|
Year |
2002 |
|---|---|
|
Question Number |
123 |
|
Category |
Musculoskeletal Trauma |
Question
Nonsurgical management is most appropriate for which of the following transverse patellar fractures?
1- Nondisplaced fracture in an active 25-year-old laborer who can perform a straight leg raise
2- Minimally displaced fracture in a 40-year-old patient who cannot perform a straight leg raise
3- Displaced fracture in an 80-year-old retired farmer
4- Displaced fracture in a patient on renal dialysis
5- Displaced fracture in a patient with diabetes mellitus
Figures
Answer (click for answer)
Preferred Answer: 1
The indication for nonsurgical treatment of patellar fractures is all nondisplaced patellar fractures and minimally displaced fractures associated with an intact extensor mechanism. Answer 1 describes an active 25-year-old laborer with a nondisplaced fracture who can perform a straight leg raise (which indicates the extensor mechanism is intact).
Answer 2 is a 40-year-old patient who cannot perform a straight leg raise and therefore does not have an intact extensor mechanism.
Answers 3, 4 and 5 all describe displaced fractures. Occasionally, patients with significant comorbid medical problems and displaced fractures may be treated with nonoperative measures. However, this type of treatment does not yield the same results as operative treatment.
Reference: Kellam JF, Fischer TJ, Tornetta P III, Bosse MJ, Harris MB(eds): OKU: Trauma 2. Rosemont, IL, AAOS, 2000 pp 157-166.
Pritchett JW: Nonoperative treatment of widely displaced patella fractures. Am J knee Surg 1997;10:145-148.