Knee
Patella Fracture
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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
Patella
s 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
Retina
cular 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
Exercise
s
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 (
Patella
r 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
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