Patella is the kneecap bone. It is located in the extensor mechanism in front of the knee and acts as a lever during knee extension. Patella fractures account for approximately 1% of all fractures. Direct and indirect traumas can lead to patella fractures. Patella fractures can be simply classified as displaced and non-displaced fractures. It is important to evaluate the extensor mechanism. Nondisplaced fractures with extensor continuity can be treated conservatively with a cylindrical cast. Surgical treatment is required for displaced fractures.
Etiopathogenesis: Loads that will cause fractures in the patella are divided into two: direct and indirect. Direct blows and collisions to the patella, which is very superficial under the skin, cause fractures after direct loading on the patella. For example, the direct mechanism caused by falling on the knee on a hard ground or hitting the knee on the dashboard of a car creates fractures ranging from simple transverse fractures to comminuted fractures. Fractures that develop with an indirect injury mechanism develop in loads that cause sudden and strong contraction of the quadriceps muscle or that force the knee to flex at a time while this muscle is in strong contraction.
Fractures that occur with a direct mechanism are fractures that are more unslipped or less shifted. . In simple transverse fractures that develop in this way, no significant separation is observed in the fragments. In most cases of comminuted fractures, there are wide separations between the fragments and tears in the lateral and medial retinaculum.
Symptoms and findings: The clinical picture develops dramatically in proportion to the extent of the fracture and injury, primarily in the joint area. swelling is seen. Painful swelling in the knee and weakness or inability to extend should suggest a patella fracture. If there is separation in the fracture, the upper fragment slides upward with quadriceps contraction, while the lower fragment rotates forward, under the skin. In this case, separation in the fragments is felt by palpation. This is called the step symptom. Tears in the retinacular processes adjacent to the patella cannot allow active extension of the knee.
Radiologically, a definitive diagnosis is made with anteroposterior and lateral radiographs. And with these radiological examinations, the type of fracture is revealed. In edge fractures, front-back and side films It is mandatory to take tangential patella films.
Treatment: First of all, if there is excessive hematoma accumulation following the fracture, it is aspirated, and then the knee is placed in a grooved plaster splint in extension. In transverse fractures that do not disrupt the anatomical shape of the patella and where there is no staircase on the joint surface, there is a distance of 2-4 mm between the fracture fragments. Conservative treatment is applied in patients with a gap of 1.5 mm but in whom the lateral retinaculum is not damaged or in longitudinal fractures. In these cases, 4-6 weeks of fixation with a cylindrical leg cast is sufficient. 4mm between fragments. and in more open fractures, continuity of the joint surfaces is essential. In this case, the fragments are joined together with stainless steel cerclage wires or screws through open surgery. Tears in the retinaculum are stitched. The aim is to restore the anatomical integrity of the patella. After the surgery, the patient must receive physiotherapy under the control of the doctor and physiotherapist.
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