FRACTURES OF THE PATELLA
FRACTURES OF THE PATELLA
- Common fracture, result from a direct or an indirect force.
- In a direct injury, blow on the anterior aspect of the flexed knee, results in comminuted fracture.
- The comminution limited to a part or whole of the patella.
- The latter is also called a stellate fracture.
- Sudden violent contraction of the quadriceps, gives rise to a fracture with the fracture line.
- Running transversely across the patella, dividing it into two; the so-called two-part fracture.
CLINICAL FEATURES
Presenting complaints:
- Pain and swelling over the knee.
- In an undisplaced fracture the swelling and tenderness may be localised over the patella.
- A crepitus is felt in a comminuted fracture.
- In displaced fractures, one may feel a gap between the fracture fragments.
- The patient will not be able to lift his leg with the knee in full extension (extensor lag).
- Bruises over the front of the knee – a tell tale sign of direct trauma.
- The knee may be swollen because of haemarthrosis.
Radiological examination:
- Antero-posterior and lateral X-rays sufficient in most cases.
- In undisplaced fractures, a ‘skyline view’ of the patella.
- A fracture with wide separation of the fragments is easy to diagnose on a lateral X-ray.
COMPLICATIONS
- Knee stiffness
- Extensor weakness
- Osteoarthritis
Exam Important
- Patella commonly dislocates Laterally.
- Lateral dislocation of patella is prevented by Vastus medialis.
- A comminuted fracture of the Patella should be treated by Removal of all the patella.
- In transverse fracture of the patella, the treatment is Wire fixation.
- Transverse fracture of the patella with separation of fragments is best treated by Open reduction with Kirschner wire fixation of the fragment an tension band wiring.
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