Fracture of the patella

Dr. Ashish P
Asst. Professor
Department of Musculoskeletal Sciences
DVVPF’s College of Physiotherapy,
Ahmednagar
 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
 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
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
 On examination
• Palpable gap
• Tenderness
• signs of effusion
• Positive patellar
 Classification
Undisplaced
• Transverse fracture (80%)
• Vertical fracture
• Comminuted fracture
Displaced
Transverse (85 %)
• Oblique fracture
• Vertical fracture
• Comminuted fracture osteochondral
fracture
Classification
• Fig
 Investigation
X – ray :
• AP view
• lateral view
• Skyline view
• CT scan
• Bone scan
• MRI
 Lateral view
• Fig :
 Skyline view
• Fig
 Tests :
• Patellar tap
• Fluctuation test
 Patellar tapping
• Fig :
 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.
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.
 Patella Knee Support
• Fig
 Cont..
• Open reduction and internal fixation for
transverse fracture
 Complications
• Refracture
• Non union
• Avascular necrosis of fragments
• Osteoarthritis
• Knee stiffness
• Patellar instability
• Incomplete extension
THANK YOU