الفهرس 
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Abstract
SUMMARY
T
he patella is the largest sesamoid bone in the human body and is located anterior to knee joint within the tendon of the quadriceps femoris muscle, providing an attachment point for both the quadriceps tendon and the patellar ligament. The patella improves quadriceps efficiency by increasing the moment arm of the patellar ligament by acting as a fulcrum to increase the moment arm of the extensor mechanism of the knee.
Patellar fractures are infrequent, with an annual incidence of approximately 1.2 per 100,000. Patellar fractures represent 2% of all skeletal injuries in both adults and children.
Evaluation of a patient with knee pain begins with a detailed history and physical examination. History of a direct blow to the knee or eccentric loading should raise suspicion for patellar fracture or other extensor mechanism injury. Associated injuries remain rare but must be actively looked for in certain traumas.
Patellar fractures may be displaced or undisplaced. Undisplaced fractures are usually managed by immobilizing the limb in a cylindrical cast. Classifications of patellar fractures according to the AO: Extra Articular, Partial Articular and Complete Articular.
The surgical management of patellar fractures has evolved over the years necessitated by the need for stable fixation to allow early mobilization and aggressive rehabilitation to preserve the range of knee motion in the young physically active age group; from simple cerclage wiring to tension band wiring in 1950s which was further modified to increase its strength by adding K-wires to the construct, cancellous screws have also been used in the management of patellar fractures with high failure rates compared to modified tension band wiring. The surgical management of patellar fractures is constantly evolving, with the latest additions being cable pin system, mini-screw fragment fixation system and fixed angle plate fixation for various patellar fracture configurations.
By comparison between types of fixation among post-operative complications (loss of knee motion, loss of reduction, delayed or non-union and pain during movement) there was no statistically significant difference between types of fixation, but by comparison between types of fixation among post-operative complications (Hardware removal and infection) there was statistically significant increase hardware removal and infection in modified tension band wiring method.
Cannulated screws with tension band has a better functional and radiological outcomes, a better curative effect, low incidence of complications, early start of postoperative functional exercise and higher quality of life. from a biomechanical point of view; screw tension band has higher load-carrying capacity, rigidity and can absorb higher energy.
Modified tension band wiring considered - for now - the traditional and most widely accepted method for transverse patellar fractures, however; it has certain distinct disadvantages.