Patella fracture: Difference between revisions
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==Background== | ==Background== | ||
[[File:Knee diagram2.png|thumb|Anatomy of anterolateral aspect of right knee.]] | |||
*Occurs via direct blow or forceful contraction of quadriceps muscle | *Occurs via direct blow or forceful contraction of quadriceps muscle | ||
*Do not confuse a bipartite patella with a | *Do not confuse a bipartite patella with a fracture (bipartite patellas are usually bilateral so may image contralateral knee to confirm) | ||
==Clinical Features== | ==Clinical Features== | ||
*Focal patellar tenderness, swelling, effusion | *Focal patellar tenderness, swelling, effusion | ||
*Check integrity of knee extensor mechanism by having patient perform straight-leg raise | *Check integrity of knee extensor mechanism by having patient perform straight-leg raise | ||
==Differential Diagnosis== | |||
{{Knee DDX}} | |||
==Evaluation== | |||
===Imaging=== | ===Imaging=== | ||
[[File:Fracpetella.png|thumb]] | |||
[[File:Patella fracture.jpg|thumb]] | |||
*AP and lateral | *AP and lateral | ||
**Lateral view: Distance from tibial tubercle:lower pole of patella ~ length of patella +/- 20% | **Lateral view: Distance from tibial tubercle:lower pole of patella ~ length of patella +/- 20% | ||
***If greater than this suspect patellar ligament rupture | ***If greater than this suspect patellar ligament rupture | ||
*Consider skyline (sunset) view if suspect | *Consider skyline (sunset) view if suspect fracture of articular surface | ||
==Management== | ==Management== | ||
*Nondisplaced | *Nondisplaced with intact extensor mechanism: knee immobilizer, rest, ice | ||
*Displaced >3mm or disruption of extensor mechanism: above + early referral for ORIF | *Displaced >3mm or disruption of extensor mechanism: above + early referral for ORIF | ||
==Disposition== | |||
*Outpatient | |||
==See Also== | ==See Also== | ||
Latest revision as of 21:40, 21 May 2020
Background
- Occurs via direct blow or forceful contraction of quadriceps muscle
- Do not confuse a bipartite patella with a fracture (bipartite patellas are usually bilateral so may image contralateral knee to confirm)
Clinical Features
- Focal patellar tenderness, swelling, effusion
- Check integrity of knee extensor mechanism by having patient perform straight-leg raise
Differential Diagnosis
Knee diagnoses
Acute knee injury
- Knee dislocation
- Knee fractures
- Meniscus and ligament knee injuries
- Patella dislocation
- Patellar tendonitis
- Patellar tendon rupture
- Quadriceps tendon rupture
Nontraumatic/Subacute
- Arthritis
- Gout and Pseudogout
- Osgood-Schlatter disease
- Patellofemoral syndrome (Runner's Knee)
- Patellar tendonitis (Jumper's knee)
- Pes anserine bursitis
- Popliteal cyst (Bakers cyst)
- Prepatellar bursitis (nonseptic)
- Septic bursitis
- Septic joint
- DVT
Evaluation
Imaging
- AP and lateral
- Lateral view: Distance from tibial tubercle:lower pole of patella ~ length of patella +/- 20%
- If greater than this suspect patellar ligament rupture
- Lateral view: Distance from tibial tubercle:lower pole of patella ~ length of patella +/- 20%
- Consider skyline (sunset) view if suspect fracture of articular surface
Management
- Nondisplaced with intact extensor mechanism: knee immobilizer, rest, ice
- Displaced >3mm or disruption of extensor mechanism: above + early referral for ORIF
Disposition
- Outpatient