Patellar fracture fixation: An unreported complication occurring directly attributable to tension band fixation of the patella

Patella fractures account for 1% of all fractures but there is little in the contemporary literature regarding either an optimal standardized post-operative rehabilitation regimen or the long-term outcomes following these fractures. Tension band wire fixation for displaced patella fractures is a well-recognised and accepted method of operative treatment for these fractures. In this case the authors report a new complication, yet to be documented in the literature that was directly attributable to a well-recognised complication resulting from this method of fixation. An atypical osteochondral defect, from the lateral femoral condyle, was generated as a direct result of bony spur at the site of the previous patella fracture malunion. As the patient fell on to her knee the bony spur was driven into the femoral condyle in a similar fashion to an osteotome, generating the atypical osteochondral defect. This patient had chronic anterior knee pain following the tension band fixation of her patella. An inadequate standardised follow-up regimen failed to identify her fracture malunion that was responsible for her ongoing persistent symptoms. Only as a result of this previously unreported complication, we were able to identify and surgically address the underlying primary pathology responsible for her persistent symptoms. This case highlights the importance for the identification and establishment of a more robust imaging follow-up regimen post patella fracture fixation.