Functional and Cosmetic Outcome in Vertical Midline versus Horizontal Curvilinear Patella-Centered Incision in Internal Fixation of Patellar Fractures.

Introduction: Patellar fractures require internal fixation via a skin incision that must balance intraoperative exposure with cosmetic outcome. Vertical midline and horizontal curvilinear patella-centered incisions are both used, but comparative evidence on their functional and cosmetic outcomes remains limited. Materials and Methods: A prospective, randomized comparative study was conducted on 60 patients undergoing internal fixation of patellar fractures, allocated equally to vertical midline (n = 30) or horizontal curvilinear (n = 30) incision groups by serial-number randomization. Patients were followed at 3, 6, 12, and 24 weeks, with functional outcome assessed by Oxford Knee Score, knee flexion, extension lag, and kneeling ability/comfort, and cosmetic outcome assessed by scar width, length, tenderness, pigmentation, and scar type. Data were analyzed using independent t-test and Chi-square test, with P < 0.05 considered significant. Results: Baseline characteristics, intraoperative parameters, radiological union time, and complication rates were comparable between groups (P > 0.05). The vertical group showed transiently greater knee flexion at 6 weeks (P = 0.004), which equalized by 12-24 weeks. The horizontal group demonstrated significantly better outcomes at 24 weeks, including narrower and shorter scars, less tenderness, higher Oxford Knee Score (43.20 ± 2.46 vs. 36.13 ± 3.62; P < 0.001), and superior kneeling duration and comfort (P < 0.05). Normal scar healing at 24 weeks was more frequent with horizontal incision (80.0% vs. 46.7%), though not statistically significant (P = 0.124). Conclusion: Horizontal curvilinear incision achieves functional recovery at least equivalent to, and cosmetic outcome superior to, vertical midline incision in patellar fracture fixation, without compromising surgical feasibility or safety.