Patella Fracture Case Presentation

CASE PRESENTATION

INTRODUCTION & BACKGROUND:

                   A patellar fracture is a break in the patella, or kneecap, the small bone that sits at the front of your knee. Because the patella acts as a shield for your knee joint, it is vulnerable to fracture if you fall directly onto your knee or hit it against the dashboard in a vehicle collision. A patellar fracture is a serious injury that can make it difficult or even impossible to straighten your knee or walk.

Some simple patellar fractures can be treated by wearing a cast or splint until the bone heals. In most patellar fractures, however, the pieces of bone move out of place when the injury occurs. For these more complicated fractures, surgery is needed to restore and stabilize the kneecap and allow for the return of function.

ANATOMY:

CLASSIFICATION:

  SPECK and REGAZZONI:

     AO Classification:

PATIENT INFORMATION:

Ø  Patient - ‘X’

Ø  Age - 75 years/ Female

Ø  Date of Admission: 05/12/2018

Ø  Date of Surgery: 07/12/2018

CHIEF COMPLAINT:

    The patient had pain, swelling, and tenderness over the left knee (knee cap). The patient had restricted left knee movements and inability to stand and walk few steps since fall (05/12/2018).

HISTORY OF PRESENT ILLNESS:

    The patient had restricted knee movements and inability to use Left knee since fall. The patient gave a history of slip and fall at the market. Since then patient complaints of pain, swelling, range of movements restricted.

            After the injury patient brought by ambulance to the hospital. In the hospital, the patient has been taken to the emergency department. The patient was examined by traumatologist and got admitted in the traumatology department. X-ray was taken and it showed transverse fracture patella with displacement.

v Previous Injury: The patient gave a history of fractured left wrist in 2017 treated conservatively

v Developmental History: No any developmental histories

v Drug History: No known drug allergies. The patient is on treatment for CVS.

v Past Medical History: The patient gave a past medical history of Ischemic heart diseases, Cardiosclerosis, CHF IIA, Arterial Hypertension II, Risk IV.

No DM; No Asthma; No thyroid disease.

v Past Surgical History: No & No any blood transfusion.

ON EXAMINATION:

Patient is conscious, oriented.

Vital Signs:

·       BP – 130/80 mmHg

·       PR – 80/min

·       SPO2 – 98%

LOCAL EXAMINATION:

·       Pain and Swelling over the Left knee are present.

·       Tenderness and Crepitus over the Left knee are present.

·       The range of Motion of Left knee is restricted.

·       Any attempted movements painful.

·       Active toe movements present.

·       Distal pulse present.

X-RAY FINDING:

                        Transverse Fracture Patella with displacement Left knee.

AP view:

Lat view:

PREPARATION:

Patient in Supine position: Place the patient on a radiolucent table. A small bolster can be beneath the buttock to prevent external rotation of the lower extremity.

SKIN INCISION:

Midaxial longitudinal approach: Make a longitudinal mid-axial incision from 5cm above the superior pole of the patella to the tibial tubercle.

PROCEDURE:

K-wire insertion :

Using the outside-in technique, drill the first K-wire in an axial direction. The second K-wire is then drilled parallel to the first, through the reduced fragments. It may be difficult to find the right direction and position for the wires.

Two parallel K-wires should be inserted to give more stable fixation.

Tension Band insertion:

POSTOPERATIVE X-RAY:

                                                       Lat view:                                                            

                              

AP view:

CLASSIFICATION:

Ø  According to AO Trauma Classification - C 1.1

Ø  According to Speck and Regazzoni Classification – B2

 CONCLUSION:

Ø  Early surgery, good anatomical reduction, and internal fixation help to recover the full range of movements.

Ø  Stability is RESTORED.

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