Patella Fractures Clinical Presentation

Updated: Aug 23, 2022
  • Author: Alexandra K Schwartz, MD; Chief Editor: Thomas M DeBerardino, MD, FAAOS, FAOA  more...
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Presentation

History

An individual who has sustained a patella fracture usually presents with pain in the affected knee. The history reveals a direct blow to the knee, a fall, or a combination of the two. Overlying abrasions, ecchymosis over the anterior aspect of the knee, or both may be present.

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Physical Examination

Any lacerations must be assumed to communicate with the joint until this assumption is disproved by the saline load test. Because the retinaculum may have a large tear, it may be necessary to inject a significant amount of saline (up to 100 mL) to exclude an open joint. An accompanying intra-articular effusion may be present, which, if aspirated, will reveal fat globules. If the fracture is displaced, a defect is palpable at the fracture site.

The extensor mechanism must always be evaluated. As a result of the pain associated with the injury and hemarthrosis, the patient may be unable to perform a straight leg raise. Aspiration of the hemarthrosis under sterile conditions and the instillation of lidocaine may relieve the pain sufficiently to allow performance of a reliable examination. Disruption of the extensor mechanism renders the patient unable to extend the knee against gravity and usually implies that a tear is present in the medial and lateral quadriceps expansion.

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