Neglected patella nonunion successfully treated after 8 years by quadriceps distractive lengthening with a spanning unilateral external fixation system.

Neglected patella non-unions are rare. Contraction of the quadriceps makes late repair extremely difficult. A case of distal patella pole fracture neglected for 8 years is presented. The patient was a hemiplegic young female unable to walk due to extensor mechanism deficiency with a 10 cm retraction of the patella proximal pole at her neurologically intact side. The quadriceps was lengthened using a spanning unilateral external fixation system and the fragments successfully united after trans-osseous suture repair. At 4-year follow-up the patient was independently ambulating without symptoms with a functional knee range of motion. Level of evidence IV.