Neglected patella non-unions are rare. Contraction of the quadriceps makes late repair extremely difficult. A case of distal patella pole fracture neglected for 8 years is presented. The patient was a hemiplegic young female unable to walk due to extensor mechanism deficiency with a 10 cm retraction of the patella proximal pole at her neurologically intact side. The quadriceps was lengthened using a spanning unilateral external fixation system and the fragments successfully united after trans-osseous suture repair. At 4-year follow-up the patient was independently ambulating without symptoms with a functional knee range of motion.
Level of evidence IV.
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Elattar O, Coleman SH, Warren RF, Rozbruch SR (2016) Neglected patellar tendon rupture with massive proximal patellar migration treated with patellar transport and staged allograft reconstruction: a report of 2 cases. Orthop J Sport Med 4(11):1–9
Garg P, Satyakam K, Garg A, Sahoo S, Biswas D, Mitra S (2012) Patellar nonunions: comparison of various surgical methods of treatment. Indian J Orthop 46(3):304–311
Isiklar ZU, Varner KE, Lindsey RW, Bocell JR, Lintner DM (1996) Late reconstruction of patellar ligament ruptures using Ilizarov external fixation. Clin Orthop Relat Res 322(:174–178
Nathan ST, Fisher BE, Roberts CS, Giannoudis PV (2011) The management of nonunion and delayed union of patella fractures: a systematic review of the literature. Int Orthop 35:791–795
Simpson a H, Williams PE, Kyberd P, Goldspink G, Kenwright J (1995) The response of muscle to leg lengthening. J Bone Jt Surg Br 77:630–636
Siwek CW, Rao JP (1981) Ruptures of the extensor mechanism of the knee joint. J Bone Jt Surg Am 63:932–937
Uvaraj NR, Mayil Vahanan N, Sivaseelam A, Mohd Sameer M, Basha IM (2007) Surgical management of neglected fractures of the patella. Injury 38(8):979–983
Yoon J-R, Kim T-S, Lee S-R, Yang J-H (2011) Patella tendon rupture neglected for 55 years. J Orthop Sci 16(5):656–660
Conflict of interest
The authors declare that they have no conflict of interest.
The authors received no financial support for the research, authorship, and/or publication of this article.
Patient written consent and ethical approval by 251 Hellenic Air Force Hospital were granded for this paper.
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Paxinos, O., Karamitros, A., Douras, P. et al. Neglected patella nonunion successfully treated after 8 years by quadriceps distractive lengthening with a spanning unilateral external fixation system. Knee Surg Sports Traumatol Arthrosc 26, 2784–2787 (2018). https://doi.org/10.1007/s00167-017-4738-9