Full Title
A Prospective Randomized Trial of Nonoperative versus Operative Management of Patella Fractures in the Elderly

Eligibility

Inclusion Criteria:

  • Male or female patients 65 years of age or older and ambulatory prior to injury (with or without walking aids)
  • Isolated, closed, fracture of the patella displaced by 5 mm or greater (Displacement will be determined by measuring the widest displacement on any x-ray view with the knee in full extension)
  • The patient scores between 3 and 6 on the Clinical Frailty Scale
  • Bilateral patella (patient is randomized once, both patella are treated the same)
  • Within 14 days of injury, the patient is able to perform a straight leg raise with less than 30 degrees of extensor lag
  • Willing and able to sign consent (in-person or via substitute decision maker), follow the protocol and attend follow-up visits
  • Able to read and understand English (or a qualified interpreter is available)

Exclusion Criteria:

  • Associated knee injury (tibia or distal femur fractures) or other lower limb injuries that would interfere with rehabilitation or outcome
  • Neurovascular injuries at the level of the knee requiring surgery
  • Pathologic fractures
  • Periprosthetic fractures, or other knee surgery which would contra-indicate inclusion in the study (e.g. previous patella ORIF or previous surgery involving patella such as patella tendon or quads repair)
  • Medical contra-indication to surgery
  • Likely problems, in the judgment of the investigators, with maintaining follow-up (i.e. patients with no fixed address, intellectually challenged patients without adequate support, etc.)

Contact:

PI
Dr. Chad Coles

Description

This is a multi-centre, randomized controlled trial comparing operative and non operative treatment for displaced patella fractures in elderly, low-demand patients. Patients with a displaced patellar fracture who meet the inclusion criteria and provide consent will be randomized to one of the two treatment arms. One group (Group A) will receive standardized non-operative treatment with immediate weight-bearing as tolerated in a knee immobilizer and early ROM exercises begun at 2 weeks post injury. The other group (Group B) will receive ORIF of their displaced patellar fracture with a standardized post-operative protocol.

Sample size= 88