Fractures of the patella
Objectives- Discuss the incidence of fractures of the patella in children versus that noted in the adult
- Describe the "sleeve" fracture
- Describe the "bipartite" patella
Discussion point
- Can the bipartite patella be painful?
Discussion
Patellar fractures are much less common in children than in adults. Presumably this is secondary to the smaller mass of children and lesser forces being transmitted through the extensor mechanism, also the resiliency of younger structures may be protective. Fractures of the patella may sometimes be hard to recognize. Avulsion fractures may involve the superior, medial, inferior, or lateral patella, and may appear as a bipartite patella, when the actual etiology is traumatic. A type of patellar fracture particular to children is the "sleeve fracture' first reported by Houghton and Ackroyd. In this fracture, the inferior sleeve of articular caritage is avulsed, along with the periosteum and retinaculum. A small piece of bone sometimes accompanies the avulsed cartilage, but not reliably. The sleeve fracture is actually the most common type of patellar fracture in some series, second is a transverse fracture. Displaced transverse fractures and sleeve fractures require open reduction and fixation, a modified tension band wiring is preferred by most authors. Nondisplaced fractures can of course be managed with simple immobilization. Stress fractures have been noted in the patellae of children and may predispose to a more complete fracture.
References
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- Bates DG, Hresko MT, Jaramillo D. Patellar sleeve fracture: demonstration with MR imaging. Radiology 1994;193(3):825-7
- Makhdoomi KR, Doyle J, Moloney M. Transverse fracture of the patella in children. Archives of Orthopaedic & Trauma Surgery 1993;112(6):302-3.
- Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. Journal of Trauma-Injury Infection & Critical Care 1992;32(4):464-7.
- Wu CD, Huang SC, Liu TK. Sleeve fracture of the patella in children. A report of five cases. American Journal of Sports Medicine 1991;19(5):525-8
- Bishay M. Sleeve fracture of upper pole of patella. Journal of Bone & Joint Surgery British Volume 1991;73(2):339.
- Iwaya T, Takatori Y. Lateral longitudinal stress fracture of the patella: report of three cases. Journal of Pediatric Orthopedics 1985;5(1):73-5.
- Ogden JA, McCarthy SM, Jokl P. The painful bipartite patella. Journal of Pediatric Orthopedics 1982;2(3):263-9.
- Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. Journal of Bone & Joint Surgery - British Volume 1979;61-B(2):165-8.
- Grogan DP, Carey TP, Leffers D, Ogden JA. Avulsion fractures of the patella. J Pediatr Orthop 1990;10:721-30.
May 16-19, 2012 in Denver, CO
