Presentation
Fall and left knee pain with mild soft tissue swelling
Patient Data
Vertical fracture through the patella on the frontal projection. Lateral projection (HBL) shows a small suprapatellar effusion and mild OA. No lipohemarthrosis.
Non-displaced vertical fracture through the lateral aspect of the patella. No bipartite variant. No other acute bony injury.
Degenerative disease of the knee.
Case Discussion
Vertical fractures of the patella are less common than transverse fractures, but still account for 22% of all patellar fractures 1. Fractures through the lateral patella, as here, are more common than those involving the medial facet 1.
In general vertical fractures are non-displaced. It is easy to overlook these fractures on the AP projection highlighting the importance of the skyline view if a vertical-type fracture is suspected. In this case the fracture was not reported on the original read of the radiographs. However, the orthopedic surgeon reviewing the patient was suitably concerned and requested a CT which nicely demonstrates the fracture.
Vertical fractures tend to be stable and are often conservatively managed as in this case.