Patella Fracture 822.0

synonyms: patellar fracture

Patella Fracture ICD-9

• 822.0 (fracture of patella, closed)
• 822.1 (open)

Patella Fracture Etiology / Epidemiology / Natural History

Patella Fracture Anatomy

• Patella = sesamoid bone within the extensor mechanism of the knee.
• Bipartite patella ; present in @2% of patients.

Patella Fracture Clinical Evaluation

• Knee pain, effusion usually after a direct blow to the knee.
• Inability to extend the knee.

Patella Fracture Xray / Diagnositc Tests

• A/P, lateral , Merchant or sunrise view of the knee. Fracture is generally best seen on lateral view.
• MRI: consider for patients with potential osteochondral fracture. Generally not needed.
• Intra-articular local anesthetic injection: Consider to confirm extensor mechanism is intact in patients in which pain precludes adequate physical exam.

Patella Fracture Classification / Treatment

• Nondisplaced, intact extensor mechanism (generally vertical fractures)
  -Treatment = WBAT in knee brace locked in extention, or cylinder cast.
• Displaced, extensor mechanism disrupted, transverse fracture
  -Treatment = ORIF with cannulated screws and tension band wire / fiberwire.
• Displaced, extensor mechanism disrupted, inferior pole fracture
  -Treatment = partial patellectomy (distal pole) and reattachment of the patellar tendon through drill holes. Must maintain Insall-Salvati ratio around 1.0.

Patella Fracture Associated Injuries / Differential Diagnosis

Patella Fracture Complications

Patella Fracture Follow-up Care

• Post-op: knee brace locked in extention, WBAT in brace
• 7-10 Days: Wound check, confirm reduction on xray. Consider allowing knee ROM to some degree based on stability of fixation at surgery.
• 6 Weeks: Evaluate xrays for union. Advance ROM
• 3 Months: progress with ROM and strengthening
• 6 Months: review xrays, return to full activity / sport
• 1Yr: f/u xrays, assess outcome.

Patella Fracture Review References

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