This document discusses patella and tibial plateau fractures. It describes the anatomy and mechanisms of injury for each. For patella fractures, it outlines types including undisplaced transverse, displaced transverse, comminuted, and vertical fractures. Clinical features and treatment options are provided for each type, including closed reduction, open reduction and internal fixation, and partial/total patellectomy. For tibial plateau fractures, the Schatzker classification system is described along with clinical features and treatment depending on fracture type, including closed treatment, open reduction and internal fixation. Complications of each injury are also mentioned.

1. Patella and tibial plateau
fractures
presented by
Aisha Motaher Abutaleb

2. Patella fractures

3. Anatomy

5. Mechanism
Fractures of the patella are caused by
A. Direct violence (injury)
Due to trauma to anterior aspect of the flexed knee
leading to comminuted fractures.
B. Indirect violence (injury)
Due to forced flexion of the knee when the
sudden quadriceps muscle is contracting
In these case the fracture is transfers

6. Types of fractures

7. 1. Undisplaced transverse fracture
Due to direct injury , the two fragment of
the patella are undisplaced as they are
held in position by the pre patellar
expansion of the quadriceps tendon and
patellar tendon

8. 2. Displaced transverse
fracture
Due to more sever trauma with gap between
the fragment
(this is indirect injury due to forced , passive
flexion of the knee while the quadriceps
muscle is contracted
Active knee extension is impossible

9. 3.Comminuted (stellate) fracture
Due to fall or direct injury on the front of the knee
4.Vertical fracture
One or two small fragments are separated from the medial or
lateral border of the patella

10. Clinical features
1. Local pain and tenderness
3. Swelling
1. Palpable gap between the fragment
2. presence of crepitus is felt
3. An x- ray examination
 Fissure or crack fracture
 Transverse fracture with dislocation
 Comminuted fracture

11. Treatment
1. Undisplaced transvers fractures
Immobilization of knee by long leg plaster
splintage for 4-6 weeks combined with quadriceps
exercise
If there is a heamarthrosis , it is aspirated under
aseptic condition

12. 2. Displaced transverse fractures
 Open reduction and internal fixation with screw
especially if pt is young
 Small pollar fragment may be excised
 Reduction and maintenance of the reduced position may
also be gained by strong wire passed around periphery of
the patella
 In all these cases , the leg is splinted in long leg plaster
for 8 weeks

14. 3. Comminuted fractures
 Undisplacemen-A fracture with little or no displacement
can be treated conservatively by a posterior slab of
plaster that is removed several times a day for gentle
active exercises.
 Displacement Reduction is impossible and so the best
treatment are
1. partial patelloectomy with the segment held by circlage
wire and the leg is splinted in the extended position for 2
weeks
2. Total patelloectomy is excision of all the segment and
the quadriceps aponeurosis is reconstructed by absorbable
suture

16. early physiotherapy after the
operation prevent knee
stiffness

17. Patella-hinged brace

18. Complications
Knee Stiffness
 Most common complication
Osteoarthritis
 May result from articular damage
Chondromalagia
Ununion loss of fixation

19. Dislocation of the patella
is almost always over the lateral
femoral condyle

20. Mechanism
1. Direct trauma
2. sudden muscular contraction
In the presence of
Flattening of the lateral femoral condyle
Genu valgus and external rotation
Ligamentous laxity
Anatomical bony abnormalities :-
Small or high patella

21.  clinical feature
 Locking of the knee in the flexed position
 Swelling of the knee due to haemarthrosis
 Tenderness over the anteromedial aspect of the knee joint
 Positive patellar apprehension test
 An x-ray examination would reveal the dislocation
1. Traumatic acute dislocation
this result from an injury on the medial side of
the knee while the knee in flexed position

22. Treatment
Reduced under sedation the knee is immobilized in the
extended position in a plaster of Paris cylinder for 3 weeks

24. Complication
Osteoarthritis
Recurrent dislocation

25. 2. Recurrent dislocation
predisposing factors
Post traumatic as rupture or weakness of
medial patellar retinaculum
Anatomical bony abnormalities
 Small and high patella
 Unequal pull of the quadriceps muscle
component
• Weakened vastus medialis
• Shorter vastus lateralis
• Genu valgus

27. surgical reconstruction
1. Direct medial patello-femoral ligament repair
2. Suprapatellar realignment (Insall)
3. Infrapatellar soft-tissue realignment (Goldthwaite)
3 4. Infrapatellar bony realignment (Elmslie–Trillat)
Treatment

28. TIBIAL PLATEAU
FRACTURES

29. Anatomy

33.  Mechanism of injury -:
Fractures of the tibial plateau are caused
by varus or valgus force
force is more likely to rupture the ligaments
a car striking
fall from a height

34. Classification of Schatzker -:
Type 1 – simple split of the lateral condyle
Type 2 – a split of the lateral
condyle with a more central area of depression.

35. Type 3
the articular surface with an intact condylar
rim
Type 4 – a fracture of the medial
condyle.

36. Type 5
–fractures of both condyles, but with the central
portion of the metaphysis still connected to the tibial
shaft.

37. Type 6
– combined condylar and subcondylar fractures
effectively a disconnection of the shaft from the
metaphysis.

38. Clinical feature
1. Sever pain
2. Swelling
3. Valgus deformity
4. Local tenderness
on examination:-The knee may suggest medial or lateral
instability
 the leg and foot should be carefully examined
for signs of vascular or neurological

39. X-ray:-
X-rays provide information about the position
of the main fracture lines
and areas of articular surface depression

40. CT :-
for reveal direction and extent of
displacement

41. Treatment

42. Type1
 Undisplaced type 1 fractures can be treated
conservatively
 Displaced fractures should be treated by open
reduction and internal fixation

43. Type2
1. If the depression is slight (less than 5 mm)or
patient is old , the fracture is treated closed with the aim of
regaining mobility and function rather than anatomical
restitution. skeletal traction is applied with 5kg for 4 – 6 w

44. 2. In younger patients, and in those with a central
depression of more than 5 mm, open reduction with
elevation of the plateau and internal fixation is often
preferred

45. Type3 Depression of more than 5 mm in a type 3 fracture
can be treated by elevation from below and supported by bone
grafts and fixation

46. Type 4
Treated by open reduction and internal fixation .

47. Type 5,6
 Open reduction and internal fixation with plate
and screw.
 A combination of screw fixation and circular
external fixation is lower risk complication .

48. Complication
EARLY:-
Compartment syndrome
Late :-
Joint stiffness.
Deformity.
Osteoarthritis

49. Thanks