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
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 :

13. Skyline view
Fig

14. Tests :
Patellar tap
Fluctuation test

15. Patellar tapping
Fig :

16. 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.

17. 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.

18. Patella Knee Support
Fig

19. Cont..
Open reduction and internal fixation for transverse fracture

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