Fracture of the patella Cont Fig Anatomy Largest

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Fracture of the patella

Fracture of the patella

Cont. . • Fig

Cont. . • Fig

Anatomy • Largest sesamoid bone in the body. • Quadriceps tendon inserted on the

Anatomy • Largest sesamoid bone in the body. • Quadriceps tendon inserted on the superior pole and the patellar ligament originates from the inferior pole. • Funtion of the patella is to increase the mechanical advantage and protection.

Cont. . • Fig

Cont. . • Fig

Mechanism of injury • • Direct trauma : Due to direct fall over the

Mechanism of injury • • Direct trauma : Due to direct fall over the patella Usually cause comminuted fractures and are the common causes Indirect trauma (quadriceps contraction ): Sudden forceful contraction of the quadriceps (as in sports ) Age : common in 20 – 50 years age group

Clinical evaluation • Patient usually non ambulatory. • Pain, swelling • Abrasion over the

Clinical evaluation • Patient usually non ambulatory. • Pain, swelling • Abrasion over the patella. • Unable to extend the knee • Both the active and passive movements are restricted

On examination • • Palpable gap Tenderness signs of effusion Positive patellar

On examination • • Palpable gap Tenderness signs of effusion Positive patellar

Classification Undisplaced • Transverse fracture (80%) • Vertical fracture • Comminuted fracture Displaced Transverse

Classification Undisplaced • Transverse fracture (80%) • Vertical fracture • Comminuted fracture Displaced Transverse (85 %) • Oblique fracture • Vertical fracture • Comminuted fracture osteochondral fracture

Classification • Fig

Classification • Fig

Investigation X – ray : • AP view • lateral view • Skyline view

Investigation X – ray : • AP view • lateral view • Skyline view • CT scan • Bone scan • MRI

Lateral view • Fig :

Lateral view • Fig :

Skyline view • Fig

Skyline view • Fig

Tests : • Patellar tap • Fluctuation test

Tests : • Patellar tap • Fluctuation test

Patellar tapping • Fig :

Patellar tapping • Fig :

Treatment • Non operative – For non displaced fracture – Cylinder cast: extending from

Treatment • Non operative – For non displaced fracture – Cylinder cast: extending from the groin to just above the malleoli for 4 to 6 weeks. – Followed by physiotherapy- quadriceps strengthening exercise.

Operative • Tension band wiring. (figure of 8) • Patellectomy – Partial: for proximal

Operative • Tension band wiring. (figure of 8) • Patellectomy – Partial: for proximal pole fracture; major fragment is preserved; . – Complete: for comminuted fractures. – Knee should be immobilized for 3 to 6 weeks in a long leg cast at 10 degrees flexion for both partial and complete patellectomy.

Patella Knee Support • Fig

Patella Knee Support • Fig

Cont. . • Open reduction and internal fixation for transverse fracture

Cont. . • Open reduction and internal fixation for transverse fracture

Complications • • • Refracture Non union Avascular necrosis of fragments Osteoarthritis Knee stiffness

Complications • • • Refracture Non union Avascular necrosis of fragments Osteoarthritis Knee stiffness Patellar instability