DESCRIPTION
Patellar Fracture
Tibial Plateau Fracture
Tibial Tuberosity Fracture
SIGNS & SYMPTOMS
Patellar Fracture
Tibial Plateau Fracture
Tibial Tuberosity Fracture
DIAGNOSTIC TESTS
What test can you use for fractures?
PT IMPLICATIONS
Patellar Fracture
Tibial Plateau Fracture
Tibial Tuberosity Fracture
(click here to see references)
Patellar Fracture
- Patellar is a sesamoid bone located on the anterior portion of the knee joint. Patellar fractures are frequently caused by direct trauma to the patella bone. There are four major types of patellar fractures: stable fracture, displaced fracture, communuted fracture, and open fracture. A stable fracture is a non-displaced fracture in which the breaks on the patella can be correctly aligned. A displace fracture is characterized when the breaks on the patella are separated and do not line up. Displaced fractures often require surgery. A comminuted patellar fracture is when the patella bone is shattered into three or more smaller bone fragments. An open fracture is a fracture in which the skin has been broken, exposing the bone. Open fractures to the patella often involve damage to surrounding anatomical structures around the knee.
Tibial Plateau Fracture
- Tibial plateau fractures are caused by side loading secondary to either a varus or valgus force combined with axial compression, which results in the femoral condyle impacting on the tibia.
Tibial Tuberosity Fracture
- Tibial tubercle avulsion fractures are rare injuries
- more prevalent in adolescences undergoing growth spurt.
SIGNS & SYMPTOMS
Patellar Fracture
- Common mechanism of injury include dashboard injury from MVA and a violent knee flexion injury. Avulsion fracture of patella as a result of pull of the quadricep muscle against resistance.
- Swelling and pain in anterior knee
- Extensor weakness
Tibial Plateau Fracture
- Common mechanism of injury include motor vehicle crashes, falls and athletic activities such as skiing.
- Pain and swelling in knee
- Patients hold their knee in a slightly flexed position
Tibial Tuberosity Fracture
- Most tibial tuberosity fractures are the result of an indirect force delivered by an eccentric load (eg. sudden flexion force applied while knee is in flexion and quadricep muscle is tightly contracted).
- Swelling and tenderness over anterior aspect of the tibia.
- Joint effusion
- Injured knee is usually held in 20º to 40º of flexion secondary to hamstring spasm
- Patient may not be able to extend knee secondary to pain or loss of knee extensor mechanism
DIAGNOSTIC TESTS
What test can you use for fractures?
- Ottawa Knee Rules (test sensitivity = 98%, test specificity = 28%)
- The Ottawa knee rules are used by a clinician to determine if radiographic imaging is needed after acute knee trauma. A knee radiograph series is required in patients with any of the following criteria.
- Age 55 and older
- Isolated tenderness or patella (meaning no bone tenderness in knee other than patella)
- Tenderness of fibular head
- Inability to flex knee to 90º
- Inability to bear weight both immediately and in the emergency department for 4 steps regardless of limping.
- Age 55 and older
PT IMPLICATIONS
Patellar Fracture
- Patellar superficial local anatomical location makes it more susceptible to fracture.
- Acute treatment of patellar fractures consist of rest, ice, elevation, pain control and straight-leg knee immobilizer.
- For non-displaced fractures, if the knee extensor mechanism is intact, non-operative interventions are considered.
- When knee extensor mechanism is disrupted, immediate surgical repair is indicated.
Tibial Plateau Fracture
- When a tibial plateau fracture is suspected, careful assessment of associated ipsilateral bony, soft tissue and neurovascular status should be conducted, given the high rate of association of such injuries with tibial plateau fractures.
- Non-operative treatment: indicated when minimal or non-displacement fractures, peripheral fractures and fractures occur. Patients should not bear weight on affected leg for 4 to 6 weeks.
Tibial Tuberosity Fracture
- Initial treatment of tibial tuberosity avulsion fracture is similar to that for both quadriceps and patellar tendon injuries. Minimally displaced fractures are treated conservatively.
- Displaced fractures frequently require open reduction and internal fixation surgery.
(click here to see references)