From the Research
Urgent orthopedic referral is indicated for a patella fracture when the patient is unable to extend the leg at the knee, as this suggests a disruption of the extensor mechanism. This is because the extensor mechanism is critical for normal ambulation and knee stability, and when compromised, surgical repair is typically necessary to restore function 1. The inability to extend the leg at the knee is a key indicator of extensor mechanism disruption, which can lead to chronic pain, instability, and post-traumatic arthritis if left untreated.
Some key features that may indicate the need for urgent orthopedic referral include:
- Inability to extend the leg at the knee
- Open fractures
- Significant hemarthrosis (blood in the joint)
- Visible deformity of the knee
- Comminuted fracture pattern, which may require surgical intervention to restore proper knee function 2
It's worth noting that an ankle-brachial index of 1.0 is not directly relevant to the need for urgent orthopedic referral in the context of a patella fracture. Similarly, a positive Lachman test is more commonly associated with anterior cruciate ligament (ACL) injuries, rather than patella fractures 1.
In general, the treatment of patella fractures depends on the type of fracture, the associated soft tissue damage, and patient factors such as age and activity level. Non-displaced fractures with an intact extensor mechanism can be treated non-operatively, while displaced fractures or those that disrupt the extensor mechanism may require surgical intervention 3.