The patella is the largest sesamoid bone, embedded in the quadriceps tendon. Its posterior surface has medial and lateral articular facets (odd facet — the most medial) in contact with the trochlear groove, and its geometry determines patellofemoral contact areas. The trabecular pattern within the patella transmits quadriceps forces to the patellar tendon while resisting the compressive forces of the retropatellar cartilage.
Patellar fractures from direct impact or eccentric quadriceps contraction require ORIF for displaced fractures (>3 mm gap or >2 mm articular step) to restore the extensor mechanism. Tension band wiring converts the distraction force to a compressive force at the articular surface. Comminuted inferior pole fractures with patellar tendon avulsion require inferior pole excision with patellar tendon reattachment.
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