Bracing

The patello-femoral joint is biomechanically very stressed when the knee is loaded. Any compromise of the joint surface is likely to lead to degenerative joint disease.
In patellar fractures, the condition of the patient can preclude surgery and non-operative management must be chosen. It is also chosen for undisplaced vertical fractures, non-distracted transverse fractures and multifragmentary fractures which cannot be reconstructed surgically.
A padded splint allowing full weight bearing is used for 4-6 weeks with the leg in complete extension. After this, the hinged knee brace is a good option increasing knee flexion as the fracture becomes completely healed.

Presenting AP X-ray in an elderly woman with a minimally displaced transverse fracture.

Lateral X-ray at presentation showing minimally displaced transverse patellar fracture. The joint surface has no displacement, but the dorsum of the patella has about 5 mm of gapping.

6 Weeks later after extension and immobilization but full weight bearing, this non-displaced fracture is on the way to complete healing.

6 weeks lateral X-ray showing non-displaced joint surfaces after immobilization in complete extension but with full weight bearing.