Dr. Ebraheim’s educational animated video describes Patellar Fractures, its types, and fixation.
Movement of the patella across the knee is normally a gliding, smoot movement.
A patellar fracture is an injury to the kneecap. These fractures are commonly caused by a direct blow to the kneecap or from a fall.
Patellar fracture types
1-Transverse fracture: fracture can be non-displaced or displaced.
nondisplaced fracture or minimally displaced fracture: the patella can be pulled apart by the attached thigh muscles. The patient is able to extend the knee with full extension.
Displaced fracture: the patient is unable to extend the knee.
2-Upper or lower pole fracture: fracture at the site of attachment of the patellar tendon.
3-Comminuted fracture: multiple pieces. Fracture can be non-displaced or displaced. This fracture type shatters into three or more pieces and is very unstable.
4-Vertical fracture: fracture is nondisplaced and stable. The fracture fragments usually stay in place during healing.
5-Osteochondral fracture of the patella usually associated with acute dislocation of the patella. Osteochondral fractures are located in the facet area of the patella.
Treatment
Transverse patellar fractures
Nondisplaced or minimally displaced transverse fracture: knee immobilizer or brace.
Displaced fracture:
•reduction of fracture with reduction clamp
•k-wires are placed perpendicular to the fracture.
•Figure 8 tension band wire is applied for compression of the fracture.
•The wires convert anterior distractive forces to compressive forces at the articular surface.
•Cannulated lag-screw with tension band: wire passes through the screws and across the patella in figure 8- tension band.
Partial patellectomy
•Usually involving the distal pole, smaller fragments are escised.
•The patellar tendon is reattached anteriorly with sutures.
Total patellectomy
•Indicated for comminuted and displaced fractures that cannot be reconstructed.
•Bone fragments are excised before reattachment of the patellar tendon.

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