Fractured Patella

[Physiobase]

I have a new patient who has been recovering well from a fractured patella. He is about 8 weeks post fracture and is now full weight-bearing.

Although his surgeon is now happy for him to "push" for return of quads control and muscle bulk I am wondering if someone can assist in suggesting a planned approach in terms of bone healing. His fracture was treated conservatively although it did extend in vertical direction and went all the way into the joint line. The patella feels like one solid piece however I cannot see any callous formation on a skyline x-ray view. Perhaps this is normal for patella fractures?

Any protocol info would be greatly appreciated 8o

[somasimple]

Hi,

The patella feels like one solid piece

The patella is highly surrounded by fibrous tendons/ligaments and maintains bones in relative good place.
I had a such patient and the principal thing was recovering a normal functioning with a graded exposure. If patient does not have pain and is normally moving then?

Bone healing was simply... unanswered :lol

If it is sure that it was the facture of the patella, it is important to be able to differentiate radiographically between a fracture of the patella where the fracture lines tends to be more oblique then the bipartite patella and even stress fracture of the patella-most patellar stress fractures are of the transverse type, occasionally occur lateral longitudinal fractures;if it was undispaced fracture with normal continuity of the extensor mechanism it managed conservatively, initially with an extensor splint. Fracture units in period of 6-8 weeks. When the fragments are dislocated, and where the extensor mechanism is not intact, require sugical treatment. This involves reduction of the patella and fixaton, usually with a tension band wire technique. The vastus muscle also needs to be repaired. The rehabilitation following this procedure is as for undisplaced fracture.

Best regards Nale

[Physiobase]

Thanks Nale, my thoughts are like yours. It is a vertical, not transverse fracture and is in the later third so the VMO etc is intact. The fracture is to the joint line however although the skyline view shows good alignment (but no callous formation). The lack of callous at 6 weeks was/is really my dilemma 8o