpose of this study was to quantify the functional outcomes of operative treatment of patellar fractures.
  
  
  METHODS
  Functional outcome data on thirty patients with an isolated unilateral patellar fracture were prospectively obtained at three, six, and twelve months postoperatively.
  
  
  RESULTS
  All fractures healed. There were two complications (7%) related to the surgery (wound dehiscence and refracture), and eleven patients (37%) underwent removal of symptomatic implants. The tibial plateau-patella angle demonstrated patella baja in seventeen (57%) of the patients. Anterior knee pain during activities of daily living was experienced by twenty-four (80%) of the patients. Clinical improvement occurred over the first six months. However, functional impairment persisted at twelve months, with objective testing demonstrating that the knee extensor mechanism on the injured side had deficits in strength (-41%), power (-47%), and endurance (-34%) as compared with the uninjured side.
  
  
  CONCLUSIONS
  Despite advances in surgical protocols and acceptable radiographic outcomes, functional impairment remains common after treatment of patellar fractures. Rehabilitation strategies following surgical stabilization of these injuries will be a fruitful area for future clinical research.
authors.affiliation: Orthopedic Trauma Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. lionellazaro@gmail.com
authors.forename: Lionel E
authors.initials: LE
authors.lastname: Lazaro
authors.forename: David S
authors.initials: DS
authors.lastname: Wellman
authors.forename: Gina
authors.initials: G
authors.lastname: Sauro
authors.forename: Nadine C
authors.initials: NC
authors.lastname: Pardee
authors.forename: Marschall B
authors.initials: MB
authors.lastname: Berkes
authors.forename: Milton T M
authors.initials: MT
authors.lastname: Little
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Nguyen
authors.forename: David L
authors.initials: DL
authors.lastname: Helfet
authors.forename: Dean G
authors.initials: DG
authors.lastname: Lorich
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007718:Knee Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D007719:Knee Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009119:Muscle Contraction / Q000502:physiology; D053580:Muscle Strength / Q000502:physiology; D010329:Patella / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D010808:Physical Examination; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D016896:Treatment Outcome