Bilateral Sleeve Fracture of the Inferior Poles of the Patella in a Healthy Child: Case Report and Review of the Literature

Guy, Stephen; Marciniak, J.; Tulwa, Nirmal; Cohen, A.

doi:10.4061/2011/428614

Cited by 20 publications

(33 citation statements)

References 20 publications

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“…There are few case reports on sleeve fractures available in the literature [2,3,5,6,8,9,13,15], but they all describe inferior or superior pole fractures; however, all the previous authors have also emphasized an early diagnosis and prompt surgical intervention of such injuries. Guy et al [2] described a case of bilateral sleeve avulsion fractures of the lower poles of the patellae in an 11-yearold boy following an indirect trauma to both knees.…”

Section: Discussionmentioning

confidence: 95%

“…Guy et al [2] described a case of bilateral sleeve avulsion fractures of the lower poles of the patellae in an 11-yearold boy following an indirect trauma to both knees. Prompt diagnosis and emergent surgical intervention using heavy suture material augmented by cerclage wire led to optimal outcome and full functional recovery.…”

Section: Discussionmentioning

confidence: 98%

“…Of all the patellar fractures, less than 2% occur in the skeletally immature [1]. A sleeve fracture is defined as an avulsion of a small bony fragment from the distal or proximal pole of the patella, along with its articular cartilage, periosteum, and retinaculum, which is pulled off from the main body of the patella in the coronal plane [2]. This type of fracture accounts for almost half of all the patellar fractures in this age group [1,[3][4][5].…”

Section: Introductionmentioning

confidence: 99%

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Sleeve fracture of the patella with lateral slip of the retinaculum

Majeed

Datta

Remedios

2014

Journal of Pediatric Orthopaedics B

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Adolescents are susceptible to patellar sleeve fractures. We present an interesting case of a patellar sleeve fracture in an 11-year-old child with lateral slip of the retinacular sleeve. Clinical assessment was difficult; however, an MRI scan confirmed the diagnosis. Surgical repair was undertaken, and the retinacular sleeve was repaired along with repair of the patellar tendon. The patient recovered well after surgery and underwent physiotherapy. A patellar sleeve fracture should always be suspected in patients less than 16 years of age, particularly in those with indirect acute trauma to the knee. Prompt surgical repair is important to achieve full functional recovery.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Sleeve fracture of the patella with lateral slip of the retinaculum

Majeed

Datta

Remedios

2014

Journal of Pediatric Orthopaedics B

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“…On examination, children may have a knee effusion and painful knee flexion, features that were found in the patient in this case report [5]. An inability to raise his leg straight may also be present, especially in transverse fractures [6].…”

Section: Discussionmentioning

confidence: 98%

An Isolated Articular Surface Fracture of the Distal Patella: An Unusual and Previously Unreported Paediatric Injury

Shivji

Ramoutar

Hunter

2013

Case Reports in Orthopedics

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Paediatric patella fractures are uncommon, accounting for less than 1% of all paediatric fractures. This case report describes a previously undocumented patella fracture in a child, with a clear mechanism of injury. We present a case of a previously healthy 14-year-old boy who fell directly onto his right knee after coming off his pushbike. He sustained an isolated fracture involving the articular surface of the distal part of the patella with minimal displacement. The patient was managed conservatively in a Richard splint for three weeks, followed by a knee brace with gradually increasing degrees of flexion. He was instructed to be nonweight bearing for two weeks and then partial weight bearing for six weeks. At the final followup, after 9 weeks, the patient had full return of function and standard radiographs show the fracture to be healed. This case report has demonstrated how direct compression to the paediatric patella can cause a fracture isolated to its articular surface. It has detailed the natural progression of this injury to radiographic union, using a conservative management strategy. The authors believe that this case report provides an interesting insight into the variation of paediatric patella fractures and their contrasting management strategies.

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“…2 This mechanism causes an avulsion of the periosteum, retinaculum, and cartilage from the patella. 1,5 Patients can present with anterior knee pain, inability to extend their leg, and effusion. 5 Treatment consists of nonoperative options for nondisplaced or minimally displaced fractures.…”

Section: Discussionmentioning

confidence: 99%

Patellar Sleeve Fracture With Ossification of the Patellar Tendon

Damrow¹,

Valin²

2017

Orthopedics

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Patellar sleeve fractures make up greater than 50% of all patellar fractures. They are essentially only seen in the pediatric population because of the thick periosteum and the distal patellar pole apophysis in this group. These fractures can lead to complications if not treated appropriately and in a timely fashion. Complications of missed or untreated patellar sleeve fractures include patella alta, anterior knee pain, and quadriceps atrophy. These can all result in severe limitations in activity. The authors describe a case of a 16-year-old boy who sustained a patellar sleeve fracture 3 years prior to presentation. On presentation, he had patella alta, diminished strength, 5° of extensor lag, and radiographs that revealed bone formation along the patellar tendon. Despite this, he was able to maintain a high level of activity. This case report explores how the patient could have maintained a high level of activity despite having a patellar sleeve fracture. Also, because of the delayed presentation, the patella was ossified and the quadriceps was retracted, which led to a novel approach to reconstructing his distal extensor mechanism. This approach included a V-Y advancement of the quadriceps tendon and patellar tendon reconstruction using the patient's hamstring tendon (semitendinosus). This technique, combined with physical therapy postoperatively, resulted in his return to varsity high school soccer. To the best of the authors' knowledge, this technique has not been reported for this rare condition. [Orthopedics. 2017; 40(2):e357-e359.].

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Bilateral Sleeve Fracture of the Inferior Poles of the Patella in a Healthy Child: Case Report and Review of the Literature

Cited by 20 publications

References 20 publications

Sleeve fracture of the patella with lateral slip of the retinaculum

Sleeve fracture of the patella with lateral slip of the retinaculum

An Isolated Articular Surface Fracture of the Distal Patella: An Unusual and Previously Unreported Paediatric Injury

Patellar Sleeve Fracture With Ossification of the Patellar Tendon

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