Bilateral sleeve fractures of the patella in a 12-year-old boy with hereditary spastic paraparesis and crouch gait

Bilateral Sleeve Fracture of the Patella in a Healthy 11-Year-Old Male: A Case Report

Bilateral sleeve fracture of the patella (SFP) in skeletally immature children is a rare injury. We report the case of a healthy 11-year-old male who suffered bilateral SFP while playing tag. The avulsed fragments of his left patella were highly comminuted. Open reduction and internal fixation (ORIF) were performed using suture anchors, and the knees were immobilized using a cylinder cast for three weeks. At the one-year follow-up assessment, both knees were found to have regained full strength with no extension lag. However, we observed malunion due to lateral shift of the avulsed fragment, cystic lesions, and clicking in the patella, and the patient experienced residual pain in the left knee. Based on this, we conclude that the sleeve fracture of the patella with comminuted cartilaginous fragments was difficult to treat and might have led to poor clinical results if anatomical reduction and fixation had not been performed.

Gait analysis patterns and rehabilitative interventions to improve gait in persons with hereditary spastic paraplegia: a systematic review and meta-analysis

Background

Hereditary spastic paraplegias (HSPs) are a group of inheritance diseases resulting in gait abnormalities, which may be detected using instrumented gait analysis. The aim of this systematic review was 2-fold: to identify specific gait analysis patterns and interventions improving gait in HSP subjects.

Methods

A systematic review was conducted in PubMed, Cochrane Library, REHABDATA, and PEDro databases, in accordance with reporting guidelines of PRISMA statement and Cochrane's recommendation. The review protocol was recorded on the PROSPERO register. Patients with pure and complicated HSP of any age were included. All types of studies were included. Risk of bias, quality assessment, and meta-analysis were performed.

Results

Forty-two studies were included: 19 were related to gait analysis patterns, and 24 were intervention studies. The latter ones were limited to adults. HSP gait patterns were similar to cerebral palsy in younger subjects and stroke in adults. Knee hyperextension, reduced range of motion at knee, ankle, and hip, reduced foot lift, and increased rapid trunk and arm movements were reported. Botulinum injections reduced spasticity but uncovered weakness and improved gait velocity at follow-up. Weak evidence supported intrathecal baclofen, active intensive physical therapy (i.e., robot-assisted gait training, functional exercises, and hydrotherapy), and functional electrical stimulation. Some improvements but adverse events were reported after transcranial magnetic stimulation, transcutaneous spinal direct current stimulation, and spinal cord stimulation implant.

Conclusion

Knee hyperextension, non-sagittal pelvic movements, and reduced ROM at the knee, ankle, and hip represent the most peculiar patterns in HSP, compared to diplegic cerebral palsy and stroke. Botulinum improved comfortable gait velocity after 2 months. Nonetheless, interventions reducing spasticity might result in ineffective functional outcomes unveiling weakness. Intensive active physical therapy and FES might improve gait velocity in the very short term.

Bilateral Medial Patella Sleeve Fractures in a Child: A Case Report

CASE

An 8-year-old girl presented with a displaced right medial patella sleeve fracture. She underwent open reduction and suture fixation. Three years later, she presented with a left medial patella sleeve fracture that was less displaced than on the right. This was treated with immobilization and structured rehabilitation. She was able to return to full activity with normal radiographs at the final follow-up.

CONCLUSION

Patella sleeve fractures are rare. We report a unique case of bilateral medial patella sleeve fractures in an otherwise healthy child in which one side was treated operatively and the other was treated nonoperatively.