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Patella Fracture in 54M
HPI
A 54-year-old male presents to the ED with a chief complaint of left knee pain after a fall. He reports falling directly onto his left knee when he slipped on a recently cleaned hardwood floor. The patient was unable to ambulate after the fall. He denies any pain in any other extremity. He denies any head trauma or loss of consciousness.
PMH
Hypertension
PE
A focused examination of the left lower extremity demonstrates swelling over the patella without open wounds. There is a palpable defect overlying the patella. He's unable to perform a straight leg raise. Motor is grossly intact to EHL/FHL/GSC. Sensation intact to all distributions of the LLE. PT and DP pulses are palpable.
1.
In addition to the radiographs provided, would you obtain any further imaging to guide your management?
No - Current radiographs are sufficient
41%
569/1357
Yes - additional radiographs (aXR)
3%
43/1357
Yes - CT scan (CT)
45%
624/1357
Yes - MRI
2%
37/1357
Yes - aXR + CT
1%
26/1357
Yes - aXR + MRI
0%
10/1357
Yes - CT + MRI
1%
23/1357
Yes - aXR + CT + MRI
0%
4/1357
Outside my area of expertise - best if I don't vote
1%
21/1357
2.
Would you use a classification system for this injury to guide management?
No - a classification system would not help me
68%
889/1290
Yes - AO/OTA
22%
289/1290
Yes - Other
2%
27/1290
Outside my area of expertise - best if I don't vote
6%
85/1290
3.
How would you manage this injury?
Nonoperative
0%
13/1308
Operative
97%
1272/1308
Outside my area of expertise - best if I don't vote
1%
23/1308
4.
If you choose Operative management, what procedure would you perform?
I would not choose Operative management
0%
6/1296
Open reduction internal fixation (ORIF)
84%
1092/1296
Partial Patellectomy +/- Patellar Tendon repair/advancement
9%
117/1296
Total Patellectomy +/- Patellar Tendon repair/advancement
2%
38/1296
Outside my area of expertise - best if I don't vote
3%
43/1296
5.
If you choose ORIF, what technique would you utilize for your primary fixation?
I would not choose ORIF
0%
4/1290
Screw(s) only
0%
6/1290
Suture(s) only
0%
4/1290
Cerclage wire(s) only
5%
72/1290
Plate and screws only
6%
88/1290
Tension band
11%
151/1290
Combination of above
71%
924/1290
Outside my area of expertise - best if I don't vote
3%
41/1290
6.
If you choose Tension band, what technique would you use?
I would not use a Tension band
17%
213/1203
K-wires + wire
40%
487/1203
K-wires + suture
10%
122/1203
Cannulated screws + wire
16%
200/1203
Cannulated screws + suture
11%
135/1203
Outside my area of expertise - best if I don't vote
3%
46/1203
7.
If you choose a Tension band construct, would you supplement your fixation?
I would not choose a Tension band construct
12%
138/1149
No - not necessary
4%
57/1149
Yes - with suture
37%
431/1149
Yes - with wire
41%
480/1149
Outside my area of expertise - best if I don't vote
3%
43/1149
8.
If you choose ORIF with Plate and screws, what type of plate would you utilize?
I would not choose ORIF with plate and screws
35%
397/1116
Mesh plate
23%
261/1116
Mini fragment plate
13%
155/1116
Mesh + mini fragment plate
19%
219/1116
Other
1%
16/1116
Outside my area of expertise - best if I don't vote
6%
68/1116
9.
If you choose ORIF with Plate and screws, would you supplement your fixation?
I would not choose ORIF with plate and screws
38%
398/1041
Yes, with suture
25%
263/1041
Yes, with wire
18%
191/1041
Yes, with wire and suture
12%
131/1041
Other
1%
12/1041
Outside my area of expertise - best if I don't vote
4%
46/1041
10.
If you choose ORIF and attained the construct shown below, how would you immobilize the patient postoperatively?
I would not choose ORIF with plate and screws
9%
90/959
I would not immobilize the patient
4%
44/959
Hinged knee brace
42%
405/959
Knee immobilizer
28%
274/959
Long leg posterior splint
8%
79/959
Long leg cast
5%
49/959
Outside my area of expertise - best if I don't vote
1%
18/959
11.
If you choose ORIF, and attained the construct shown below, when would you allow full range of motion?
Immediately
3%
35/1016
< 2 weeks
2%
26/1016
2-4 weeks
13%
137/1016
5-6 weeks
46%
475/1016
7-8 weeks
25%
260/1016
9-10 weeks
1%
20/1016
>10 weeks
4%
44/1016
Outside my area of expertise - best if I don't vote
1%
19/1016
12.
If you choose ORIF and attained the construct shown below, what would be your strategy for hardware removal?
I would not choose ORIF with plate and screws
5%
55/956
Remove only if symptomatic once fracture union confirmed with radiographs
53%
508/956
Remove only if symptomatic once fracture union confirmed with CT
23%
222/956
Planned removal regardless of symptoms once fracture union confirmed with radiographs
8%
78/956
Planned removal regardless of symptoms once fracture union confirmed with CT scan.
4%
39/956
Planned removal regardless of symptoms and without confirmation of fracture union with imaging at a specific time point (e.g., 6 months)
2%
26/956
Outside of my area of expertise - best is I don't vote
2%
28/956
PROCEDURE #1
DOP: 10/29/2021
OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNAL FIXATION AND/OR PARTIAL OR COMPLETE PATELLECTOMY AND SOFT TISSUE REPAIR - CPT 27524
Intra-procedure P1
OUTCOMES
Post-procedure P1
4 months
Post-procedure P1