Patellar Fracture Non-Union with Patella Baja Treated with Repeat Open Reduction Internal fixation and Tibial Tubercle Osteotomy: A Case Report

The following case explores a possible treatment modality for instances of patellar non-union with patellar Baja after fracture. The incidence of patellar non-union is rare, and review of treatment possibilities is limited to a few case series. In this case, a 59-year-old male presents with anterior knee pain and a dysfunctional extensor mechanism. It was found that the patient had patellar non-union after a failed patellar fracture reconstruction four years prior to presentation. The pain was restricting his mobility and reducing his ability to carry out his activities of daily living, and he was seeking definitive treatment. After careful consideration, it was decided a tibial tubercle osteotomy and lift was necessary to ascend the patella Baja, and the patella would be approximated and fixed with k-wire. The procedure was successful and one year later the patient returned for hardware removal. The patient healed well and had regained function in his extensor mechanism. The patient was lost to follow up and did not complete physical therapy. Three years later the patient had returned for checkup and reports significant reduction in pain but is still having difficulty with extension. The patient was found to have atrophied quadriceps muscles in the affected leg leading to weakness and suboptimal knee extension. Though the original reconstruction model had merit, the tibial tubercle osteotomy was elevated slightly too far leading to hyperflexion in the knee and a weak extensor mechanism. This case report serves to review the causation of the patient's outcome and the possible merit in the procedure to treat patellar non-union with Baja. By reviewing cases like these the literature base is increased to help guide clinical decision making in similar situations.