Purpose <p>Patella fractures are common and may result in significant morbidity. Open patellar fractures are less common, and there are few investigations into their outcomes and complications. This study aimed to determine acute outcomes after operative treatment of open versus closed patella fractures.</p> Methods <p>This study was a retrospective cohort study from a single academic Level One tertiary trauma center. Patients who underwent open reduction internal fixation of open and closed patella fractures with a minimum of 6&#xa0;months of follow-up from 2013 to 2018 were included. Those who underwent patellectomy or nonoperative treatment were excluded. The main outcome measures assessed for reoperation rates and clinical complications.</p> Results <p>Forty-six patella fractures treated with operative fixation were included. Of them, 25 were open and 21 were closed fractures. The reoperation rate was significantly higher in the open group compared to the closed group, 43% versus 8%, respectively. Knee manipulation for was also significantly more common in the open group at 24% compared to zero in the closed group. On multivariate analysis, compared to closed injuries, open patella fractures were associated with all-cause reoperation (odds ratio 5.2, 95% confidence interval 1.2–34.5, <i>p</i> = 0.048). Patients in the open group also had significantly increased rates of a high-energy mechanism of injury. Nonunion, malunion, and surgical site infection were not statistically different between the groups.</p> Conclusion <p>Reoperation rates are significantly higher in open patella fractures compared to closed fractures. The increased reoperation rate was mainly driven by the need for manipulation under anesthesia.</p>