12 - Patellar, tibial, and fibular fractures

Abstract

Fractures of the patella are uncommon and occur primarily in patients between 20 and 50 years of age. Determining the integrity of the quadriceps extensor mechanism is crucial in the diagnosis of these fractures. Patients with nondisplaced fractures and intact knee extension heal well with immobilization and rehabilitation. Most patellar fractures in children are avulsion or osteochondral fractures. The tibia is the most frequently fractured long bone. Near-anatomic alignment is important in minimizing the risk of nonunion or malunion in these fractures. Even minimal displacement in tibial fractures necessitates referral to an orthopedist. Primary care and emergency medicine clinicians must stay alert to the signs of an acute compartment syndrome when evaluating fractures of the tibia. Tibial fractures in children can result from relatively minor injuring forces. The accidental toddler’s fracture is common and must be distinguished from a fracture caused by child abuse. Recognition of neurovascular and ligamentous injuries or compartment syndromes that may accompany fibular fractures is essential in distinguishing uncomplicated from complicated fractures. Truly isolated fractures of the fibula shaft are treated symptomatically and heal well with minimal treatment.