Patellar Sleeve Fracture

Sullivan, Scott; Maskell, Kevin F.; Knutson, Tristan

doi:10.5811/westjem.2014.8.22265

Cited by 9 publications

(8 citation statements)

References 4 publications

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“…PSFs are rare injuries (<1% of all pediatric fractures) specific to the skeletally immature population that can be misdiagnosed and have limited literature to guide orthopaedic surgeons and general medical professionals. 16,18…”

Section: Discussionmentioning

confidence: 99%

“…PSFs are rare injuries (\1% of all pediatric fractures) specific to the skeletally immature population that can be misdiagnosed and have limited literature to guide orthopaedic surgeons and general medical professionals. 16,18 As a large, inferior pole injury retrospective cohort study, this study compared clinical and radiographic findings of PSF with 2 other commonly seen inferior pole pathologies, IPF and SLJS. Often confused on radiographs, delay in diagnosis or misdiagnosis of these injuries, especially PSF, can have significant clinical implications such as reduced knee flexion, weakness of knee extension, ectopic bone formation, or patellar avascular necrosis.…”

Section: Discussionmentioning

confidence: 99%

“…6,21 Due to this unique ossification pattern, skeletally immature patients are susceptible to patellar sleeve fractures (PSFs) 12 : a cartilage avulsion injury, most commonly off the inferior pole of the patella, that results from eccentric loading of the contracted quadriceps muscles. 1,18 The avulsed fragment includes a thick sleeve of periosteum with unossified peripheral cartilage, often a large fragment of articular cartilage, and a bony fragment that is variable in size. 9 Given a relatively small size of ossified patella compared with the avulsed cartilage fragment (which often has no bony fragment), this injury can easily be missed on plain radiographs and result in improper or delayed treatment.…”

mentioning

confidence: 99%

“…Inferior pole patellar injuries occurring in skeletally immature children require prompt and accurate diagnosis given variable possible pathologies and treatments. 14,18 Patellar ossification starts centrally between 3 and 6 years of age, at which point the ossified patella is surrounded by cartilage. Secondary ossification is complete around late adolescence.…”

mentioning

confidence: 99%

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Clinical and Radiographic Differentiation of Pediatric Patellar Sleeve Fractures and Other Inferior Pole Pathologies

et al. 2022

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Background: Inferior pole patellar sleeve fractures (PSFs) are rare injuries that occur in skeletally immature patients that may be missed or falsely diagnosed as an inferior pole fracture (IPF) or Sinding-Larsen-Johansson syndrome (SLJS). Purpose: The objective of this study was to evaluate and compare clinical and radiographic features of patients with PSF, IPF, and SLJS. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Retrospective review of skeletally immature patients diagnosed with PSF, IPF, and SLJS between 2011 and 2019 at a single urban academic center was performed. Chart and radiographic review was completed. Between-group differences were assessed using analysis of variance, Kruskal-Wallis test, and Fisher exact test, as appropriate to variable distributions. Results: In total, 125 patients (82% male) were included, with a mean (SD) age of 10.7 (2) years (16 PSF, 51 IPF, 58 SLJS). There were no significant differences in patient characteristics between the 3 groups. One hundred percent of the patients with PSF ( P < .001) and IPF ( P < .001) had acute trauma, compared with 24% of patients with SLJS. Fewer patients with PSF had an intact straight leg raise (38%) compared with those with IPF (94%; P < .001) and SLJS (98%; P < .001). Fewer patients with SLJS had knee swelling (41%) compared with those with PSF (93%; P < .001) and IPF (94%; P < .001). More patients with PSF had knee effusion (81%) compared with those with IPF (37%; P = 0.011) and SLJS (3%; P < .001). More patients with SLJS were able to bear weight (88%) compared with those with IPF (12%; P < .001) and PSF (0; P < .001). Radiographically, compared with those with IPF and SLJS, patients with PSFs had increased mean prepatellar swelling (6.1 [ P < .001] and 6.5 [ P < .001] vs 12.9 mm), intra-articular effusion (6.1 [ P = .014] and 4.9 [ P = .001] vs 9.2 mm), maximum fragment size (26 [ P = .004] and 17.7 [ P < .001] vs 45.3 mm), and maximum fragment displacement (1.24 [ P = .002] and 1.45 [ P = .003] vs 13.30 mm), respectively. Compared with those with SLJS (1.10), patients with PSF (1.92; P < .001) and IPF (1.22; P < .001) had patella alta with higher mean Insall-Salvati ratios >1.2. Conclusion: Differences in clinical features such as ability to straight leg raise, knee swelling, knee effusion, ability to bear weight, and radiographic features, such as prepatellar swelling, intra-articular effusion, fragment displacement/size/shape/location, and patellar height, can all be helpful in recognizing rare pediatric inferior patellar pathology, thus increasing efficiency in indicating for higher-level imaging to reach a prompt diagnosis and provide appropriate treatment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical and Radiographic Differentiation of Pediatric Patellar Sleeve Fractures and Other Inferior Pole Pathologies

et al. 2022

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“…1.2) may be present (75). At younger ages, growth cartilage covers the entire inferior pole of the patella, with the patellar ligament attaching directly to the cartilage, so the visible fracture may herald a much larger and more important cartilage injury requiring urgent repair (75,(77)(78)(79). MR imaging or US may be warranted to fully assess the scope of the injury (79).…”

Section: State Of the Art: Sports And The Growing Musculoskeletal Systemmentioning

confidence: 99%

Sports and the Growing Musculoskeletal System: Sports Imaging Series

et al. 2017

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Increased youth participation in sports has resulted in increased injury tolls due to shifts toward participation in competitive sports at earlier ages, increased training intensity and competition schedules, as well as specialization into one sport. The physiology of the growing musculoskeletal system makes the growing athlete particularly vulnerable to specific types of injuries. Radiologists must understand the differences between pediatric and adult athletes to recognize the particular injuries to which these young athletes are prone. Imaging and pertinent clinical details of major representative acute and overuse injuries characteristic to pediatric athletes will be discussed. RSNA, 2017.

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