Basildon EM Handbook 2018

Patella fractures

March 2018 | by EMauthor

Introduction

•Can result from a fall on the patella or sudden strong contraction of the quadriceps

•Clinically there is inability to weight bear, inability to extend the knee and inability to straight leg raise, a palpable gap may be felt.

•Diagnosis is by x-ray, AP and lateral (in extension) will be enough in most cases, Skyline view may be helpful if the condition is strongly suspected

•Be careful not to confuse congenital bipartite patella with fracture, it is found on the upper and outer quadrant of the patella

Management

•Undisplaced fractures with intact knee extension mechanism (able to straight leg raise)

oSplit POP cylinder or similar

oNon-weight bearing crutches

oFracture clinic follow up

•Displaced fractures and or disrupted knee extension mechanism will require surgery

oApply split POP cylinder

oRefer to orthopaedics  

•All compound fractures need dressing, IV antibiotics and urgent referral

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