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trauma

Patella Fracture

advanced
6 min
28 marks
6 questions
Clinical Scenario
A 55-year-old woman presents after a direct blow to the knee from falling onto the kneecap. She is unable to perform a straight leg raise. There is significant swelling with a palpable gap over the patella. Distal neurovascular examination is intact.
AP and lateral radiographs demonstrating displaced transverse patella fracture through the mid-portion with 5mm separation between fragments. The proximal pole is migrated superiorly due to quadriceps pull, indicating extensor mechanism disruption. Knee effusion is present.
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AP and lateral radiographs demonstrating displaced transverse patella fracture through the mid-portion with 5mm separation between fragments. The proximal pole is migrated superiorly due to quadriceps pull, indicating extensor mechanism disruption. Knee effusion is present.

Source: Imaging of Patellar Fractures: Transverse Fracture • PMC5265199 • CC-BY

Questions

Question 1 (4 marks)

Describe the radiographic findings and classify this fracture.

Question 2 (5 marks)

What clinical features determine operative versus non-operative management?

Question 3 (6 marks)

Describe the surgical techniques available and your tension band wiring technique.

Question 4 (5 marks)

What is the post-operative rehabilitation protocol?

Question 5 (4 marks)

What complications would you discuss and when would you remove hardware?

Question 6 (4 marks)

How does management differ for comminuted inferior pole fractures?

Exam Day Cheat Sheet

Must Mention

  • •SLR = key clinical test for extensor mechanism
  • •Surgery if: >2-3mm gap, unable to SLR, >2mm step
  • •TBW converts tensile → compressive forces
  • •Wire anterior to transverse axis of patella
  • •Hardware prominence 20-30% (most common complication)
  • •Early ROM essential

Common Pitfalls

  • •K-wires posterior to transverse axis (lose TBW advantage)
  • •Not repairing retinaculum
  • •Delayed mobilization → stiffness
  • •Not checking ROM in theatre
  • •Attempting TBW for severely comminuted
  • •Missing bipartite patella (check contralateral)