Patellar fracture
Updates to Article Attributes
Patella fracture is one of the common knee injuries usually post direct trauma to the patella or sudden forceful contraction of the quadriceps muscles in the context of a sports injury.
Clinical presentation
Patients present with marked swelling and pain over the patella with point tenderness and marked reduction in extension strength. Usually, there is a large joint effusion or haemarthrosis.
Pathology
There are different causes of patella fracture:
- a direct blow to patella, e.g. dashboard injury
- severe forces by extensor mechanism
- after anterior cruciate ligament reconstruction
- after total knee reconstruction
- pathological fracture
Morphology
- transverse fracture of mid patella (most common)
- comminuted fracture
- vertical fracture (rare)
- osteochondral defect usually from medial facet
- patellar sleeve fracture in children
Some fractures are more subtle and need to be differentiated from normal variants.
Treatment and prognosis
Treatment is determined by the amount of displacement of the fracture and whether the extensor mechanism of the knee is intact or disrupted.
For patients with a non displaced or minimally displaced fracture and an intact extensor mechanism non operative treatment may be suitable. This usually involved a Zimmer Knee Splint for 4-6 weeks. The patient is usually allowed to weight bear in the splint during this period6.
In the case of displaced fractures or disrupted extensor mechanism surgical management is usually required6. The surgical treatment of transversethese fractures, the most widely accepted method is modified usually involves tension band wiring (K wire technique).
Differential diagnosis
The main differential is of multipartite patella, where there is a failure of fusion of secondary ossification centres. The unfused fragments are almost always in the superolateral quadrant of the patella. With a multipartite patella, the volume of the true patella plus that of the smaller ossification centres is greater than that expected of a normal patella. With a patellar fracture, the volume of the fractured components is equivalent to that of a normal patella.
-<p><strong>Patella fracture</strong> is one of the common knee injuries usually post direct trauma to the <a title="Patella" href="/articles/patella">patella</a> or sudden forceful contraction of the <a title="Quadriceps muscles" href="/articles/quadriceps-muscles">quadriceps muscles</a> in the context of a sports injury.</p><h4>Clinical presentation</h4><p>Patients present with marked swelling and pain over the patella with point tenderness and marked reduction in extension strength. Usually, there is a large <a title="Joint effusion" href="/articles/joint-effusion">joint effusion</a> or <a title="Haemarthrosis" href="/articles/haemarthrosis">haemarthrosis</a>.</p><h4>Pathology</h4><p>There are different causes of patella fracture:</p><ul>- +<p><strong>Patella fracture</strong> is one of the common knee injuries usually post direct trauma to the <a href="/articles/patella">patella</a> or sudden forceful contraction of the <a href="/articles/quadriceps-muscles">quadriceps muscles</a> in the context of a sports injury.</p><h4>Clinical presentation</h4><p>Patients present with marked swelling and pain over the patella with point tenderness and marked reduction in extension strength. Usually, there is a large <a href="/articles/joint-effusion">joint effusion</a> or <a href="/articles/haemarthrosis">haemarthrosis</a>.</p><h4>Pathology</h4><p>There are different causes of patella fracture:</p><ul>
-<li>after <a title="TKR" href="/articles/total-knee-arthroplasty">total knee reconstruction</a>- +<li>after <a href="/articles/total-knee-arthroplasty">total knee reconstruction</a>
-<a title="Transverse fracture" href="/articles/transverse-fracture">transverse fracture</a> of mid patella (most common)</li>-<li><a title="Comminuted fracture" href="/articles/comminuted-fracture">comminuted fracture</a></li>- +<a href="/articles/transverse-fracture">transverse fracture</a> of mid patella (most common)</li>
- +<li><a href="/articles/comminuted-fracture">comminuted fracture</a></li>
-</ul><p>Some fractures are more subtle and need to be differentiated from normal variants.</p><h4>Treatment and prognosis</h4><p>For the treatment of transverse fractures, the most widely accepted method is modified tension band wiring (<a title="K wire" href="/articles/k-wire">K wire technique</a>).</p><h4>Differential diagnosis</h4><p>The main differential is of <a href="/articles/multipartite-patella">multipartite patella</a>, where there is a failure of fusion of secondary ossification centres. The unfused fragments are almost always in the superolateral quadrant of the patella. With a multipartite patella, the volume of the true patella plus that of the smaller ossification centres is greater than that expected of a normal patella. With a patellar fracture, the volume of the fractured components is equivalent to that of a normal patella.</p>- +</ul><p>Some fractures are more subtle and need to be differentiated from normal variants.</p><h4>Treatment and prognosis</h4><p>Treatment is determined by the amount of displacement of the fracture and whether the extensor mechanism of the knee is intact or disrupted.</p><p>For patients with a non displaced or minimally displaced fracture and an intact extensor mechanism non operative treatment may be suitable. This usually involved a Zimmer Knee Splint for 4-6 weeks. The patient is usually allowed to weight bear in the splint during this period<sup>6</sup>.</p><p>In the case of displaced fractures or disrupted extensor mechanism surgical management is usually required<sup>6</sup>. The surgical treatment of these fractures usually involves tension band wiring (<a href="/articles/k-wire">K wire technique</a>).</p><h4>Differential diagnosis</h4><p>The main differential is of <a href="/articles/multipartite-patella">multipartite patella</a>, where there is a failure of fusion of secondary ossification centres. The unfused fragments are almost always in the superolateral quadrant of the patella. With a multipartite patella, the volume of the true patella plus that of the smaller ossification centres is greater than that expected of a normal patella. With a patellar fracture, the volume of the fractured components is equivalent to that of a normal patella.</p>
References changed:
- 6. Gwinner C, Märdian S, Schwabe P, Schaser KD, Krapohl BD, Jung TM. Current concepts review: Fractures of the patella. (2016) GMS Interdisciplinary plastic and reconstructive surgery DGPW. 5: Doc01. <a href="https://doi.org/10.3205/iprs000080">doi:10.3205/iprs000080</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/26816667">Pubmed</a> <span class="ref_v4"></span>
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