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Patella Fracture
Posted: Dec 17 2020 #(C101680)
A

Patella Fracture in 55F

HPI

55-year-old female presents to the ED after being struck by a vehicle while crossing the street. Patient is amnestic to the event but EMS reports that she was attempting to cross the street when a vehicle struck her causing her to fall to the ground. They estimate the vehicle was traveling 10 MPH. She was unable to ambulate on scene. Patient reports pain localized to her right knee. Denies any numbness/tingling.

PMH

Anxiety, Depression, HTN, DM2

PE

Focused exam of the RLE: Moderate swelling about the right knee with diffuse TTP. There is a palpable effusion as well as a small abrasion anteriorly. No attempt was made to have the patient straight leg raise secondary to pain. Motor is grossly intact EHL/FHL/GSC. Sensation intact to all distributions of the right foot. PT/DP pulses are palpable. Compartments are soft and compressible.

Poll
1 of 9
1. In addition to plain film radiographs, would you obtain any further imaging to guide your treatment?
No - current radiographs are sufficient
47%
790/1654
Yes - additional radiographs (XR)
1%
31/1654
Yes - CT of the knee (CT)
40%
672/1654
Yes - MRI of the knee (MRI)
3%
55/1654
Yes - XR + CT
3%
64/1654
Yes - XR + MRI
0%
9/1654
Yes - XR + CT + MRI
0%
11/1654
Outside my area of expertise - best if I don't vote
1%
22/1654
2. Would you use a classification system for this injury to guide management?
No - a classification system would not help me
71%
1113/1565
Yes - AO/OTA
22%
345/1565
Yes - Other
2%
33/1565
Outside my area of expertise - best if I don't vote
4%
74/1565
3. How would you manage this injury?
Nonoperative
49%
806/1627
Operative
49%
802/1627
Outside my area of expertise - best if I don't vote
1%
19/1627
4. If you choose Operative management what procedure would you perform?
I would not choose Operative management
29%
473/1580
Open reduction internal fixation (ORIF)
67%
1067/1580
Partial patellectomy
0%
8/1580
Total patellectomy
0%
2/1580
Outside my area of expertise - best if I don't vote e
1%
30/1580
5. If you choose ORIF, what technique would you utilize for fixation?
I would not choose ORIF
16%
249/1552
Screw(s) only
3%
55/1552
Suture(s) only
0%
10/1552
Cerclage wire(s) only
10%
169/1552
Plate and screws only
3%
51/1552
Tension band
31%
493/1552
Combination of above
31%
491/1552
Outside my area of expertise - best if I don't vote
2%
34/1552
6. If you choose Tension band, what technique would you use?
I would not use a Tension band
11%
172/1445
K-wires + wire
46%
667/1445
K-wires + suture
6%
98/1445
Cannulated screws + wire
19%
275/1445
Cannulated screws + suture
13%
194/1445
Outside my area of expertise - best if I don't vote
2%
39/1445
7. If you choose a Tension band construct, would you supplement your fixation?
I would not choose a Tension band construct
10%
147/1379
No - not necessary
37%
513/1379
Yes - with suture
22%
309/1379
Yes - with wire
27%
375/1379
Outside my area of expertise - best if I don't vote e
2%
35/1379
8. If you choose ORIF and attained the construct shown below, how would you immobilize the patient postoperatively?
I would not immobilize the patient
17%
231/1335
Hinged knee brace
43%
582/1335
Knee immobilizer
27%
368/1335
Long leg posterior splint
7%
94/1335
Long leg cast
3%
45/1335
Outside my area of expertise - best if I don't vote
1%
15/1335
9. If you choose ORIF, and attained the construct shown below, when would you allow full range of motion?
Immediately
8%
122/1365
< 2 weeks
5%
78/1365
2-4 weeks
21%
294/1365
5-6 weeks
43%
593/1365
7-8 weeks
14%
202/1365
9-10 weeks
1%
23/1365
>10 weeks
2%
28/1365
Outside my area of expertise - best if I don't vote
1%
25/1365
PROCEDURE #1

ORIF Patella Fracture, CPT 27524

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OUTCOMES
Post-procedure P1
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