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Patella   fractures

6/28/2015

0 Comments

 
HPI: young male s/p ATV accident

Exam: Inspection: edema and deformity. No open wounds.  Palpation: TTP, palpable deformity. 2+ DP/PT pulses. SILT lower extremity. ROM: unable to perform straight leg raise. limited ROM secondary to pain. Limited assessment of anterior/posterior drawer, varus/valgus testing

Imaging:
 # Best seen on lateral xray. 
#In pediatric patients, MRI if xrays do not show fracture and child unable to perform straight leg raise
Picture
Pictureorthobullets.com










Bipartate patella: 
#often mistaken for fracture-use history and clinical exam
#8-10 % of population, 50 % bilateral, usually superolateral

Fracture Patterns:
  • nondisplaced
  • transverse
  • pole or sleeve (upper or lower)
  • vertical
  • marginal
  • osteochondral
  • comminuted (stellate)

Management:
# Nonoperative:
-Extensor mechanism intact (straight leg test)
-nondisplaced/minimally displaced
-vertical fractures
-Knee immobilized in extension (cylinder cast/brace)

#Operative
-extensor mechanism failure
-open fractures
-articular displacement > 2 mm
-displacement > 3 mm
-patella sleeve fractures in children (fracture between cartilage sleeve and patella)
-severely communited fractures

Discussion:
-Patella fractures 1 % of skeletal injuries
-Mechanism: direct impact of indirect eccentric contraction
-Complications: weakness and anterior knee pain, loss of reduction, nonunion, osteonecrosis, infection, stiffness

Key Points:  
#History of mechanism and exam is important-especially palpation, straight leg testing
#Best seen on lateral xray, consider MRI in pediatric patients given history and exam findings
#Bipartate patella-seen in 8-10 % of population, usually superolateral
#Orthopedic consultation-open vs closed, fracture pattern, straight leg testing, displacement
#Consider patella sleeve fractures in pediatric patients
#Management-minimally displaced, vertical, closed, extensor mechanism intact-immobilize in brace or cast and follow up as outpatient; Open, extensor mechanism not intact, communited, displaced-surgical

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction