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Usami S, Naraoka T, Sasaki S, Oishi K, Ishibashi Y. Bilateral Sleeve Fracture of the Patella in a Healthy 11-Year-Old Male: A Case Report. Cureus 2023; 15:e50347. [PMID: 38205483 PMCID: PMC10781533 DOI: 10.7759/cureus.50347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
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.
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Affiliation(s)
- Shintaro Usami
- Orthopedic Surgery, Kuroishi General Hospital, Kuroishi, JPN
- Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Takuya Naraoka
- Orthopedic Surgery, Kuroishi General Hospital, Kuroishi, JPN
- Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Shizuka Sasaki
- Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Kazuki Oishi
- Orthopedic Surgery, Kuroishi General Hospital, Kuroishi, JPN
- Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Yasuyuki Ishibashi
- Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
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Devana SK, Trivellas A, Bennett A, Jackson N, Beck JJ. Clinical and Radiographic Differentiation of Pediatric Patellar Sleeve Fractures and Other Inferior Pole Pathologies. Am J Sports Med 2022; 50:977-983. [PMID: 35142232 DOI: 10.1177/03635465221073995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Inferior pole patellar sleeve fractures (PSFs) are rare injuries that occur in skeletally immature patients that may be missed or falsely diagnosed as an inferior pole fracture (IPF) or Sinding-Larsen-Johansson syndrome (SLJS). PURPOSE The objective of this study was to evaluate and compare clinical and radiographic features of patients with PSF, IPF, and SLJS. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Retrospective review of skeletally immature patients diagnosed with PSF, IPF, and SLJS between 2011 and 2019 at a single urban academic center was performed. Chart and radiographic review was completed. Between-group differences were assessed using analysis of variance, Kruskal-Wallis test, and Fisher exact test, as appropriate to variable distributions. RESULTS In total, 125 patients (82% male) were included, with a mean (SD) age of 10.7 (2) years (16 PSF, 51 IPF, 58 SLJS). There were no significant differences in patient characteristics between the 3 groups. One hundred percent of the patients with PSF (P < .001) and IPF (P < .001) had acute trauma, compared with 24% of patients with SLJS. Fewer patients with PSF had an intact straight leg raise (38%) compared with those with IPF (94%; P < .001) and SLJS (98%; P < .001). Fewer patients with SLJS had knee swelling (41%) compared with those with PSF (93%; P < .001) and IPF (94%; P < .001). More patients with PSF had knee effusion (81%) compared with those with IPF (37%; P = 0.011) and SLJS (3%; P < .001). More patients with SLJS were able to bear weight (88%) compared with those with IPF (12%; P < .001) and PSF (0; P < .001). Radiographically, compared with those with IPF and SLJS, patients with PSFs had increased mean prepatellar swelling (6.1 [P < .001] and 6.5 [P < .001] vs 12.9 mm), intra-articular effusion (6.1 [P = .014] and 4.9 [P = .001] vs 9.2 mm), maximum fragment size (26 [P = .004] and 17.7 [P < .001] vs 45.3 mm), and maximum fragment displacement (1.24 [P = .002] and 1.45 [P = .003] vs 13.30 mm), respectively. Compared with those with SLJS (1.10), patients with PSF (1.92; P < .001) and IPF (1.22; P < .001) had patella alta with higher mean Insall-Salvati ratios >1.2. CONCLUSION Differences in clinical features such as ability to straight leg raise, knee swelling, knee effusion, ability to bear weight, and radiographic features, such as prepatellar swelling, intra-articular effusion, fragment displacement/size/shape/location, and patellar height, can all be helpful in recognizing rare pediatric inferior patellar pathology, thus increasing efficiency in indicating for higher-level imaging to reach a prompt diagnosis and provide appropriate treatment.
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Affiliation(s)
- Sai K Devana
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.,Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Andromahi Trivellas
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.,Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Abbie Bennett
- Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
| | - Nicholas Jackson
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Jennifer J Beck
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA.,Orthopedic Institute for Children's Center for Sports Medicine, Los Angeles, California, USA
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Kuwabara A, Kraus E, Fredericson M. Narrative Review - Knee Pain in the Pediatric Athlete. Curr Rev Musculoskelet Med 2021; 14:239-245. [PMID: 33818701 PMCID: PMC8137791 DOI: 10.1007/s12178-021-09708-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW This review article seeks to highlight common youth athlete knee conditions due to overuse or trauma and elucidate differences from the adult populations. RECENT FINDINGS Overuse conditions presented include apophysitis, osteochondritis dissecans plica syndrome, and discoid meniscus. Traumatic conditions presented include patellar instability, patellar sleeve fracture, and patellofemoral osteochondral fractures. Knee injuries affect a significant proportion of youth athletes. These injuries place athletes at higher risk of chronic pain and potentially osteoarthritis. We have reviewed common overuse and traumatic knee injuries and differentiating factors between the adult population to improve and expedite the diagnosis, treatment, and prognosis for youth athletes with knee injuries.
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Affiliation(s)
- Anne Kuwabara
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| | - Emily Kraus
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
| | - Michael Fredericson
- Department of Physical Medicine and Rehabilitation, Stanford University, 500 Jefferson Avenue #823, Redwood City, CA 94063 USA
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Schmidt-Hebbel A, Eggers F, Schütte V, Achtnich A, Imhoff AB. Patellar sleeve avulsion fracture in a patient with Sinding-Larsen-Johansson syndrome: a case report. BMC Musculoskelet Disord 2020; 21:267. [PMID: 32326930 PMCID: PMC7181494 DOI: 10.1186/s12891-020-03297-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/17/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patellar sleeve avulsion (PSA) fractures are rare injuries that occur in in skeletally immature patients. Initial diagnosis is key to a successful outcome, as these injuries are easily overlooked on plain radiographs with poor results well documented from delayed management. High index of suspicion from the mechanism of injury, thorough clinical examination and Magnetic Resonance Imaging (MRI) help to avoid misdiagnosis. CASE PRESENTATION The case of a 12-year-old male athlete with an acute PSA after a conservative treatment of a SLJ syndrome is described. The patient was referred to our clinic due to severe pain and loss of function after performing a high jump. Plain radiographs (X-ray) and MRI confirmed an inferior pole PSA which was fixed with double trans osseous ultra-high strength tapes. At the 3-month follow- up visit the patient was able to ambulate brace free. At 2-years follow up the patient was able to play soccer and ice hockey. To our knowledge, there are no case reports of inferior pole PSA with prior SLJ syndrome described in literature. CONCLUSIONS Early clinical suspicion and distinguishing this PSA from other enchondral ossification disorders around the knee is critical to avoid misdiagnosis. Whether SLJ syndrome increases the risk of sustaining a PSA is still not clear. Trans osseous fixation with suture tapes leads to good functional results in a young athlete with inferior pole PSA.
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Affiliation(s)
- Andrés Schmidt-Hebbel
- Clínica Alemana de Santiago, Departamento de Ortopedia y Traumatología, Av. Vitacura 5951, Santiago de, Chile
| | - Felipe Eggers
- Technical University of Munich. Klinikum rechts der Isar, Abt. f. Sportorthopädie- Ismaninger Str. 22, 81675 Munich, Germany
| | - Vincent Schütte
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost, Marseburger Str. 165, 06112 Halle/Saale, Germany
| | - Andrea Achtnich
- Technical University of Munich. Klinikum rechts der Isar, Abt. f. Sportorthopädie- Ismaninger Str. 22, 81675 Munich, Germany
| | - Andreas B. Imhoff
- Technical University of Munich. Klinikum rechts der Isar, Abt. f. Sportorthopädie- Ismaninger Str. 22, 81675 Munich, Germany
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Denduluri SK, Gamble JG. Bilateral Medial Patella Sleeve Fractures in a Child: A Case Report. JBJS Case Connect 2020; 10:e1900533. [PMID: 32649152 DOI: 10.2106/jbjs.cc.19.00533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Sahitya K Denduluri
- 1Department of Orthopaedic Surgery, Lucille Salter Packard Stanford Children's Hospital, Stanford, California
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Mortensen SO, Stausholm AM, Thorninger R. Screw osteosynthesis of transverse fracture of the patella in children. WORLD JOURNAL OF PEDIATRIC SURGERY 2019. [DOI: 10.1136/wjps-2018-000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified superior technique for children. The aim of this study is to assess the functional outcome after screw fixation of transverse patella fractures in children.MethodsTwo boys at 11 years of age were presented with a transverse fracture of the patella within the same week. Open reduction and fixation of the fractured patella with periost sutures and a 4.0 mm titanium screw inserted from the distal fragment. Afterward, the quadriceps expansion was meticulously repaired with sutures.ResultsThe patients could fully weight bear immediately on a fully extended knee in an orthosis. After 4 weeks, radiological healing was obtained. At the 8-week and 6-month follow-up, the modified Hospital of Special Surgery knee score was 100 points in both patients.ConclusionSingle screw fixation provides an excellent outcome after 8 weeks with a full range of motion and full weight bearing, providing a faster recovery.
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Schütte V, Schmidt-Hebbel A, Imhoff AB, Achtnich A. [Patellar sleeve fractures : Bracing and augmentation technique with suture tape]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 31:56-62. [PMID: 30539194 DOI: 10.1007/s00064-018-0581-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Transosseous augmentation of patellar sleeve fractures (PSF) with suture tape in young athletes. INDICATIONS Acute avulsions of the proximal or distal patellar pol with clinical relevant deficit of knee extension. CONTRAINDICATIONS Local infections, severe soft tissue damage (relative contraindication), fractures of the patella or tibial tuberosity. SURGICAL TECHNIQUE Direct longitudinal anterior approach to the patella. Debridement of the proximal patellar tendon insertion. Anatomic reduction of any osteochondral fragments. Transosseous augmentation of the tendon with FiberTapes® (Arthrex, Naples, FL, USA). POSTOPERATIVE MANAGEMENT Passive motion exercise to 30° of flexion from day 1; increase to 60° from week 3; 90° from week 5. Partial load-bearing of 20 kg with knee in locked full extension brace during first 2 weeks. Isometric exercises from week 3. Free active ROM and full weight bearing from week 7. RESULTS If diagnosis and treatment is early and sufficient augmentation of the tendon and periosteum is provided, good to excellent functional outcome can be expected.
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Affiliation(s)
- V Schütte
- Tech. Universität München, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland.
| | | | - A B Imhoff
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland
| | - A Achtnich
- Abteilung für Sportorthopädie, Klinikum rechts der Isar, Ismaninger Str. 22, 81675, München, Deutschland
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Damrow DS, Van Valin SE. Patellar Sleeve Fracture With Ossification of the Patellar Tendon. Orthopedics 2017; 40:e357-e359. [PMID: 27798714 DOI: 10.3928/01477447-20161026-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/17/2016] [Indexed: 02/03/2023]
Abstract
Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.].
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Le Petit C, Desdoits A, Laquievre A, Dolet N, Bronfen C. Un diagnostic à ne pas méconnaître : la fracture avulsion de la patella. Arch Pediatr 2016; 23:398-401. [DOI: 10.1016/j.arcped.2016.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/28/2022]
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Hermansen LL, Freund KG. Bifocal osseous avulsion of the patellar tendon from the distal patella and tibial tuberosity in a child. Knee Surg Sports Traumatol Arthrosc 2016; 24:712-4. [PMID: 26410095 DOI: 10.1007/s00167-015-3800-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 09/16/2015] [Indexed: 12/01/2022]
Abstract
This case report describes a 12-year-old boy, who suffered an injury to the right knee in a skateboard accident. Radiographs and surgery confirmed the extremely rare bifocal avulsion fracture including the distal patellar pole and tibial tuberosity. Open reduction and internal fixation was accomplished, and 4-month follow-up demonstrated a good outcome.
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Affiliation(s)
- Lars L Hermansen
- Department of Orthopaedics, Hospital of South West Denmark, Finsensgade 35, 6700, Esbjerg, Denmark.
| | - Knud G Freund
- Department of Orthopaedics, Hospital of South West Denmark, Finsensgade 35, 6700, Esbjerg, Denmark
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Knutson T, Bothwell J, Durbin R. Evaluation and management of traumatic knee injuries in the emergency department. Emerg Med Clin North Am 2015; 33:345-62. [PMID: 25892726 DOI: 10.1016/j.emc.2014.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Posttraumatic knee pain is a common presentation in the emergency department (ED). The use of clinical decision rules can rule out reliably fractures of the knee and reduce the unnecessary cost and radiation exposure associated with plain radiographs. If ligamentous or meniscal injury to the knee is suspected, the ED physician should arrange for expedited follow- up with the patient's primary care physician or an orthopedic specialist for consideration of an MRI and further management. Patients presenting after high-energy mechanisms are at risk for occult fracture and vascular injuries. ED providers must consider these injuries in the proper clinical setting.
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Affiliation(s)
- Tristan Knutson
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA.
| | - Jason Bothwell
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA
| | - Ricky Durbin
- Department of Emergency Medicine, Madigan Army Medical Center, 9040 Fitzsimmons Drive, Tacoma, WA 98431, USA
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Sullivan S, Maskell K, Knutson T. Patellar sleeve fracture. West J Emerg Med 2014; 15:883-4. [PMID: 25493142 PMCID: PMC4251243 DOI: 10.5811/westjem.2014.8.22265] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/24/2014] [Accepted: 08/30/2014] [Indexed: 11/15/2022] Open
Affiliation(s)
- Scott Sullivan
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Kevin Maskell
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Tristan Knutson
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
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Sleeve fracture of the patella with lateral slip of the retinaculum: a case report in an 11-year-old child. J Pediatr Orthop B 2014; 23:422-5. [PMID: 24887051 DOI: 10.1097/bpb.0000000000000070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adolescents are susceptible to patellar sleeve fractures. We present an interesting case of a patellar sleeve fracture in an 11-year-old child with lateral slip of the retinacular sleeve. Clinical assessment was difficult; however, an MRI scan confirmed the diagnosis. Surgical repair was undertaken, and the retinacular sleeve was repaired along with repair of the patellar tendon. The patient recovered well after surgery and underwent physiotherapy. A patellar sleeve fracture should always be suspected in patients less than 16 years of age, particularly in those with indirect acute trauma to the knee. Prompt surgical repair is important to achieve full functional recovery.
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An Isolated Articular Surface Fracture of the Distal Patella: An Unusual and Previously Unreported Paediatric Injury. Case Rep Orthop 2013; 2013:605852. [PMID: 24383029 PMCID: PMC3870657 DOI: 10.1155/2013/605852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/12/2013] [Indexed: 12/05/2022] Open
Abstract
Paediatric patella fractures are uncommon, accounting for less than 1% of all paediatric fractures. This case report describes a previously undocumented patella fracture in a child, with a clear mechanism of injury. We present a case of a previously healthy 14-year-old boy who fell directly onto his right knee after coming off his pushbike. He sustained an isolated fracture involving the articular surface of the distal part of the patella with minimal displacement. The patient was managed conservatively in a Richard splint for three weeks, followed by a knee brace with gradually increasing degrees of flexion. He was instructed to be nonweight bearing for two weeks and then partial weight bearing for six weeks. At the final followup, after 9 weeks, the patient had full return of function and standard radiographs show the fracture to be healed. This case report has demonstrated how direct compression to the paediatric patella can cause a fracture isolated to its articular surface. It has detailed the natural progression of this injury to radiographic union, using a conservative management strategy. The authors believe that this case report provides an interesting insight into the variation of paediatric patella fractures and their contrasting management strategies.
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