Lower Limb
Patella Fracture
Non-Operative & Operative management
About Your Injury
A patella (kneecap) fracture is a break in the bone at the front of the knee. It usually results from a direct blow to the knee, such as a fall onto a hard surface or a dashboard injury in a motor vehicle accident.
Non-Operative Management
Patella fractures can often be safely and effectively managed without surgery. The decision is individualised to each patient, based on patient factors (age, comorbidities, occupation) and specific characteristics of the fracture (displacement, articular congruity, extensor mechanism integrity).
Recovery Timeline
Weeks 0–2
Hinged knee brace locked straight, weight-bearing as tolerated with crutches, swelling control.
Weeks 2–6
Repeat X-rays to confirm the fracture position is maintained; brace gradually unlocked to allow some bend as advised.
Weeks 6–8
Brace weaned once healing is confirmed; physiotherapy for quadriceps strengthening.
3–4 months
Progressive return of knee bend, strength, and normal walking pattern.
4–6 months
Return to higher-impact activity once strength has recovered.
Follow-Up Schedule
2 weeks
Clinical review and repeat X-ray to check for displacement.
6 weeks
X-ray to assess healing and progress brace settings.
3 months
Review of movement and strength, with physiotherapy progression.
Operative Management
Fractures that are displaced, or where the extensor mechanism (the tendons that let you straighten your knee) is disrupted, are treated with surgery to restore the joint surface and your ability to actively straighten the knee.
The fracture fragments are secured with tension band wiring, a technique that uses wires (and often pins or screws) to compress the fracture ends together, taking advantage of the pull of the quadriceps tendon to keep the fracture compressed as the knee moves. This procedure is performed under general anaesthetic, with local anaesthetic infiltration at the time of surgery for good pain control in the first 12–24 hours afterward, and is usually done as day surgery or with a single overnight stay.
Recovery Timeline
Weeks 0–4
Weight-bearing as tolerated throughout, in a hinged ROM brace locked to 0–20 degrees of movement.
Weeks 4–6
Brace advanced to 0–60 degrees.
Weeks 6–8
Brace advanced to 0–90 degrees.
Weeks 8–10
Brace unlocked, allowing full range of movement.
12 weeks
Final X-ray to confirm healing.
Follow-Up Schedule
2 weeks
Wound check and review of brace fit and movement.
6 weeks
X-ray to assess healing and progress brace settings.
12 weeks
Final X-ray to confirm healing.
Hardware Removal
Tension band wiring more often needs to be removed than other types of fixation, as it can become irritating under the skin over the long term. If needed, this is a day surgery procedure usually performed 6–12 months after your original operation.