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Patella Fracture
Posted: Mar 6 2014 #(C1815)
A

Patella fracture in 59F

HPI

s/p nonsyncopal fall at work earlier today. No prior knee pain or injuries.

PMH

None. Nonsmoker. BMI 34. Works full-time in a mailroom.

PE

R knee: loss of extensor mechanism, mild contusion to anterior knee, + effusion, no lacerations/skin defects/scars to knee. Nontender elsewhere.

Poll
1 of 11
1. In addition to plain film radiographs, would you obtain any other imaging to guide management?
No - current radiographs are sufficientent
76%
1085/1420
Yes - additional radiographic views (XR)
3%
50/1420
Yes - CT scan of the knee (CT)
12%
183/1420
Yes - MRI scan of the knee (MRI)
2%
34/1420
Yes - CT + XR
1%
24/1420
Yes - MRI + XR
0%
4/1420
Yes - MRI + CT
0%
14/1420
Yes - MRI + CT + XR
0%
2/1420
Outside my area of expertise - best I don't answer
1%
24/1420
2. Would you use a classification system to guide management?
No - a classification system would not help me
75%
1003/1336
Yes - AO classification
16%
225/1336
Yes - Speck and Regazzoni
2%
32/1336
Yes - Other
0%
11/1336
Outside of my area of expertise - best I don't answer
4%
65/1336
3. How would you manage this injury?
Nonoperative
2%
40/1389
Operative
95%
1332/1389
Outside my area of expertise - best if I don't vote
1%
17/1389
4. If you choose Operative management, what type of surgery would you perform?
I would not choose Operative management
0%
12/1357
Open reduction internal fixation (ORIF)
94%
1286/1357
Partial patellectomy (includes tendon repair/advancement)
2%
28/1357
Total patellectomy
0%
6/1357
Outside of my area of expertise - best I don't answer
1%
25/1357
5. If you choose Open reduction internal fixation (ORIF), what construct would you use?
I would not choose ORIF
0%
6/1349
Tension band (K-wires or Screws) only
35%
477/1349
Cerclage only
2%
32/1349
Plate/screws only
2%
39/1349
Tension band + Cerclage
42%
570/1349
Tension band + Plate/screws
6%
84/1349
Plate/screws + Cerclage
4%
55/1349
Tension band + Cerclage + Plate/screws
3%
46/1349
Outside my area of expertise - best I don't answer
2%
40/1349
6. If you choose ORIF with a Tension band construct, what implants would you use?
I would not choose ORIF with a Tension band construct
1%
21/1272
K-wires + Wire
45%
581/1272
K-wires + Cable
16%
205/1272
K-wires + Heavy non-absorbable sutures (e.g. fiberwire)
6%
85/1272
Screws + Wire
11%
143/1272
Screws + Cable
3%
48/1272
Screws + Heavy non-absorbable sutures (e.g. fiberwire)
11%
142/1272
Outside my area of expertise - best if I don't vote
3%
47/1272
7. If you choose ORIF with a Cerclage construct, what implants would you use?
I would not choose ORIF with a Cerclage construct
16%
199/1210
Wire
54%
655/1210
Cable
8%
107/1210
Heavy non-absorbable sutures (e.g. fiberwire)
17%
210/1210
Outside of my area of expertise - best I don't answer
3%
39/1210
8. If you choose ORIF with a Plate/Screw construct, what implants would you use?
I would not choose ORIF with a Plate/Screw construct
65%
758/1153
Mesh plate(s)/screws
10%
126/1153
Mini-frag plate(s)/screws
10%
120/1153
Mesh + Mini-frag plate(s)/screws
5%
59/1153
Other
3%
35/1153
Outside of my area of expertise - best I don't answer
4%
55/1153
9. If you choose Operative management and attained the construct shown below, how would you immobilize the patient post-operatively?
I would not choose Operative management
0%
3/1121
No immobilization (soft dressings only)
17%
200/1121
Knee immobilizer
21%
242/1121
ROM hinged knee brace (locked in extension)
49%
551/1121
Long-leg splint
5%
58/1121
Long-leg cast
3%
43/1121
Outside my area of expertise - best if I don't vote
2%
24/1121
10. If you choose Operative management and attained the construct shown below, when would you begin range of motion of the knee?
I would not choose Operative management
0%
1/1135
Immediately
19%
226/1135
1-2 weeks
23%
265/1135
3-4 weeks
32%
370/1135
5-6 weeks
18%
208/1135
7-8 weeks
2%
29/1135
>8 weeks
0%
10/1135
Outside my area of expertise - best if I don't vote
2%
26/1135
11. If you choose Operative management and attained the construct shown below, what would be your strategy to remove the hardware?
I would not choose Operative management
0%
4/1125
Leave in unless symptomatic
67%
755/1125
Planned removal once union on radiographs
6%
75/1125
Planned removal once union on CT scan
1%
16/1125
Planned removal at 3-4mo
2%
24/1125
Planned removal at 5-6mo
2%
26/1125
Planned removal at >6mo
17%
193/1125
Outside my area of expertise - best if I don't vote
2%
32/1125
PROCEDURE #1 DOP: 3/6/2014

ORIF Patella

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