Journal Reading

Imaging of Patellar Fracture

Mohamed Jarraya, et al.

Presented by
Azlansa A.K.P. (1610029062)
DPK: dr. Freddy Yoedyanto, Sp.Rad

FAKULTAS KEDOKTERAN UNIVERSITAS

MULAWARMAN
2017
Introduction

Patellar fractures account for

approximately 1% of all skeletal fractures
Most prevalent in individuals between 20
and 50 years of age
Occur twice as often in men as in women
May result from direct, indirect, or
combined trauma
Outline

Anatomy and Function

Imaging modalities
Mechanism of injury and classification of
patellar fractures
Management
Anatomy and Function
Anatomy and Function
Anatomy and Function
Anatomy and Function
Anatomy and Function
Imaging modalities

Evaluation and classification of patellar

fractures is based on anteroposterior (AP),
lateral, and skyline view radiographs of the
knee
CT provided more accurate evaluation of
comminuted fracture of the lower pole
Imaging modalities

MRI commonly used when a

radiographically occult patellar fracture is
suspected
MRI may provides additional information
on the integrity of the soft tissue
components of the extensor mechanism
Imaging modalities (supine AP view)
Imaging modalities (standing AP/PA view)
Imaging modalities (standing AP/PA view)
Imaging modalities (lateral view)
Imaging modalities (lateral view)
Imaging modalities (axial view)
Imaging modalities (axial view)
Mechanism of Injury &
Classification of Patellar Fracture
Result of direct, indirect, or combined injury
The fracture pattern is not determined solely by
mechanism of injury
Commonly classified according to their
morphologic pattern and degree of displacement
Transverse fractures
80% occur in the middle to lower third of the
patella
> 2/3 are displaced
Typically associated with indirect longitudinal
forces
Transverse fracture
Pole fractures
Small proximal or distal avulsion-type fractures
Adolescents are most vulnerable
Pole fracture
Pole fracture
Stellate fractures
65% are non-displaced
Result from direct blow w/ knee in flexed position
Stellate fracture
Stellate fracture
Vertical fractures
Up to 22% of patellar fractures
Commonly involves the lateral facet
Result from direct compression of the patella on a
hyperflexed knee
Vertical fracture
Osteochondral fractures
May be seen after dislocation / subluxation
Fragments can shear from medial patellar facet or
lateral femoral condyle
Osteochondral fracture
Osteochondral fracture
Bipartile Patella
An important differential diagnosis of patellar
fracture
Result from non-fusion of the accesory patellar
ossification centre
Both radiographic appearance and clinical
presentation are critical for correct diagnosis
Bipartile Patella
Bipartile Patella
Dorsal Defect of The Patella (DDP)
Commonly associated w/ bipartite or multipartite
patella
Believed to be an ossification anomaly
Usually heals spontaneously
Management
Goal of management is directed toward restoring
the extensor mechanism while maximizing articular
congruency
Management
Non-surgical management is indicated for fractures
with a clinically intact extensor mechanism and
minimal step-off (<23 mm) and/or fracture
displacement (<14mm)
Management
Surgical management is indicated in the case of an
incompetent extensor mechanism, fracture
separation, intraarticular loose bodies, or
osteochondral fracture
When surgery is indicated, open reduction with
internal fixation may use one or a combination of
the following: tension bands, K-wires, cerclage
wires, cannulated screws, and fixation plate
Management
Management
Partial patellectomy has been described for
displaced transverse and comminuted fractures.
Retention of a portion of the patella is thought to
preserve some of the patellar moment and improve
strength
Management
Total patellectomy is indicated in rare cases of
failed internal fixation, infection, tumour, or
patellofemoral arthritis
Management
Terima Kasih