Patella fracture and tibial condyle fracture

1. Patella fracture and tibial
Condyle fracture
Dr VIVESH KR SINGH
MS ORTHOPAEDIC

2. ANATOMY
• Largest sesamoid bone
• Plays an important role in the biomechanics of
the knee.
• Very hard & triangular-shaped bone

3. • Situated in an exposed position in front
of the knee joint
• separated from the skin by subcutaneous
bursa.
• Patella Surfaces
• Ant.
• Post
• Lat. & med.

4. • Patella borders
- Base
- Med and Lat.
- Apex
• Articulation
• Post. surface central portion, is covered
with a layer of hyaline cartilage.
• • Articular cartilage of the patella is the
thickest in the body (up to 7-mm thick).

5. PATELLAR ALIGNMENT
• Q-angle is the angle formed by two
intersecting lines.
• A normal Q-angle, women >men, is 10 to
15.

6. Types of fracture

7. RISK FACTOR
• Sudden impact
• Osteoporosis
• History of falls

8. SIGNS AND SYMPTOMS
• Localized pain aggravated by movement
• Muscle guarding with passive movement
• Decreased function of the part
• Swelling, deformity, abnormal movement
• Sharp, localized tenderness at the site

9. CLINICAL MANIFESTATIONS
• Pain in the affected knee.
• Lacerations
• Intra-articular effusion
• Palpable defect at the fracture site.
• Hemarthrosis
• Unable to perform a straight leg raise
• Inability to extend the knee against gravity

10. ETIOLOGY
• Subcutaneous location of the patella makes it prone to
injury.
• Fractures occur as a result of a compressive force such as a
direct blow, a sudden tensile force as occurs with
hyperflexion of the knee, or from a combination of these.

11. TESTS AND DIAGNOSTIC PROCEDURES
• X-rays
• Aspiration of a hemarthrosis followed by instillation of intra-articular lidocaine

12. TREATMENT: NON-SURGICAL
• Rest
• gentle motion,
• muscle-setting exercises in pain-free positions.
• Casts or splints
• Crutches

13. TREATMENT: SURGICAL
• Timing of surgery
• If the skin around your fracture has not been broken may recommend waiting until
any abrasions have healed before having surgery.
• Open fractures, however, expose the fracture site to the environment urgently need
to be cleansed and require immediate surgery.

14. • TENSION BAND WIRING(TBW)
• Canulated lag-screw with tension band
• Partialpatellectomy
• Total patellectomy

15. TBW
• This is a surgical procedure to treat transverse patellar fractures, transverse patellar
fracture may be non-displaced or displaced
• In non-displaced or minimally transverse fracture the patient is able to do extend
the knee with full extension.In this condition simply “knee immobiliser” or “knee
brace” is applied to treat the fracture.

16. • Reduction of fracture is done with
reduction clamp.
• K-wires are placed perpendicular
to the fracture.
• Figure of 8 tension band wire is
applied for compression of the
fracture.
• The wire convert anterior
distractive forces to compressive
forces at the articular surface
during the knee flexion and
extension.

17. Canulated lag-screw with tension band
• Wires passes through the screws and across the patella in figure of 8
tension band.

18. PARTIAL PATELLECTOMY
• Usually involving the distal pole,smaller fragments are excised.
• The patellar tendon is attached anteriorly with sutures.

19. TOTAL PATELLECTOMY
• Indicated for comminuted and displaced fractures that cannot be reconstructed.
• Bone fragments are excised before reattachment of the patellar tendon.

20. TIBIAL CONDYLE FRACTURE

21. Mechanism of injury
• Varus or valgus force with axial
loading in fully extended or
partially flexed knee.
• A result of high energy trauma
in adults.
• A result of tivial fall in
osteopenic elderly.

22. Symptoms and sign
• Pain
• Swelling & Haemarthroses knee
• Inability to bear weight
• Restricted mobility
• Instability
• Deformity Around the Knee
• Pale, Cool Foot

23. Associated injuries
• Neurovascular injury
• Compartment syndrome
• DVT
• Contussion & crush injury with open wounds.
• Ligamentous injury – more with # dislocation pattern (60%) as compared to pure #
pattern (4-33%)

24. Radiological assessment
• X-rays
• Antero posterior
• Lateral
• Oblique
• Beam at a 10 degree angle caudally
• Computed tomography.
• Magnetic Resonance Imaging.

25. Classification
• Moore and Hohl classification of primary # pattern

26. Moore and Hohl classification of # dislocation
pattern

27. Schatzkers classification
• Type -1 › 4-6%. Valgus force + Axial loading
• Type–2 › 60-75% Valgus force
• Type–3 Very rare. Pure compression
• Type–4. 7-10% High energy varus force +/- Axial loading
• Type–5 › 2-3% High energy complex varus and valgus force
• Type–6 › 16-20% High energy complex varus and valgus force

29. Treatment
• GOALS:
• Restore articular congruity.
• Axial alignment.
• Joint stability.
• Functional motion at knee.

30. Surgical treatment
• Indications
• Unstable # + ligament injury + articular
• displacement: a) Instability - > 10 degrees of varus or valgus
b) Depression or displacement > 10 mm
• Open #
• # with compartment syndrome › # with vascular injury

31. Treatment modalities
• Percutaneous screw fixation
• › Indications - Nondisplaced type I fractures
• › Advantages - Simple technique with minimal soft-tissue injury.
• › Disadvantages - Not applicable for other patterns of fracture.

32. • Percutaneous elevation and screw fixation
• Indications - Type II and III fractures in osteoporotic bone.
• Advantages - Simple technique with minimal soft-tissue
injury.
• Disadvantages - Not useful for high-energy fractures with
ligamentous and meniscal injuries.

33. • Arthroscopic-assisted elevation and screw fixation
• Indications - Types I, II, III, and IV fractures with ligamentous and meniscal
injuries.
• Advantages –
• Minimal soft-tissue injury.
• Helps to diagnose and treat intra-articular injuries.
• Aids in reduction of depressed articular fractures.
• Allows for joint lavage.
• Disadvantages - Not useful in high-energy fractures

34. • Open reduction and internal fixation with or without bone grafting
• Indications - Types II,III, IV, V, and VI fractures without soft-tissue injury.
• Advantages –
• Allows anatomic reduction.
• rigid internal fixation and bone grafting.
• facilitates joint exploration and treatment of intra-articular injuries.
• Disadvantages –
• Should not be performed in the acute setting in the presence of soft-tissue injury.

35. • External fixators - Half-pin fixator, ring fixator, hybrid fixator
• Indications – Open injuries and high-energy (types IV, V,
• and VI) fractures with soft-tissue injury.
• Fractures with vascular injury with or without compartment syndrome and polytrauma patients
• Advantages –
• Minimal soft-tissue injury.
• Disadvantages –
• Nonrigid fixation.
• Difficult to achieve anatomic fracture reduction.
• Joint stiffness.
• Pin-tract infections.
• Septic arthritis.

36. Follow up
• Non – weight-bearing precautions generally continue
for 12 weeks.
• Active flexion and passive extension are encouraged
for 6 weeks, after which active knee extension is
started.

37. THANK YOU