Operative Management of Periprosthetic Patella Fractures: A Case Series

Purpose To evaluate clinical, radiographic, and functional outcomes following operative fixation of periprosthetic patella fractures (PPPFs), compare results across fixation methods, and assess recovery using extension lag, ambulation status, and PROMIS Physical Function scores. Methods We retrospectively reviewed 15 patients who underwent open reduction and internal fixation for PPPFs between 2018 and 2025, with a minimum of 3 months of follow-up. Data collected included demographics, fracture pattern, fixation technique, and component status. Outcomes included radiographic and clinical union, complications, reoperations, extension lag, ambulatory status, and PROMIS Physical Function score change. Fixation methods included plate and screws (n=6), tension band wiring (n=5), and cerclage constructs (n=4). Results Clinical union was achieved in 13 of 15 patients (87%) and radiographic union in 10 of 15 (67%). Five patients (33%) required reoperation, most commonly for nonunion or hardware irritation. In this small cohort, plate fixation appeared to yield favorable outcomes, though interepretation is limited by sample size. Mean PROMIS Physical Function score change was +4.2 for plate fixation, +0.2 for tension band wiring, and –3.6 for cerclage fixation. Four patients developed significant extensor lag (≥20°). Conclusions Operative fixation of PPPFs can achieve acceptable union and functional outcomes, though complication and reoperation rates remain high. Plate-based fixation may offer advantages in patients with comminution or poor bone quality. These findings support an individualized fixation strategy and rrfeasibility of surgical treatment even after distal femoral replacement. Level of Evidence: Level IV, therapeutic case series.