In longitudinal fractures, screw fixation is the method of choice either by cannulated or normal 4.0 cancellous screws. Reduction is maintained by a reduction forceps. The screws can often be inserted percutaneously.

In lower pole fractures, in addition to transosseous sutures, a patellotibial cerclage is necessary, which is passed through the tibial tuberosity or through the whole of a cannulated screw or around a 3.5 mm screw.

Whenever possible, patellectomy should be avoided to keep the lever arm intact. In case of a severe comminution in the middle of the patella, an osteotomy can be performed and the two remaining fragments can be fixed under shortening by screws and cerclage wires. If this is not possible, patellectomy has to be performed, leaving as much as possible of the extensor apparatus and suturing it directly together.

Early motion by continuous passive motion (CPM) is helpful and should be started very early, with up to 90° of flexion. Weightbearing up to 20 kg for 4–6 weeks is allowed. In patellectomy and partial patellectomy, flexion should be limited to 60° with additional support provided by a brace.