Rehabilitation
Irrespective of surgical or non-surgical resolution to the fracture, a physical therapist can advise on progressive weight-bearing exercises and help with strengthening muscles of the leg, improving range of motion of the knee and in reducing stiffness. Prognosis
Outcomes with treatment are generally good, unless there is involvement of the articular surface or the quadriceps mechanism. There is an increased risk of developing osteoarthritis in people who have broken their patella.There is limited evidence supporting the different surgical interventions for treating fractures of the patella in adults. There is also no evidence of trials that could evaluate the effects of surgical treatment compared with the conservative treatment or other different types of conservative interventions. Epidemiology
Patella fractures make up about 1% of all broken bones. Males are affected more often than females. Those of middle age are most often affected. 6% to 9% of patellar fractures are of the open type. An ageing population and global increase in the number of TKAs has led to an increasing number of periprosthetic fractures of which a patella fracture is one type. History
Prior to the 19th century most patella fractures were treated non-surgically with extension splinting, frequently resulting in poorly joined fragments of bone and long-term pain and disability. Incomplete understanding of the importance of the patella led to the trend of removing the whole patella, also resulting in pain, disability and dissatisfaction. The first open reduction and internal fixation for a patella fracture was performed in 1877 by Scottish surgeon Sir Hector Cameron.
Omacetaxine mepesuccinate (INN, trade names Synribo ), formerly named as homoharringtonine or HHT, is a pharmaceutical drug substance that is indicated for treatment of chronic myeloid leukemia (CML). HHT is a natural plant alkaloid derived from Cephalotaxus fortunei. HHT and related compound esters of cephalotaxine were described first in 1970, and were the subject of intensive research efforts by Chinese investigators to clarify their role as anticancer and antileukemic agents from the 1970s until the present. It was approved by the US FDA in October 2012 for the treatment of adult patients with CML with resistance and/or intolerance to two or more tyrosine kinase inhibitors (TKIs). Medical uses
Omacetaxine/homoharringtonine is indicated for use as a treatment for patients with chronic myeloid leukaemia who are resistant or intolerant of tyrosine kinase inhibitors.In June 2009, results of a long-term open label Phase II study were published, which investigated the use of omacetaxine infusions in CML patients. After twelve months of treatment, about one third of patients showed a cytogenetic response. A study in patients who had failed imatinib and who had the drug resistant T315I mutation achieved cytogenetic response in 28% of patients and hematologic response in 80% of patients, according to preliminary data.Phase I studies including a small number of patients have shown benefit in treating myelodysplastic syndrome (MDS, 25 patients) and acute myelogenous leukaemia (AML, 76 patients). Patients with solid tumors did not benefit from omacetaxine. Adverse effects
By frequency:
Very common (>10% frequency):

Common (1–10% frequency):

Seizures
Haemorrhage† Myelosuppression, including: thrombocytopenia, anaemia, neutropenia and lymphopenia, in descending order of frequency.