Patellar Fractures - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the condition of patellar fractures.
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Patellar Fractures
Patellar fractures can involve different topic, and I am going to try and highlight the important points related to patellar fractures. The medial patellofemoral ligament is the primary stabilizer of the patella, so when the patella dislocates, you will have an injury to that ligament and also an injury to the medial patellar facet articulation cartilage or an osteochondral fragment. In addition to the medial patellar facet injury, you will get a lateral femoral condyle injury. Bipartite patella occurs in about 8% of the population. It could be bilateral in about 50%, and it usually occurs in the superolateral aspect of the patella. You should observe it and not fix it. It is not an acute fracture that may need excision or lateral retinacular release. It can occur in children between 8-10 years old. It is a rare condition. The patient will be unable to do straight leg raising, so you suspect that the extensor mechanism is injured. The patient may have a high riding patella on x-ray with a palpable gap when you examine the patient. The x-ray may show small flecks of bone as the patellar tendon avulses with a portion of the distal pole of the patella. Sometimes the bony injury is so small that the condition can be missed. You should have a high index of suspicion. You may need to get an MRI to confirm diagnosis. The treatment is usually ORIF if the fracture is displaced.
The patella is a large sesamoid bone. The quadriceps muscle is inserted at the proximal pole and the distal pole gives attachment to the patellar tendon. The patella is triangular in shape. The proximal 3/4 of the patella is covered with cartilage, however the distal 25% of the patella is not covered with cartilage. The patella increases the power of the extensor mechanism by about 50% because it displaces the extensor mechanism anteriorly, and that will increase the moment arm.
Transverse fractures of the patella can be non-displaced or displaced. The patella can be pulled apart by the attached quadriceps tendon. The patient will be unable to do active extension of the knee. Upper or lower pole fractures of the patella are fractures at the site of attachment of the patellar tendon. Comminuted fractures of the patella can be non-displaced or displaced. Comminuted fractures have multiple pieces, are very unstable, and are difficult to fix. Vertical fractures of the patella are the most common, and they are stable and nondisplaced. Osteochondral fractures of the patella are small fractures of the patella usually associated with acute dislocation of the patella.
In examination, you may feel a palpable gap. The area of the knee is usually swollen. The patient will be unable to do straight leg raise. The lateral view of the knee is the best view to see the fracture. 2-3 mm of displacement will probably mean that the patient will need surgery.
If you think that the patient’s extensor mechanism is intact, and the patient is able to do straight leg raise, and the fracture is nondisplaced or minimally displaced, it is usually a transverse fracture in this situation, then immobilize the knee straight in a hinged knee brace for 4-6 weeks with weight bearing as tolerated. Sometimes the patient cannot move the knee because of the pan and injection of lidocaine inside the knee can help to assess the integrity of the extensor mechanism. If the patient has a total knee with 2mm displacement of the patella, and the extensor mechanism is intact, then the patient will be treated conservatively in a brace or in a knee immobilizer (no surgery).
Indication for surgery is a displaced patellar fracture and the inability to do straight leg raising. First, preserve the patella (if possible). The tension band fixation technique is the gold standard. The first step in the tension band technique is to reduce the fracture with reduction clamps. Next, at least two K-wires are placed across the fracture. An anterior tension band is applied, organized in a Figure-8 pattern. You need to put the Figure-8 tension band wire close to the patella superiorly and not far away from the patella because that may cause construct instability and fracture displacement. A second wire may be placed circumferentially around the patella. Bending the K-wires from both ends may decrease migration of the wires and decrease the complications. The wire that is bent at both ends may be difficult to remove. Tension band fixation technique may be done with K-wires or also with cannulated screws (through the cannulated screws, you place the wires). It does not matter if you have an open or closed fracture, you treat it the same way. When you place K-wires, it means symptomatic hardware and thus a secondary reoperation. It was found that the longitudinal screws and the tension band wires are a more superior fixation.

[@kford6643]

34 years ago l had 3 surgeries on my left knee and 2 surgeries on my right knee after I broke both knees simultaneously while playing basketball at the YMCA after a freakish injury after a sudden jump stop move proved too forceful for my knees as they both snapped instantly. My doctors had never heard of such an injury involving both knees while playing basketball.. This included a near fatal case of toxic shock syndrome when my left knee became infected while my wounds were healing. For the next 20 years I had knee pain and stiffness off and on. Then I decided to focus on changing my mindset as well as exercise and a healthy diet (losing 40 pounds in the process) and that was a game changer. Today at 55 years old I have virtually no knee pain and I'm in the best shape of my adult life. Now I'm a wellness coach with the goal of helping others overcome their own similar challenges. Have you heard of a similar injury to the one l experienced? I'm very curious. Thank you

[@bernardshear2546]

Thankyou sir, it was really a concise lecture on varied pattlar factor and appropriate remedial operations !

[@kaoritsuchimoto]

This was super helpful. I recently got a patellar fracture and have been anxious about my recovery but this information helped my understanding to know I’m on the right path. I appreciate you !

[@nathancarnevale5945]

Fractured superior lateral part of my kneecap 10 years ago and after 5 surgeries still living in constant pain. Looks like the best solution may be to release part of the tendons connecting to the kneecap on that outside area. This video is incredible and gives me a lot of hope. Thank you!

[@rks1681]

Hi

[@imogenekluson9702]

Thank you for this excellent presentation. I now better understand my patellar fracture & treatment.

[@shazam51707]

Thank you. I have a lot of patient with knee fracture. I will recomend this video to them

[@miguelsalamanca5415]

interesting points ,if anyone else wants to uncover patellar tendonitis injury try Mackorny Treat Bones Blueprint ( search on google )? It is a great exclusive guide for dealing with chronic knee pain minus the normal expense. Ive heard some pretty good things about it and my partner got amazing success with it.

[@drmnreddy]

👍 nice video to watch!

[@abhilashdwivedi781]

thank you for this information

[@ahmedsrssamir8192]

Thank you

[@betterbonesph]

Thank you!

[@celineait8131]

Thank you very mutch

[@abdoelshahawi1167]

شكرا جدا طبيبنا المصرى الكبير

[@md.maniruzzamanraju3482]

Thank you, sir..

[@petrap752]

I have had the suture implant after complicated osteoporotic fracture .I am doing well and appreciate this informative video

[@saimafarooq930]

Jazakallah sir♥️❤️❤️

[@ericbosken3114]

I had a transverse fracture with significant displacement of the upper half in July, 2020. The surgeon put a titanium claw around my patella, which I am supposed to have removed soon. Recovery has gone well, though I am nervous about recovery after I get the implant removed. My commute to work is a 40 minute bike ride 2x per day and I am timing the implant removal so that much of my recovery will be during our Christmas holiday.

[@intelligentcat192]

Thank you for this video! I have two pattela fractures and I really appreciated the diagrams:)

[@abhiAJ001]

Hey how are you now? Do you still face any complications?

[@ahmedbehiry3426]

cant thank u enough

[@christinagurrola5335]

Has anyone done PRP for grade 3-4 chondromalacia patella?

[@burhan6826]

Thanks for your lecture which is very useful for exactly a similar pateint like myself with engineering background seems as if an combination of both but your explanation is beautiful.

[@omprakashverma8394]

Nice vedio sir

[@adriansanchez5409]

Ami me operaron de la rotula transversal me pusieron cerclaje alambres tengo 2 semanas de la cirugía y no me puedo mover estoy postrado en una cama con férula quisiera saber cuándo voy a poder flexionar la rodilla y cuando voy a ala fisioterapia estoy muy angustiado mucho dolor demasiado

[@prashantdubey3728]

Can we start foot pumping exercise before stitches removal or only after stitches removal??

[@user-ws4iq8oz1b]

Exscllent

[@lakirris20]

I just have both knees patella fracture 2 weeks ago, now im using braces in both, had a surgery, do you know when I can start walking?

[@worldtraveler101]

2 months

[@tapas1505]

@@worldtraveler101 without surgery. If the patella is non-displaced?

[@mahendrathulibili3350]

Sir patella recover best exercise please sir

[@zhuli693]

thtanks, excellent video. fall of bike yesterday, got a vertical fracture, wondering how long will it take to recover. no pain, no swelling so far.

[@PureBlood42]

Hope you recover quickly. I suffered a transverse (horizontal) fracture 2 weeks ago. I find that keeping my leg elevated in my recliner with a throw pillow behind the knee is helpful. I had swelling even after 5-8 days and it was due to not using crutches and brace consistently enough. Ice will help if you get swelling, regardless of how long ago your fracture occurred. I have also had relief to the knee using a mineral oil spray. I'm back to using my brace more regularly now, but driving with my brace is just not doable, as the rigid rods within the brace dig into my upper leg. Good luck!

[@Capt_McNuggetDMZ]

I'm a year out from my surgury with ROM issues. Only 90 degrees. Hope yours isnt as bad

[@lanlai5063]

Hi DR . Nabil . Thank you for this link . I will have another surgery on my back April this year , call lumbar spine [ I fell few year ago ] , any time when I caught I have a pain on my left leg . Can you explain why ? Thanks so much ...

[@charmsglitzandsparklez2159]

I have an acute fracture to my patella and I know my xray said it’s displaced. It’s been 6 days and I haven’t had any pain since day one. I dot see my dr till day 9 due to availability. I’m so scared I need surgery. I’m in an immobilizer. I’m praying I won’t need surgery

[@ranjithkumarvc6893]

Now are you fully recovered

[@charmsglitzandsparklez2159]

@@ranjithkumarvc6893 yes I am. No surgery. It was so hard recovering. Thank you

[@ranjithkumarvc6893]

@@charmsglitzandsparklez2159 I am also fracture my patella 2 and half month back , no surgery now I have some pain and swelling in my knee , solely recovering. Is your fracture non displaced or displaced?

[@charmsglitzandsparklez2159]

@@ranjithkumarvc6893 I believe it was nondisplaced. The break didn’t have a lot of space between the two parts of the patella. I’m about 7 months out and I can’t put all my weight on the knee when going up or down stairs. It still buckles time to time but I did not keep up with physical therapy. I hope you heal soon. Glad no surgery for you

[@ranjithkumarvc6893]

@@charmsglitzandsparklez2159 thank you sir for sharing your valuable experience with me.

[@Capt_McNuggetDMZ]

I fracture my patella in 7 places. ORIF surgury figure 8 with 2 rods. Year later having ROM issues..only 90 degrees. Going to get manipulated

[@nidawaseem3041]

Thank u sir

[@pramodmehta1349]

ONLINE EDUCATION IS FUTURE EDUCATION

[@user-pb3gb7vr5n]

❤

[@julie5668]

All I've been told is I have fractured my knee and also my ankle in 2 places. I have no idea what sort of knee fracture I sustained.

[@Mudo-nunca-creas]

Can I run again just rupture my inferior lower patella

[@myrnadioquino-pk3xz]

pag complete transverse fracture Po ba nadadala pa ba sa hilot?

[@lanlai5063]

I did MRI 2 times , my pain call L4 , L5 . And I had 3 shots on my back [ 2017 I have a small surgery , with 3 shots , but no help ] ...

[@myrnadioquino-pk3xz]

pag halimbawa po ayaw mg paopera ng patella fracture anu po ba mngyayare?

[@poorabkumar2978]

I had a patella fracture it took almost 8months to recover without surgery

[@poorabkumar2978]

Don't worry just be confident u can run within 1 year

[@tapas1505]

Was it displaced fracture or non-displaced fracture?

[@tarachakraborty242]

Sir, my patella was fracture in 2017.A Doctor removed the patella.Please sir tell me what can I do ?

[@kaushalkumar-ni3qu]

Sir what's problem you are facing..because Doctor removed my patella 3 months ago..

[@radioactivemike1]

I had a 60% removal and can confirm the poor outcomes. Sucks, but play the cards your dealt I guess.

[@joshuacurtis1465]

That is incorrect, you can do straight leg raises. I had both of my patella fractured from a fall. 4 surgeries later but it’s back together.

[@user-fo6fj3ez2v]

كيف حالك الان

[@dinalvaoliveira6052]

Música gospel

[@princepatrickcasungcad4444]

sa kamay

[@nikolinalazarevski1181]

Thank you!