Patella fracture

patella fracture

1. Fracture of the patella
Dr. Ashish P
Asst. Professor
Department of Musculoskeletal Sciences
DVVPF’s College of Physiotherapy,
Ahmednagar

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 :

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
•Incomplete extension

21. THANK YOU