6 patellar fracture dnbid lecture

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6 patellar fracture dnbid lecture

  1. 1. PATELLAR FRACTURES Dr. D. N. Bid
  2. 2. Definition <ul><li>Patellar #s are classified as either non-displaced or displaced. Those that are less than 1-2 mm articular step-off or 3 mm of fragment separation displaced are considered nondisplaced #s. </li></ul><ul><li>Patellar #s may also be described as transverse, longitudinal, or comminuted. </li></ul><ul><li>Extraarticular patellar #s involve the poles of patella and are usually secondary to avulsion injuries. </li></ul>dnb
  3. 4. Transverse patellar # with retinacular tear. dnb
  4. 5. Patellar #s may be described as longitudinal or comminuted. These #s are intra-articular. dnb
  5. 6. Mechanism of Injury <ul><li>A direct blow to the patella accounts for the majority of patellar fractures. </li></ul><ul><li>Indirect force from a violent contraction of the quadriceps muscle can also result in a patellar #. </li></ul>dnb
  6. 8. Treatment Goals <ul><li>Orthopaedic Objectives </li></ul><ul><ul><li>Alignment </li></ul></ul><ul><ul><ul><li>1. Fracture Displacement. </li></ul></ul></ul><ul><ul><ul><li>2. Articular congruity. </li></ul></ul></ul><ul><ul><li>Stability </li></ul></ul><ul><ul><ul><li>Stability is best achieved by restoring bony congruity and using hardware to rigidly fix the #. </li></ul></ul></ul>dnb
  7. 9. <ul><li>Rehabilitation Objectives </li></ul><ul><ul><ul><li>Range of Motion </li></ul></ul></ul><ul><ul><ul><li>Muscle strength </li></ul></ul></ul><ul><ul><ul><li>Functional Goals </li></ul></ul></ul>dnb
  8. 10. <ul><li>Rehabilitation Objectives </li></ul><ul><ul><ul><li>Range of Motion </li></ul></ul></ul><ul><ul><ul><ul><li>1. Restore full ROM of the knee in flexion and extension to prevent extension lag. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>2. Restore the rectus femoris (two joint muscle) to its full length so as to achieve full ROM of the hip and knee. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>3. Maintain ligamentous flexibility, which may be reduced secondary to trauma and immobilization. </li></ul></ul></ul></ul>
  9. 11. <ul><li>Rehabilitation Objectives </li></ul><ul><ul><ul><li>Muscle strength </li></ul></ul></ul><ul><ul><ul><ul><li>A) improve the strength of the quadriceps muscle. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>B) improve the strength of the hamstrings muscles. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>C) improve the quadriceps-hamstring balance. </li></ul></ul></ul></ul>
  10. 12. <ul><li>Rehabilitation Objectives </li></ul><ul><ul><ul><li>Functional Goals </li></ul></ul></ul><ul><ul><ul><ul><li>Normalize the gait pattern, specially in stance phase. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Undertake proprioceptive and sport specific training. </li></ul></ul></ul></ul>
  11. 13. Expected time of Bone Healing <ul><li>8-12 weeks </li></ul>dnb
  12. 14. Expected Duration of Rehabilitation <ul><li>12-15 Weeks </li></ul>
  13. 15. Methods of Treatment <ul><li>Cast or Knee Immobilizer </li></ul><ul><li>Open Reduction and Internal Fixation </li></ul><ul><li>Partial / Total Patellectomy </li></ul>
  14. 16. Transverse patellar fracture with intraarticular involvement dnb
  15. 17. Transverse patellar fracture treated with lag screw fixation. This is stress shielding device unless solid fixation is not achieved. dnb
  16. 18. Transverse patellar # with displacement. dnb
  17. 19. Transverse patellar # treated with tension band wiring. As the quadriceps muscle attempts to separate # fragments, the wire tightens, forcing them back together. dnb
  18. 22. Tension band fixation for a transverse patellar #. The parallel wires control alignment and the tension band wire tightens with any attempt to distract the fracture. This is a stress sharing device. dnb
  19. 23. Special considerations of the Fracture <ul><li>Bipartite Patella </li></ul><ul><li>Long term sequelae </li></ul>
  20. 24. <ul><li>Bipartite Patella </li></ul><ul><ul><li>Frontal view of the knee demonstrates the characteristic appearance of a bipartite patella . </li></ul></ul><ul><ul><li>The ununited ossification center is typically in the upper, lateral aspect of the patella (red arrow). This occurs in about 2% of the population, is much more common in males and is bilateral 57% of the time. </li></ul></ul>
  21. 25. Associated Injury <ul><li>Retinacular tear </li></ul>
  22. 26. <ul><li>Weight bearing </li></ul>
  23. 27. Gait Cycle <ul><li>What is the effect during each phase? </li></ul><ul><li>Stance Phase </li></ul><ul><ul><li>Heel strike </li></ul></ul><ul><ul><li>Foot flat </li></ul></ul><ul><ul><li>Mid-Stance </li></ul></ul><ul><ul><li>Push off </li></ul></ul><ul><li>Swing Phase </li></ul><ul><ul><li>Acceleration </li></ul></ul><ul><ul><li>Mid-swing </li></ul></ul><ul><ul><li>Deceleration </li></ul></ul>
  24. 28. Treatment <ul><li>Treatment: Early to immediate </li></ul><ul><li>(Day One to One week) </li></ul><ul><li>Treatment: Two weeks </li></ul><ul><li>Treatment: Four to Six weeks </li></ul><ul><li>Treatment: Eight to Twelve weeks </li></ul>
  25. 29. Long Term Considerations and Problems
  26. 30. <ul><li>Thank You </li></ul>

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