Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Patella Fracture
Posted: Oct 29 2021 #(C101834)
A

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.

Poll
1 of 12
1. In addition to AP and LAT radiographs of the knee, what additional imaging would you obtain to guide your management?
None, AP and LAT radiographs of the knee are sufficient
42%
579/1377
Additional radiographs (aXR)
3%
45/1377
CT scan (CT)
45%
632/1377
MRI
2%
37/1377
aXR + CT
1%
26/1377
aXR + MRI
0%
10/1377
CT + MRI
1%
23/1377
aXR + CT + MRI
0%
4/1377
Outside my area of expertise - best if I don't vote
1%
21/1377
2. Would you use a classification system for this injury to guide management?
No - a classification system would not help me
68%
902/1309
Yes - AO/OTA
22%
294/1309
Yes - Other
2%
27/1309
Outside my area of expertise - best if I don't vote
6%
86/1309
3. How would you manage this injury?
Nonoperative
0%
13/1327
Operative
97%
1291/1327
Outside my area of expertise - best if I don't vote
1%
23/1327
4. If you choose Operative management, what procedure would you perform?
I would not choose Operative management
0%
6/1315
Open reduction internal fixation (ORIF)
84%
1111/1315
Partial Patellectomy +/- Patellar Tendon repair/advancement
8%
117/1315
Total Patellectomy +/- Patellar Tendon repair/advancement
2%
38/1315
Outside my area of expertise - best if I don't vote
3%
43/1315
5. If you choose ORIF, what technique would you utilize for your primary fixation?
I would not choose ORIF
0%
4/1308
Tension Band Only
11%
152/1308
Plate (with plate screws) Only
6%
90/1308
Stand-Alone Screw(s) Only
0%
7/1308
Suture(s)/Tapes(s) Only
0%
4/1308
Cerclage Wire(s) Only
5%
73/1308
Combination of above
71%
937/1308
Outside my area of expertise - best if I don't vote
3%
41/1308
6. If you choose ORIF with Tension Band fixation, what method would you use?
I would not choose ORIF with a Tension band
17%
217/1221
K-wires + wire
40%
493/1221
K-wires + suture
10%
123/1221
Cannulated screws + wire
16%
205/1221
Cannulated screws + suture
11%
137/1221
Outside my area of expertise - best if I don't vote
3%
46/1221
7. If you choose ORIF with Tension Band fixation, would you supplement your fixation?
I would not choose a Tension band construct
11%
138/1167
No - not necessary
5%
60/1167
Yes - with suture
37%
437/1167
Yes - with wire
41%
489/1167
Outside my area of expertise - best if I don't vote
3%
43/1167
8. If you choose ORIF with a Plate (with plate screws) Alone, what type of plate would you utilize?
I would not choose ORIF with plate and screws
35%
404/1134
Mesh plate
23%
267/1134
Mini fragment plate
13%
156/1134
Mesh plate + Mini fragment plate
19%
223/1134
Other
1%
16/1134
Outside my area of expertise - best if I don't vote
5%
68/1134
9. If you choose ORIF with a Plate with screws, would you supplement your fixation?
I would not choose ORIF with plate and screws
38%
404/1057
Yes, with suture
25%
268/1057
Yes, with wire
18%
194/1057
Yes, with wire and suture
12%
133/1057
Other
1%
12/1057
Outside my area of expertise - best if I don't vote
4%
46/1057
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%
91/974
I would not immobilize the patient
4%
44/974
Hinged knee brace
42%
414/974
Knee immobilizer
28%
279/974
Long leg posterior splint
8%
79/974
Long leg cast
5%
49/974
Outside my area of expertise - best if I don't vote
1%
18/974
11. If you choose ORIF and obtained the construct shown, when would you allow full range of motion?
Immediately
3%
36/1031
< 2 weeks
2%
26/1031
2-4 weeks
13%
142/1031
5-6 weeks
46%
481/1031
7-8 weeks
25%
263/1031
9-10 weeks
1%
20/1031
>10 weeks
4%
44/1031
Outside my area of expertise - best if I don't vote
1%
19/1031
I would not have performed the construct shown
0%
0/1031
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%
56/971
Remove only if symptomatic once fracture union confirmed with radiographs
53%
517/971
Remove only if symptomatic once fracture union confirmed with CT
22%
223/971
Planned removal regardless of symptoms once fracture union confirmed with radiographs
8%
80/971
Planned removal regardless of symptoms once fracture union confirmed with CT scan.
4%
41/971
Planned removal regardless of symptoms and without confirmation of fracture union with imaging at a specific time point (e.g., 6 months)
2%
26/971
Outside of my area of expertise - best is I don't vote
2%
28/971
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
icon
OUTCOMES
Post-procedure P1
4 months after
Post-procedure P1
Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options