Patellar Fracture Management

Initial Treatment and Prevention

The American College of Rheumatology recommends initiating appropriate pain management with analgesics to facilitate early mobilization in patients with patellar fractures 1, 2, 3, 4, 5
Early physical training and muscle strengthening should begin immediately after the 4-week immobilization period 1, 2, 3, 4, 5
Long-term balance training and multidimensional fall prevention programs should be implemented 1, 2, 3, 4, 5

The American Academy of Orthopaedic Surgeons suggests providing appropriate pain management considering patient comorbidities, such as avoiding NSAIDs in patients with chronic kidney disease or cardiovascular disease 1, 2, 3, 4, 5, 6
Range-of-motion exercises should begin within the first postoperative days 6
Prolonged bed rest should be avoided as it accelerates bone loss, muscle weakness, and increases the risk of deep vein thrombosis and pressure ulcers 6

The National Osteoporosis Foundation recommends systematic osteoporosis evaluation, including DEXA scan, vitamin D level, calcium level, and parathyroid hormone level, for patients aged 50 years and over 7
FRAX analysis and BMD with vertebral fracture assessment should be performed for patients aged 40 years and over 8
Clinical fracture risk factors, including glucocorticoid use, smoking, alcohol, prior fractures, and fall history, should be assessed 8
Calcium 1000-1200 mg/day and vitamin D 800 IU/day should be prescribed for all patients to reduce non-vertebral fractures and falls 6
Oral bisphosphonates, such as alendronate or risedronate, should be considered for high/very high fracture risk patients with GFR ≥30 mL/min 6, 8
Denosumab 60 mg subcutaneously every 6 months should be considered for patients with GFR <30 mL/min or oral intolerance 6

Smoking cessation and alcohol limitation are recommended 1, 2, 3, 4, 5, 6
Weight-bearing exercise programs should be implemented to improve bone mineral density and muscle strength 6
Multidimensional fall prevention programs should be implemented to reduce fall frequency 6