膝蓋骨上極sleeve fractureの一例

概要

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We report a case of the sleeve fracture of the upper pole of the patella. A sixteen-year-old boy presented with a history of falling down the stairs, landing on his knee, after which he could not walk with sudden pain in the right knee. Local examination showed a severe effusion and localised tenderness on the upper pole of the patella. He was unable to extend the knee actively. Aspiration produced 130ml of blood-stained fluid containing fat globules. Radiographs demonstrated avulsion of the upper pole of the patella. T1-weighted magnetic resonance images in the sagittal plane showed an avulsion fracture of the upper pole of the patella with an attached sleeve of cartilage. Thease findings were confirmed in the operation room. The avulsed patella fragment of the upper pole had included an sleeve of cartilage. The patella and its cartilage sleeve and the extensor retinaculum were repaired. After three days he started passive knee flexion. Now he has regained recovered his full range of movements and he is able to extend his knee completely. Such fracture may be misdiagnosed because of the painful swelling, the absence of a palpable gap in the extensor mechanism, and a fragment of avulsed bone that is too small to be detected radiographically. Early diagnosis, operative reduction, and fixation are thus important.
西日本整形・災害外科学会の論文
1999-03-25