Fracture of the patella - PowerPoint PPT Presentation

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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