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Fracture of the patella

Fracture of the patella. Cont. Fig . 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 .

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Fracture of the patella

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  1. Fracture of the patella

  2. Cont.. • Fig

  3. 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.

  4. Cont.. • Fig

  5. 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

  6. 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

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

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

  9. Classification • Fig

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

  11. Lateral view • Fig :

  12. Skyline view • Fig

  13. Tests : • Patellar tap • Fluctuation test

  14. Patellar tapping • Fig :

  15. 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.

  16. 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 10degrees flexion for both partial and complete patellectomy.

  17. Patella Knee Support • Fig

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

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

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