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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. Suggestions/queries @ [email protected] 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 Suggestions/queries @ [email protected] 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 # Suggestions/queries @ [email protected] 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 Suggestions/queries @ [email protected] 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 Suggestions/queries @ [email protected] Total patellectomy