Presentation
Tripped over her friend’s dog resulting in a direct impact injury to the left knee. On examination, has swelling and tenderness localized over the patella, associated bruising, but neurovascularly intact distally and was able to extend her knee fully.
Patient Data
There is a minimally displaced avulsion type fracture of the inferior pole of the patella. Marked overlying soft tissue swelling is present. Mild suprapatellar joint effusion. No fractures identified elsewhere. The patella is not subluxed. Normal knee joint alignment without valgus or varus deformity.
Case Discussion
A patellar sleeve avulsion fracture is defined as an avulsion injury of the patella in skeletally immature patients, often between the ages of eight to twelve years old.
Non operative management via a cylinder cast for six weeks is indicated for nondisplaced fractures with intact extensor mechanisms. Operative management with an open reduction and internal fixation is indicated for patella sleeve fractures with a displacement if more then 3mm or disrupted extensor mechanisms. Complications from patella sleeve fractures include patella alta, extensor lag, quadricep atrophy and malunion.
Our patient was managed with crutches, tubigrip and discharged with a plan for outpatient fracture clinic follow-up. She was asymptomatic when seen at her two-week orthopedic follow-up and was subsequently discharged.