PATELLA

FRACTURE
Dwi Yuliannisa Amri

Fracture Data
Relative frequencies of
fractures to the knee in adults

Most frequently overlooked

fractures in an ED

1.

Patella (40%)

1.

Tibial plateau (16%)

2.

Tibial plateau (32%)

2.

Radial head (14%)

3.

Fibular head (9%)

3.

Elbow child (14%)

4.

Distal femur (8%)

4.

Scaphoid (13%)

5.

Tibial spine (7%)

5.

Calcaneus (10%)

6.

Tibial tuberosity (2%)

6.

Patella (6%)

7.

Osteochondral junction (1%)

7.

Ribs (4%)

--Stiell 1996, Weber 1995,

Bauer 1995

--Data from Freed and

Shields 1984

The Patella

Most common
bony element of
the knee injured
(account for 1%
of all bony
fractures)

Most common in
pts 20-50yo,
men>women 2:1

Fracture usually
following direct
trauma or
forceful quads
contraction

Anatomy

Range of motion

www.ukmsc.com.my

DOH!!!
The knee is the
perfect joint to
apply the DOH
pneumonic

Dislocations?
Occult fractures?
Half pathology?

There is plenty of
minutia, but we are
responsible for the
big stuff

Common DOH findings

1. Knee dislocations are either
there or theyre not
2. The occult fractures are most
common: along the tibial
plateau, to the patella, or to the
proximal lateral tibia (Segond)
3. The only half pathology is the
Maissoneuvre fx (see ankle
radiology)

Patellar Fracture Classifications

Transverse most common

From Hohl M, Johnson EE,

Wiss DA. Fractures of the
knee, in Rockwood CA Jr,
Green DP, Bucholz RW (eds):
Fractures in Adults, 3d ed,
vol. 2. Philadelphia,

Patella Fracture

Sunrise View

This is only indicated for patients in

which you suspect a vertical fracture
If you have a patient with an obvious
transverse fracture, flexion of the knee
could cause further separation

Merchants View
Modified sunrise, requires the angle to be
30

Trochlear groove

1. The more prominent condyle (blue

arrow) denotes the side being
imaged (i.e. if it is prominent on
the left, it is the left femur)
2. A normal patella has a degree of
tilt to it (lower right image)
3. The upper right image
demonstrates patellar subluxation

Complications

Most

Improper restoration of the normal

anatomic relationships

Have been reported

Extensor lag
Patella alta
Quadriceps atrophy

Daftar pustaka

Patellar Fractures RSAT 365.ppt Angie

Whittington
Patellar Fractures - Everything You Need
To Know - Dr. Nabil Ebraheim
Apley's System of Orthopaedics and
Fractures 9th ed

Patellar Zebra
Bipartite Patella
Normal anatomic
variant, commonly
misinterpreted as
vertical fracture
Note the clean
borders and lack of
cortical margin
disruption
Most often located
superolateral
If in doubt, get other
knee (is bilateral in
50% of cases)

Patellar Positioning

Patella alta and

baja denote a highriding and low-riding
patella, respectively,
and can be identified
by using
Blumensaats Line
This is a line drawn
by the oblique
hyperlucent shadow
of the distal femur
(see left)

Patellar Sleeve Fracture

Unique to children

M>F 3:1, peak age

12.7yrs

Avulsion fracture of the

distal patellar pole

MOI: Forceful
quadriceps contraction
against a fixed lower
leg or high impact
jumping
PE: Look for
hemarthrosis,
decreased ability to
extend leg, local pain
Bates DG, Hresko MT, and Jaramillo D. Patellar
sleeve fracture:
andDemonstration
TTP with MR imaging.
Radiology 1994;193:825-827.

Hunt D and Somashekar N. A review of sleeve

1. Patella alta (relationship to

Blumensaats line)
2. May see small fragments of avulsed
bone (blue arrows), but this is not

Patellar Sleeve Fracture

Patella alta

Hemarthrosis

Hemarthrosis and
physical exam
findings are more
predictive than
radiographic
evidence
There is a high
morbidity
associated with
this injury, so a low
index of suspicion
should be held

Avulsed fragment