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Patella Fractures Workup

  • Author: Alexandra K Schwartz, MD; Chief Editor: Thomas M DeBerardino, MD  more...
 
Updated: Jun 10, 2016
 

Imaging Studies

Most patella fractures can be adequately visualized and classified by using standard anteroposterior (AP), lateral, and axial (Merchant or sunrise) radiographs of the knee (see the images below). The AP view helps in assessing the fracture pattern and the direction of displacement, whereas the lateral and Merchant views assist in evaluating the amount and location of comminution.

Preoperative anteroposterior radiograph of patellaPreoperative anteroposterior radiograph of patella fracture.
Preoperative lateral radiograph of patella fracturPreoperative lateral radiograph of patella fracture.
Preoperative sunrise radiograph of patella fracturPreoperative sunrise radiograph of patella fracture. Note that vertical fracture is not appreciated on anteroposterior and lateral views.

Occasionally, oblique views or computed tomography (CT) may be indicated for assessment of osteochondral fractures and intra-articular fragments. If a stress fracture is suspected, bone scanning may be helpful for making the diagnosis.

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Diagnostic Procedures

Aspiration of a hemarthrosis followed by instillation of intra-articular lidocaine may relieve the pain related to the fracture and permit a more thorough evaluation of extensor mechanism disruption. This measure is not usually necessary, but if it is, it must be performed under sterile conditions to minimize the risk of infection.

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Contributor Information and Disclosures
Author

Alexandra K Schwartz, MD Associate Clinical Professor, Chief, Division of Orthopedic Trauma, Director of Residency Program, Department of Orthopedic Surgery, University of California at San Diego

Alexandra K Schwartz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, Western Orthopaedic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Thomas M DeBerardino, MD Associate Professor, Department of Orthopedic Surgery, Consulting Surgeon, Sports Medicine, Arthroscopy and Reconstruction of the Knee, Hip and Shoulder, Team Physician, Orthopedic Consultant to UConn Department of Athletics, University of Connecticut Health Center

Thomas M DeBerardino, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Arthrex, Inc.; Ivy Sports Medicine; MTF; Aesculap; The Foundry, Cotera; ABMT<br/>Received research grant from: Histogenics; Cotera; Arthrex.

Additional Contributors

Robert D Bronstein, MD Associate Professor, Department of Orthopedics, Division of Athletic Medicine, University of Rochester School of Medicine

Robert D Bronstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Medical Society of the State of New York

Disclosure: Nothing to disclose.

References
  1. Axford WL. A Method of Wiring Fractures of the Patella. Ann Surg. 1888 Jul. 8(1):1-5. [Medline].

  2. CRENSHAW AH, WILSON FD. The surgical treatment of fractures of the patella. South Med J. 1954 Aug. 47(8):716-20. [Medline].

  3. GRISWOLD AS. Fractures of the patella. Clin Orthop. 1954. 4:44-56. [Medline].

  4. Macewen W. I. On the Pathology of Transverse Fractures of the Patella and Olecranon: Showing the Chief Cause of Non-Osseous Union in these Fractures and how to Obviate it. Ann Surg. 1887 Mar. 5(3):177-200. [Medline].

  5. McMASTER PE. Fractures of the patella. Clin Orthop. 1954. 4:24-43. [Medline].

  6. Pilcher LS. I. The Question of the Propriety of Resorting to Arthrotomy for Suturing Recent Simple Fractures of the Patella. Ann Surg. 1890 Dec. 12(6):401-13. [Medline].

  7. Stimson LA. VI. Co-aptation Fork for Treating Fractures of the Patella. Ann Surg. 1885 May. 1(5):464-5. [Medline].

  8. Gao GX, Mahadev A, Lee EH. Sleeve fracture of the patella in children. J Orthop Surg (Hong Kong). 2008 Apr. 16(1):43-6. [Medline].

  9. Lebrun CT, Langford JR, Claude Sagi H. Functional Outcomes After Operatively Treated Patella Fractures. J Orthop Trauma. 2011 Dec 15. [Medline].

  10. Rabalais RD, Burger E, Lu Y, Mansour A, Baratta RV. Comparison of two tension-band fixation materials and techniques in transverse patella fractures: a biomechanical study. Orthopedics. 2008 Feb. 31(2):128. [Medline].

  11. El-Sayed AM, Ragab RK. Arthroscopic-assisted reduction and stabilization of transverse fractures of the patella. Knee. 2009 Jan. 16(1):54-7. [Medline].

  12. Wright PB, Kosmopoulos V, Coté RE, Tayag TJ, Nana AD. FiberWire is superior in strength to stainless steel wire for tension band fixation of transverse patellar fractures. Injury. 2009 Nov. 40(11):1200-3. [Medline].

  13. Dargel J, Gick S, Mader K, Koebke J, Pennig D. Biomechanical comparison of tension band- and interfragmentary screw fixation with a new implant in transverse patella fractures. Injury. 2010 Feb. 41(2):156-60. [Medline].

  14. Muzaffar N, Ahmad N, Ahmad A, Ahmad N. The chopstick-noodle twist: an easy technique of percutaneous patellar fixation in minimally displaced patellar fractures. Trop Doct. 2012 Jan. 42(1):25-7. [Medline].

  15. Wang CX, Tan L, Qi BC, Hou XF, Huang YL, Zhang HP, et al. A retrospective comparison of the modified tension band technique and the parallel titanium cannulated lag screw technique in transverse patella fracture. Chin J Traumatol. 2014 Aug 1. 17(4):208-13. [Medline].

  16. Catalano JB, Iannacone WM, Marczyk S, Dalsey RM, Deutsch LS, Born CT, et al. Open fractures of the patella: long-term functional outcome. J Trauma. 1995 Sep. 39(3):439-44. [Medline].

  17. Torchia ME, Lewallen DG. Open fractures of the patella. J Orthop Trauma. 1996. 10(6):403-9. [Medline].

  18. Anand S, Hahnel JC, Giannoudis PV. Open patellar fractures: high energy injuries with a poor outcome?. Injury. 2008 Apr. 39(4):480-4. [Medline].

  19. Berg EE. Open reduction internal fixation of displaced transverse patella fractures with figure-eight wiring through parallel cannulated compression screws. J Orthop Trauma. 1997 Nov. 11(8):573-6. [Medline].

  20. Fortis AP, Milis Z, Kostopoulos V, Tsantzalis S, Kormas P, Tzinieris N, et al. Experimental investigation of the tension band in fractures of the patella. Injury. 2002 Jul. 33(6):489-93. [Medline].

  21. Baran O, Manisali M, Cecen B. Anatomical and biomechanical evaluation of the tension band technique in patellar fractures. Int Orthop. 2008 Jul 11. [Medline].

  22. Luna Pizarro D, Zuno JC, Pérez Hernández J, Meraz Lares G. [Transpatellar "W" cerclage with anterior tension band for fixation of transverse fractures of the patella]. Acta Ortop Mex. 2008 Sep-Oct. 22(5):282-6. [Medline].

  23. Matsuo T, Watari T, Naito K, Mogami A, Kaneko K, Obayashi O. Percutaneous cerclage wiring for the surgical treatment of displaced patella fractures. Strategies Trauma Limb Reconstr. 2014 Apr. 9(1):19-23. [Medline]. [Full Text].

  24. Cho JH. Percutaneous cannulated screws with tension band wiring technique in patella fractures. Knee Surg Relat Res. 2013 Dec. 25(4):215-9. [Medline]. [Full Text].

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Chondral fragments from comminuted patella fracture.
Preoperative anteroposterior radiograph of patella fracture.
Preoperative lateral radiograph of patella fracture.
Preoperative sunrise radiograph of patella fracture. Note that vertical fracture is not appreciated on anteroposterior and lateral views.
Postoperative anteroposterior radiograph of patella fracture.
Postoperative lateral radiograph of patella fracture.
Postoperative sunrise view of patella fracture. Vertical fracture is stabilized with lag screw.
 
 
 
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