Download Fracture Patella - Dr Vivek Pandey

Anatomy Function
Injury classification
Clinical freature
Investigation
Treatment &
complication
Fracture
Patella
[Document subtitle]
Vivek Pandey
Fracture Patella
Anatomy:
 Two surfaces: articular, non-articular
 Articular side has seven facets and covered by thickest cartilage
Function:
 The most important function of patella is to increase the lever
arm of quadriceps facilitating the quadriceps action and
lowering its energy demand to extend the knee
Knee with preserved patella
Post-Patellectomy knee
 Other functions are
- Provides shape to the knee
- Protects femoral condyles
Mechanism of injury
1. Direct trauma to the knee
2. Indirect trauma: violent contractions of quadriceps which is
trying to prevent vertical free fall of body.
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It is important to differentiate between direct and indirect injuries
because there is no patellar retinacular tear in direct injuries
(stellate/comminuted #s) whereas retinacula is torn in all indirect
injuries (Transverse/polar fractures)
1. Retinacular tears contribute to extensor lag
2. Retinacular tears need repair while managing patella #
Classification:
Based upon radiological presentation
1.
2.
3.
4.
5.
Transverse
Polar: # line separating the superior/inferior pole of patella
Vertical
Stellate: Undisplaced comminuted # patella
Comminuted
All types can be Undisplaced/displaced
Transverse
Polar
Stellate
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Vertical
Comminuted
Clinical features: Symptoms
1. Pain
2. Swelling
3. Inability to walk or bear weight over the injured extremity
Sign
1. Palpable gap over patella
2. Extensor lag
3. Painful and limited movement
Investigations
1. Plain xray of knee: AP, Lateral
Skyline view is done to look for vertical # which may remain
obscure on AP & Lateral views
AP view of knee showing
comminuted patella #
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Lateral view of knee showing
Inferior pole fracture
Treatment:
It depends upon
1. Undisplaced or displaced #
2. The radiological type of fracture
1. All Undisplaced #s / Stellate # can be treated with above knee
cylindrical cast for 6 weeks
Followed by
a) knee mobilisation and quadriceps strengthening exercises
b) gradual weight bearing
2. Displaced fractures are treated by following methods
a) Transverse #: ORIF and tension band wiring
b) Polar fracture: excision of pole (partial patellectomy) and
repair of quadriceps mechanism
c) Vertical #: ORIF by cancellous screws
d) Comminuted #: Total patellectomy & repair of quadriceps
Mechanism
Transverse #
Polar #
Vertical #
Comminuted #
ORIF &
Tension Band
wiring
Partial
patellectomy
& repair of
extensor
mechanism
ORIF and
screw
fixation
Salvageable
patella
Yes
ORIF &
Tension Band
wiring or
cerclage
wiring
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No
Total
patellectomy
& repair of
extensor
mechanism
Tension band wiring (TBW)
Inferior pole excision
(partial patellectomy)
Complications of patella fracture
1. Knee stiffness
2. Extensor lag
3. Patellofemoral osteoarthritis
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Total patellectomy