Patella Fracture

0
2012

Patella Fracture

  • Pathophysiology
    • The fracture may remain undisplaced because the fragments are held in position by intact pre-patellar expansion of the quadriceps tendon in front, and by patellar retinaculae on the sides
    • If the force of the quadriceps contraction is strong, it will pull the fragments apart and will result in rupture of patellar retinaculae(MCQ)
  • Clinical features
    • The patient complains of pain and swelling over the knee.
    • A crepitus is felt in a comminuted fracture. (MCQ)
    • 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; it remains in a position short of full extension (extensor lag) because of disruption of the extensor apparatus.
    • There may be 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 of the knee are sufficient in most

cases.

      • In some undisplaced fractures, a ‘skyline view’ of the patellamay be required. (A very high yield MCQ)
      • A fracture with wide separation of the fragments is easy to diagnose on a lateral X-ray
    • Treatment based on different Clinical Scenarios ( A very high yield MCQ in PG Medical Entrance)
      • Clinical Scenario 1 :Undisplaced fracture: (MCQ)
        • A plaster cast extending from the groin to just above the malleoli, with the knee in full extension (cylinder cast) should be given for 3 weeks, followed by physiotherapy.
      • Clinical Scenario 2 :Clean break with separation of fragments (two-part fracture): (MCQ)
        • The pull of the quadriceps muscle on the proximal fragment keeps the fragments apart, hence an operation is always necessary.
        • The operation consists of
          • reduction of the fragments
          • fixingfragments with tension-band wiring   (TBW) (MCQ)
          • repair   of   extensor retinaculae.
        • The knee can be mobilised early following this operation.
        • In cases where it is not possible to achieve accurate reduction of the fragments, it is better to excise the fragments (patellectomy) and repair the extensor retinaculae.
      • Clinical Scenario 3 :In cases where one of the fragments constitutes only one of the poles of the patella, – partial patellectomy is done ( A common clinical Vignette in PG Medical entrance )
        • Minor patellar fragment is excised.
        • the major patellar fragment is preserved
        • extensorretinaculae repaired
        • Such operations on the patella are followed by support in a cylinder cast for 4-6 weeks.
      • Clinical Scenario 4 :Comminuted   fracture (MCQ)
        • In comminuted  fractures with displacement, it is difficult to restore a perfectly smooth articular surface, so excision of the patella (Total patellectomy) is the preferred option.
        • This takes care of any future risk of osteoarthritis at the patello-femoral joint.    With    improvement    in    fixation techniques, more and more comminuted fractures of the patella are being reconstructed (patella saving operations).
    • Complications
      • Knee stiffness:(MCQ)
        • It is a common complication after a fracture of the patella
        • Occur mostly due to intra-and peri-articular adhesions.
        • Treatment is by physiotherapy.
        • Sometimes, an arthroscopic release of adhesions may be required.
      • Extensor weakness:
        • This results from an inadequate repair of the extensor apparatus or due to quadriceps weakness. (MCQ)
      • Osteoarthritis:
        • Patello-femoral osteoarthritis occurs a few years after the injury. (MCQ)

    ‘Himawari’ method for comminuted patellar fractrure
    This new surgical technique provide good stability for all type of fracture even severe comminution. Each fragment are reduced and several pin sleeves are inserted circumferentially and tighten by braded cable through the sleeve box. The final features of surgery seems blooming sunflower ‘Himwari in Jananese’.
    The advanage of this operation is
    1. Good stability allows early agressive rehabilitation
    2. Low rate of implant failure
    3. Less irritation
    4. Early recovery of knee function
    5. Accurate articular reconstruction prevent PF OA
    Patellar Fractures – Everything You Need To Know – Dr. Nabil Ebraheim
    Educational video describing fractures and fixation of patellar fractures.
    Wiring of fracture patella Dr. Aloke Samanta (orthopaedician)bulu kapat.
    Orthopaedic operation wiring of fracture patella done by dr Aloke Samanta.
    patellar injury rehabilitation techniques
    UTA strength and conditioning project
    Logan and Chris
    Tension Band Video no audio compression
    Physical Therapy Shattered Patella
    This is my first attempt at removing my cast on my own to exercise my knee. I realize my leg has been immobilized since March 1, but it seems extremely rigid.
    Tibia patella fracture review
    Open Reduction Internal Fixation of Patella
    Medical Animations by Certified Medical Illustrations.
    Patella Fractures by Steve Malekzadeh, MD
    speedy recovery after patellar fracture
    This client came to TLC with status post left knee patellar fracture with ORIF done. He came with zero degree in knee flexion. After two weeks intensive PT program, his knee arom improved to 90 degree in flexion. Amazing!!!
    Patella fracture recovery, positive test for hydrops
    Minimal effusion / Sweep test / Bulge Sign.
    Workgroup Diagnostic Skills at Fontys University of Applied Sciences, Physiotherapy Education
    Knee Exercises to Strenghen Muscles around the Patella to Avoid Knee Pain
    This video shows you a quick and easy exercise you can practice almost anywhere to help strengthen the muscles around the knee cap and learn how to stabilize the knee joint to avoid locking the knee.
    Learn Application of Patellar Tendon Bearing (PTB) Cast in Fracture Tibia…
    Application of PTB (Patellar Tendon Bearing) Cast..
    The patella tendon bearing (PTB) cast is usually applied as the last stage of treatment for tibial fractures. The pressure applied to the fracture site as the patient walks stimulates bone growth. The PTB may also be used for rehabilitation of the knee for a patient whose leg has been immobilized by a long leg cast. In this presentation the application of the PTB will be demonstrated.
    Cast Treatment of Tibial Fractures
    Broken patellar, blood draining
    I got a huge hematoma on my right knee after breaking my patellar in several pieces. The pressure was brutal.
    Patella Mobilisation | Knee Surgery Post-Op Physio & Exercise
    n exclusive exercise video produced by the Hampshire Hospitals NHS Foundation Trust for patients to use as part of the Recovery programme following a range of Knee Surgery procedures.
    Always check with your Physio or Surgeon before embarking on a post-op exercise programme
    Checking stability of patella suturing technique
    patella fracture suturing