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Patella Fracture
Aka: Patella Fracture, Patellar Fracture
- Epidemiology
- Rare in children
- Mechanism
- Direct blow to anterior knee
- Types
- Stellate Fracture
- Direct blow to Patella
- Sleeve Fracture
- Distal Patella Fracture due to quadriceps Muscle Contraction against a fixed lower leg
- Signs
- Tenderness, swelling, Ecchymosis overlying the Patella
- Imaging
- Knee XRay (esp. lateral Knee XRay and sunrise view)
- Differential Diagnosis
- Bipartite Patella
- Consider Bilateal Knee XRay (expect both Patellas to be bipartite)
- Management: Surgical versus non-surgical management
- Surgical indications
- Fracture step-off of >2 mm on articular surface
- Fracture separation of >3 mm
- Associated with Retinacular disruption and active knee extension loss
- Non-surgical Indications
- Non-displaced Patella Fracture with intact articular surface
- Active knee extension against gravity intact
- Minimal Patella Fracture fragment displacement
- Articular surface with minimal involvement
- Management
- Acute management (for first week)
- Knee Immobilizer (knee in full extension)
- Non-weight bearing
- Ice and elevation
- Non-surgical management
- Week 1
- Start immobilization for 4-6 weeks
- Cylinder cast from groin to above ankle (with knee in full extension) OR
- Knee Immobilizer brace worn at all times except bathing (in highly compliant patients)
- Weight bearing
- Straight leg Exercises
- Week 2
- Repeat Knee XRay and confirm Fracture stable without displacement
- Continue knee immobilization
- Weeks 4-6
- Repeat Knee XRay and exam
- Continue knee immobilization until XRay demonstrates radiographic union
- Weeks 6-10
- Physical therapy for knee range of motion and quadriceps strengthening
- Repeat exam every 3-4 weeks until fully healed (typically 8-10 weeks from start of immobilization)
- Complications
- Inability to extend knee
- Disrupted knee extension mechanism (Patellar tendon)
- Premature Knee Osteoarthritis
- Related to articular surface defects
- References
- Eiff (1998) Fracture Management for Primary Care, W.B. Saunders, p. 179-83
- Spangler and Tollefson (2014) in Herbert 14(6): 9-11