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PATELLA
INJURIES
The fracture will displace if the quadriceps tendon is torn
and the quadriceps muscle pulls the fragments apart.
Lateral patella dislocations follow a direct force to the medial
side of the bone or from a twisting injury in a developmentally
unstable patella. To reduce the dislocation, place the knee
in extension and push the patella medially.
Evaluation
Suspect a fracture from the history of the injury and from
swelling and pain directly over the anterior knee. If the fracture
is displaced, the patient is unable to extend the leg and a
gap is often palpable between the displaced fragments.
A rupture of the quadriceps tendon proximal to the patella,
or to the patella tendon distal to it, has similar physical
findings. X-rays confirm diagnosis.
Treatment
Non-displaced fractures
Treat non-displaced fractures in a splint or cylinder cast
for 4–6 weeks. Permit full weight bearing in the cast.
Displaced fractures
Treat displaced fractures by surgical repair of the fracture,
or by suture of the quadriceps tendon mechanism (Figure
18.52).
Remove comminuted fragments and, if necessary, remove a portion
of the patella. Place in a splint or cast as for non-displaced
fractures.
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