Treatment

Treatment is dependent on the type of fracture. In general:

• large displaced fragments should be perfectly reduced and fixed in position - usually by open operation
  
  
• large depressed fragments may be elevated back into position by pushing upwards from below, with the residual osteoarticular cavity packed with a cancellous bone graft - either from the femoral condyles or the iliac crest
  
  
• comminuted fractures with slight depression in the plateau, comminuted fractures in elderly or unfit patients, and complex fractures, are usually managed conservatively - the fracture is reduced closed, and after the joint has been aspirated, held by skeletal traction. The patient is mobilised early - either with active exercises or initially, through a Continuous Passive Motion - CPM - machine