Patellar fracture: The Daily PANCE Blueprint
A 45-year-old male presents to the ER after falling directly onto his knee. On physical exam, he has tenderness over the patella and is unable to perform a straight leg raise. Radiographs reveal a displaced patellar fracture with 4 mm of displacement and a 3 mm articular step-off. Which of the following is the most appropriate next step in management?
A. Knee immobilization in extension with early weight bearing as tolerated
B. Open reduction and internal fixation
C. Arthroscopic evaluation only
D. Closed reduction and casting in flexion
E. Observation with serial radiographs
Answer and topic summary
The answer is B. Open reduction and internal fixation
A patellar fracture is usually due to direct injuries (e.g, fall, dashboard injury, high-energy trauma) to the knee OR indirect injuries (i.e., rapid contracture of the quadriceps with a flexed knee). It’s a relatively rare injury. On physical exam, the patient may be unable to perform a straight leg raise and may have tenderness over the patella. Treatment depends, but can be non-operative (knee immobilized in extension with early WBAT) or operative (open reduction and internal fixation), depending on the many factors (degree of displacement, extensor mechanism intact or not, open fractures, loose bodies, etc). In this specific case, the patient has a displaced patellar fracture with disruption of the extensor mechanism (inability to perform straight leg raise), which requires surgical intervention.
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Covered under ⇒ PANCE Blueprint Musculoskeletal ⇒ ⇒
