273 Open Split Fracture of the Patella in a 14-Year-Old Child: An Unusual Occurrence

Abstract

Abstract Background Patella fractures in children are rare, accounting for approximately 1 % of all paediatric fractures. Due to resilience and adequate flexibility, transverse patellar fractures are extremely rare. This case accounts for less than 10 cases of open transverse or split patellar fracture reported in literature among the paediatric population. Case Presentation A 14-year-old boy was brought in as a pediatric trauma call following a fall and collision of his right knee against a concrete wall on a turf ground while playing football. He had Crohn's disease (on Prednisolone). No history of bone or joint pain, fever, rashes, or juvenile idiopathic arthritis was noted. On clinical examination, a 5cm open horizontal wound in the right knee with no visible bony fragments was noted. Imaging showed a split fracture of the right patella with wide separation of the superior and inferior fragments. Adjacent gas locules and haematoma which extended into the joint space were noted. Clinical outcomes Tension band wiring was done and the patient was placed in a full weight-bearing hinge knee brace with initial range of motion(ROM) of 0-30 degrees followed by an increase of 30 degrees at every 2 weeks. Discussion While sleeve fractures of the patella is more common, a transverse or split pattern is rather unusual and an open fracture in the paediatric population is rare. Other anomalies of the knee joint should be always excluded. The treatment protocol for children is the same as for adults. Restoring the extensor mechanism and realigning the articular surface is essential.