Patellar Fractures RSAT 365 Angie Whittington Classification l

Patellar Fractures RSAT 365 Angie Whittington

Classification l l Displaced Non-displaced l l l 1 to 2 mm articular stepoff 3 mm fragment separation Transverse Longitudinal Comminuted

Mechanism of Injury Direct blow to patella l Indirect force from violent quadriceps contraction l Expected healing time: 8 -12 weeks l Rehabilitation duration: 12 -15 weeks l

Treatment Goals Alignment l Open repair of the retinaculum if extensor lag is present l Stability l Best achieved by restoring bony congruity with hardware to rigidly fix fracture l

Rehabilitation Goals Restore full ROM in FLEX & EXT l Improve quad & hamstring strength & balance l

Methods of Treatment l Cast or Knee Immobilizer l Biomechanics: Stress-sharing device l Mode of Bone Healing: Secondary l Indications: Used for nondisplaced Fx l Cylinder cast allows full ROM at ankle l Examine knee to insure full active EXT l Cast vs. immobilizer based on patient compliance

Methods of Treatment l Open Reduction & Internal Fixation l Biomechanics: Stressshielding & sharing l Mode of Bone Healing: Primary, unless solid fixation is not achieved, then secondary also l Indications: Used for comminuted & displaced Fx l Open reduction to align articular surface l Retinacular destruction openly repaired

Methods of Treatment l Partial/Total Patellectomy l Used when comminuted Fx cannot be repaired l Extremity immobilized in full FLEX for 4 wks to allow tendon-to-bone healing l Full AROM begins after with gradual increases of FLEX

Special Considerations l Bipartite Patella l l Pieces of patella fail to fuse together Carefully examine knee for tenderness Radiograph comparison to assist with Dx Long-Term Sequelae l l l Degenerative disease Decreased knee ROM & secondary swelling Perm. Extensor Lag

Treatment: Early to Immediate (Day One to One Week) Stability at fracture site: None l Stage of bone healing: inflammatory phase & debridement of fracture l X-ray: visible fracture line; no callus formation l

Prescription: Early to Immediate (Day One to Week One) l l Precautions: Avoid PROM (knee): None if casted Strength: None l AROM of knee in sitting position NWB with open red/internal fixation Functional Activities: FWB during transfers and ambulation assistive devices

Treatment: Two Weeks l l l Stability at fracture site: None to minimal Stage of bone healing: Beginning reparative phase X-ray: No callus; fracture line visible

Prescription: Two Weeks l l Precautions: Avoid PROM (knee): None Strength (knee): None l Active FLEX NWB with open reduction/internal fixation Functional Activities: FWB during ambulation & transfers

Treatment: Four to Six Weeks l l l Stability at fracture site: None to minimal Stage of bone healing: Reparative phase X-ray: No callus; fracture line less visible l Sesamoid bone produce minimal callus

Prescription: Four to Six Weeks l l l Precautions: maintain knee immobilizer if tender ROM (knee): AROM in FLEX/EXT Strength (knee): Isometric quad & hamstring l l Week 6: 45º-0º & 90º-0º Functional Activities: FWB during ambulation & transfers. l Remove immobilizer for level ground walking

Treatment: Eight to Twelve Weeks Stability at fracture site: Stable l Stage of bone healing: Remodeling phase l X-rays: Small callus noted; fracture line fading over time l

Prescription: Eight to Twelve Weeks l l Precautions: None ROM (knee): AROM & PROM l l Strength (knee): resistive quad & hamstring exercises with weights l l Extension lag secondary to quad weakness Isokinetics & closed chain plyometrics Functional Exercises: FWB during ambulation & transfers w/o assistive devices

Long-Term Considerations & Problems l l Radiographs should be taken at each stage of treatment for loss of correction Quad shortening can reduce knee EXT Chondromalacia patella from direct trauma to cartilage Reflex inhibition of ilipsoas muscle post surgery

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