Patella In Children Research Articles

Surgical treatment of acute patellar dislocation associated with bony avulsion in children

Purpose: The management of acute patellar dislocation in children and adolescents is controversial. Traditionally, most first–time traumatic patellar dislocations have been treated nonoperatively. However, due to new knowledge about medial patellar stabilizers some authors have advocated for surgical repair. The present report describes the mid–term subjective and functional results of operative treatment of acute patellar dislocation in children less than eighteen years of age with concomitant osteochondral fracture.
 Methods: Data on a cohort of sixteen patients (eight girls and eight boys) aged 14.9 years (mean, range 12–17 years) with acute patellar dislocation were retrospectively collected. Intraarticular fragments were detected in all patients in conventional radiographs. Operative treatment consisted of arthroscopic removal (12 cases) or refixation (4 cases) of the osteochondral fragments and direct repair of the damaged medial patellofemoral ligament (MPFL) if that was still feasible (13 cases). All patients were seen at six months, and a telephone interview with twelve patients (75%) was conducted at four years (mean, range 2–7 years).
 Results: Of the sixteen patients, two (12.5%) had a recurrent patellar luxation. The subjective IKDC score at the time of the most recent follow–up was 86 (mean, range 63–100), and the Marx Activity Rating Scale score was 9.2 (mean, range 2–16).
 Conclusions: Direct surgical repair of the injured MPFL may be considered an option to prevent subsequent dislocation and subluxation in first–time traumatic dislocation of the patella in children and adolescents with osteochondral fractures and substantial disruption of medial patellar stabilizers.

Evaluation of recurrent dislocation of the patella in children with MRI: Goldthwait technique combined with lateral release, and VMO advancement-a retrospective study of 85 knees.

There are certain risk factors responsible for patella instability that should be identified before choosing the most appropriate treatment. We evaluated 83 skeletally immature patients who, after two or more patellar dislocation episodes, underwent surgical treatment to address the condition of patellar instability. Each patient was evaluated for patellar instability risk factors using the Balcarek patellar instability severity score. Evaluation of patellar instability included knee MRI to systematically identify anatomical risk factors. The preoperative and postoperative clinical evaluation included the modified Cincinnati score and the Kujala score. The Roux-Goldthwait technique combined with lateral retinaculum release and the advancement of the vastus medialis oblique (VMO) was performed on all knees. The mean patient age at the time of surgery was 12.2 ± 1.59years (range 8-14years). The average follow-up was 4.72 ± 1.37 (range 3-8) years. Trochlear dysplasia (decreased trochlear depth), the most common anatomical risk factor, was identified in 71 knees (83.5%). The modified Cincinnati score increased from 58.46 ± 8.75 (range 49-76) points to 94.07 ± 2.88 (range 88-98) postoperatively. The mean Kujala scores increased from 58.51 ± 8.94 (range 49-76) points to 93.66 ± 2.65 (range 87-98) postoperatively. The two-tailed P value was less than 0.0001. The patients were followed until their skeletal maturation, without reporting any incidents of patella dislocation, except one. The Roux-Goldthwait technique combined with lateral retinaculum release, and the advancement of VMO, can restore patellar tracking and can decrease the probability of another dislocation. It was an effective treatment in skeletally immature patients who had two or more episodes of patellar dislocation. IV.

Habitual Patellar Dislocation-Management by Two in One Procedure, Short Term Results.

Habitual dislocation of patella is an uncommon pathological condition. Though numerous techniques have been described in the literature for the treatment of patellar dislocations, none of the single procedure is fully effective in the surgical treatment of habitual dislocation of patella. We described our experience with a two in one procedure for habitual dislocation of patella in ten children. Ten children having habitual dislocation were reviewed prospectively for twelve months following surgical procedure. The age ranged between 5 and 9years. We performed graded lateral soft tissue release and patellar tendon transposition as described by Roux Goldthwait. Clinical results were evaluated using Kujala score, ability to do straight leg raise, knee range of motion and visual analogue scale. There has been no recurrence of dislocation. The mean Kujala score before surgery was 48 which improved to 97.8 at 12months follow-up after the surgical procedure. At 12months follow-up all patients were able to do straight leg raise and had almost full range of motion. We conclude that extensive proximal lateral release along with Goldthwait Roux procedure helps in treating the habitual dislocation in patella in children. Decision for the extent of lateral release must be taken intra-operatively. Our method of treatment is simple, cost effective and reproducible with excellent functional outcome.

Results of three in one procedure for habitual dislocation of patella in children

Results of three in one procedure for habitual dislocation of patella in children

Screw osteosynthesis of transverse fracture of the patella in children

ObjectivePatella fractures in children are rare, with an incidence of less than 1% of all pediatric fractures. Literature describes different surgical techniques and outcomes, but there is not a specified...

Patella instability in children: surgical treatment results

Introduction. Despite the fact that instability of the patella is a common pathology within the structure of knee joint diseases and injuries in children, currently there is no complete information on the basis of which one could judge the effectiveness and preference of a particular method of treating instability of the patella in children. Purpose of study: to evaluate the efficacy of surgical treatment techniques in children with post-traumatic instability of the patella. Patients and methods. The study was performed on the basis of examination and treatment data on 127 patients aged from 8 to 17 years with post-traumatic instability of the patella. Arthroscopic stabilization by Yamamoto technique, modified at our department, was performed in 49 patients, patella stabilization with transposition of the tibial tuberosity - in 67 patients, with the medial patellofemoral ligament autoplasty - 9, corrective osteotomy - in 2. Treatment efficacy was assessed using AKPS and 2000 IKDC knee joint assessment scores. The questionnaires were carried out at admission, in 1, 2-4 and 4-7 years after surgery. Results. At early terms after operation (up to 2 years) in the group of children after stabilization of the patella by modified Yamamoto technique good and excellent results were observed in 77.8% of cases, after transposition of the tibial tuberosity - in 73.3%, after stabilization of the patella with medial patellofemoral ligament autoplasty - in 88.9%. Long-term follow up (5-7 years) showed 90.9 and 86.5% of cases from the 1st and 2nd groups, respectively. Conclusion. The proposed algorithm for examination and treatment provides the most effective treatment and enables to obtain good and excellent results in the majority children with post-traumatic instability of the patella.

Injuries of Children and Young People in Sports: Stress Fractures and Fracture of the Sleeve Sleeve

Introduction: With the dramatic increase in the competitive sports of children and young people, overuse injuries have become more important in the pediatric population. Among these, the most frequent injuries in young athletes are stress fractures. The absence of evident traumatic history and the subtle radiographic changes can cause a diagnostic difficulty and delay the treatment. Fracture of the patella sleeve is a rare fracture only occurs in children. The diagnosis is difficult, both clinically and radiologically. High patella and hemarthrosis are important signs to diagnose this fracture. Presentation of 2 clinical cases of injuries in children and young people in sports: stress fractures and fracture of the patella sleeve. Methods: Retrospective descriptive method with reports of clinical cases based on patients’ electronic clinical processes. Results: We present a case of a child, a 13-year-old soccer practitioner who had mentioned well localized pain in the anterior aspect of the right leg with 5 days of evolution and analgesic gait and no history of trauma. The radiographs and CT showed a juxtaposed cortical lesion with apparent contact with the cortical bone without associated periosteal reaction. NMR confirmed stress fracture of the proximal tibial shaft. It was treated conservatively with immobilization with plaster and discharge. We present the case of an 11-year-old boy who suffered a fracture of the patella sleeve. In the imaging study, a fragment of bone with a displacement from the lower pole of the patella was visible. An open fracture reduction was performed. During the surgery confirmed avulsion fracture of a small osteochondral fragment, configuration of a sleeve-like fracture. The amount of cartilage was small, so it was decided to reinsert the 2 anchorages for patellar tendon. After fracture healing and rehabilitation, both returned to sports activity without sequelae or functional limitations. Discussion/Conclusion: A knowledge of the fracture of the patella sleeve, together with its clinical and radiological features, is important to avoid misdiagnosis and treatment delay. Care should be taken not to disturb the proximal tibial process. Although relatively uncommon in the pediatric age, the incidence of fractures described stress have been increasing in this age group. A high degree of suspicion is required to make the diagnosis and avoid too invasive treatment. REFERENCES Ray JM, Hendrix J. Incidence, mechanism of injury, and treatment of fractures of the patella in children. J Trauma 1992;32:464–7. Bates DG, Hresko MT, Jaramillo D. Patellar sleeve fracture: demonstration with MR imaging. Radiology 1994;193:825–7. Wu CD, Huang SC, Liu TK. Sleeve fracture of the patella in children. A report of five cases. Am J Sports Med 1991;19:525– 8. Houghton GR, Ackroyd CE. Sleeve fractures of the patella in children: a report of three cases. J Bone Joint Surg Br 1979;61:165–8. Shands PA, McQueen DA. Demonstration of avulsion fracture of the inferior pole of the patella by magnetic resonance imaging. A case report. J Bone Joint Surg Am 1995;77:1721–3. Dai LY, Zhang WM. Fractures of the patella in children. Knee Surg Sports Traumatol Arthrosc 1999;7:243–5. Fredericson M, Bergman G, Hoffman KL, et al. Tibial stress reaction in runners: correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 1995; 23: 472-81. Hunter-Griffin LY. Clinics in sports medicine: overuse injuries. Philadelphia (PA): W.B. Saunders, 1987. Jackson DW, Bailey D. Shin splints in the young athlete: a non-specific diagnosis. Phys Sports Med 1975; 3: 45-51.

Surgical Treatment of Congenital and Obligatory Dislocation of the Patella in Children.

Congenital (fixed) dislocations and obligatory (habitual) patellar dislocations represent a complex clinical and surgical challenge. Numerous treatment options, offering different perspectives, and surgical solutions are reported in the literature.We implemented the surgical technique principles, originally described by Stanisavljevic, for congenital (fixed) and obligatory (habitual) patellar dislocations, with slight modifications. We retrospectively evaluated the results of group of 12 patients (15 knees), operated between the years 2002 and 2013. The procedure includes extensive subperiosteal quadriceps realignment and soft tissue medial plication, followed by distal realignment through patellar tendon splitting. The outcome measures were patellar stability, knee range of motion, Pedi-IKDC knee function score, and the PODCI global function score. The study group included 12 patients, 9 females and 3 males (15 knees) whose mean age was 5 years 2 months at diagnosis and 7 years 5 months at surgery. Nine patients had an underlying diagnosed genetic background [Down syndrome (n=6), Larsen syndrome (n=2), nail-patella syndrome (n=1)]. The mean follow-up was 46.2 months. Eleven patients, gained stable patella with no recurrence of dislocation. Postoperative knee active extension was improved significantly (P<0.0001) for all patients. The average postoperative Pedi-IKDC and PODCI scores were significantly higher (P<0.001) among the idiopathic group. These results suggest that the Stanisavljevic procedure principles with modifications, provides an efficient method for treatment of fixed and obligatory patellar dislocation. In our opinion, young age at surgery played an important role in the surgical outcome. Level IV-therapeutic.

'Classic Papers' in this issue of Acta Radiologica.

In this issue of Acta Radiologica we present two articles written by two pioneers from the early years. The first article was written by the Norwegian surgeon Christian Magnus Falsen Sinding-Larsen (Fig. 1). SindingLarsen was born in 1866 in Oslo (at that time named Kristiania), and obtained his MD in 1891. From 1892 he was affiliated to the Surgical Departments A and B at Rigshospitalet. His main interest was skeletal tuberculosis in especially children, and he was from 1892 candidate and thereafter consultant and Chief surgeon at ‘‘Kysthospitalet’’ at Stavern, Norway, at that time being a hospital for children with scrofulosis. In later years it became a hospital specialized in orthopedic surgery, today a rehabilitation center. In 1907 he obtained his PhD degree with his publication ‘‘Beitrag zum Studium der Huftgelenks tuberculose’’. In the following years he had several study periods at hospitals in Germany, Austria, France, and Denmark. In 1911 he was appointed managing director at Rigshospitalet in Oslo/Kristiania. Sinding-Larsen had several radiological publications even if he originally was educated as a surgeon, with more than 70 publications concerning surgical topics, but also articles as ‘‘Roentgen treatment of surgical tuberculosis’’ (1925) and ‘‘Don’t forget to obtain an X-ray image of serious back trauma’’ (1927). He was a man with many interests in topics other than surgery and radiology, and he also authored publications as ‘‘Necessary equipment in Prisons in the treatment of diseased prisoners’’ to ‘‘A letter to a fanatical total abstainer’’. On 12 February 1930 he gave a presentation at a meeting of the Norwegian Medical Society. Immediately after his presentation he had a serious heart attack, and was brought to the hospital where he died of a cardiac infarction the same evening. It was said that ‘‘he died with his boots on’’. In this issue of the ‘‘Old Classics’’ we present his article from 1921 about ‘‘An Hitherto Unknown Affection of the Patella in Children’’ (1). The second article in this month’s issue was written by the famous Danish professor Poul Flemming Moller (Fig. 2). He was born in 1885 and died in 1974. He became a medical candidate in 1911. As many radiologists at that time, he started his career first in epidemiology, and later, i.e. in 1914, he studied surgery in Germany. From 1916 he became an assistant at the radiological department at Rigshospitalet in Copenhagen, and later on he was appointed as radiologist and chief of the radiological department of Fredriksbergs hospital in 1920–1930. In 1930 he was appointed Chief of Rigshospitalet’s radiological clinic and docent at the University of Copenhagen at the same time. From 1936 he became full Professor. As the author of the other article in this issue of the ‘‘Old classics’’, Flemming Moller was interested in tuberculosis, and in 1924 when he defended his thesis dealing with Calve-Legg Perthes disease, he could show

'Classic Papers' in this issue of Acta Radiologica.

In this issue of Acta Radiologica we present two articles written by two pioneers from the early years. The first article was written by the Norwegian surgeon Christian Magnus Falsen Sinding-Larsen (Fig. 1). SindingLarsen was born in 1866 in Oslo (at that time named Kristiania), and obtained his MD in 1891. From 1892 he was affiliated to the Surgical Departments A and B at Rigshospitalet. His main interest was skeletal tuberculosis in especially children, and he was from 1892 candidate and thereafter consultant and Chief surgeon at ‘‘Kysthospitalet’’ at Stavern, Norway, at that time being a hospital for children with scrofulosis. In later years it became a hospital specialized in orthopedic surgery, today a rehabilitation center. In 1907 he obtained his PhD degree with his publication ‘‘Beitrag zum Studium der Huftgelenks tuberculose’’. In the following years he had several study periods at hospitals in Germany, Austria, France, and Denmark. In 1911 he was appointed managing director at Rigshospitalet in Oslo/Kristiania. Sinding-Larsen had several radiological publications even if he originally was educated as a surgeon, with more than 70 publications concerning surgical topics, but also articles as ‘‘Roentgen treatment of surgical tuberculosis’’ (1925) and ‘‘Don’t forget to obtain an X-ray image of serious back trauma’’ (1927). He was a man with many interests in topics other than surgery and radiology, and he also authored publications as ‘‘Necessary equipment in Prisons in the treatment of diseased prisoners’’ to ‘‘A letter to a fanatical total abstainer’’. On 12 February 1930 he gave a presentation at a meeting of the Norwegian Medical Society. Immediately after his presentation he had a serious heart attack, and was brought to the hospital where he died of a cardiac infarction the same evening. It was said that ‘‘he died with his boots on’’. In this issue of the ‘‘Old Classics’’ we present his article from 1921 about ‘‘An Hitherto Unknown Affection of the Patella in Children’’ (1). The second article in this month’s issue was written by the famous Danish professor Poul Flemming Moller (Fig. 2). He was born in 1885 and died in 1974. He became a medical candidate in 1911. As many radiologists at that time, he started his career first in epidemiology, and later, i.e. in 1914, he studied surgery in Germany. From 1916 he became an assistant at the radiological department at Rigshospitalet in Copenhagen, and later on he was appointed as radiologist and chief of the radiological department of Fredriksbergs hospital in 1920–1930. In 1930 he was appointed Chief of Rigshospitalet’s radiological clinic and docent at the University of Copenhagen at the same time. From 1936 he became full Professor. As the author of the other article in this issue of the ‘‘Old classics’’, Flemming Moller was interested in tuberculosis, and in 1924 when he defended his thesis dealing with Calve-Legg Perthes disease, he could show

A combined procedure for irreducible dislocation of patella in children with ligamentous laxity: a preliminary report.

Irreducible patellar dislocation accompanying ligamentous laxity is rarely seen in pediatric patients. The most common complaints due to this condition are inability to walk, delayed walking, and difficulties with orthotics. The purpose of this retrospective study is to describe a novel surgical technique to treat dislocated patella in patients with symptomatic ligamentous laxity. Fourteen knees of 9 patients operated on by a single surgeon between 2009-2012 were included in the study. The tensor fascia was divided into 2 strips, and these strips were passed via the joint and sutured to themselves. The combined procedure additionally includes lateral capsular release, vastus lateralis (VL) resection, medial capsular plication, and Z-plasty of the rectus femoris (RF) tendon. Mean age at the time of surgery was 6.9±3.3 years (range: 4-13 years). The mean follow-up was 37.6±0.9 months (range: 26-49 months). Patellofemoral instability was restored for all patients by using combined surgical technique. Patellar lateralization developed in 2 patients, in whom stability was obtained via secondary medial plication. Our results show that this combined surgical procedure stabilizes the knee and treats patellar dislocation accompanying ligamentous laxity in pediatric patients.

Fractured patella in children: Preservation of the patellar dimensions

Dicle Tip Derg / Dicle Med J www.diclemedj.org Cilt / Vol 39, No 4, 467-473 Orthopaedic Department, Sohag Teaching Hospital, General Organization for Teaching Hospitals and Institutes Yazisma Adresi /Correspondence: Dr. Elsayed Ibraheem Elsayed Massoud, Sohag-Tahta15 St. Egypt, Email: Elsayedmassoud@Hotmail.com Gelis Tarihi / Received: 29.07.2012, Kabul Tarihi / Accepted: 17.09.2012 Copyright © Dicle Tip Dergisi 2012, Her hakki saklidir / All rights reserved Dicle Tip Dergisi / 2012; 39 (4): 46773 Dicle Medical Journal doi: 10.5798/diclemedj.0921.2012.04.0184

A Case of Sleeve Fracture at the Superior Pole of the Patella Secondary to Disuse Osteopenia

Sleeve fracture at the inferior pole of the patella in children is relatively common, yet it is rare for the superior pole to be affected. So, only a few such cases have currently been reported. We experienced a 15 years-old patient with a sleeve fracture at the superior pole of the patella secondary to disuse osteopenia after cast immobilization due to knee trauma. We report on this case and we review the relevant literature.

Diagnostic Imaging of the Knee in Children With Arthrogryposis and Knee Extension or Hyperextension Contracture

Amyoplasia (type 1), characterized by quadrimelic limb involvement, is one of the most common types of arthrogryposis. In children with hyperextension or extension contracture of the knee, subluxation or dislocation of the knee joint with an associated subluxation or dislocation of the patella is frequently seen. Patellar malpositioning may be secondary to congenital hypoplasia of the patellar groove of the femur and/or dysplasia of the patellofemoral joint. A contracted quadriceps tendon and illiotibial band, as seen in extension contractures of the knee in arthrogryposis, may also contribute to patella alta and lateral subluxation of the patella. The aim of our study is to determine the position of the patella in children with quadrimelic arthrogryposis and knee extension contracture. The inclusion criteria for this study were as follows: patients diagnosed with arthrogryposis multiplex congenita group 1, a knee extension contracture present from birth, follow-up from birth or early childhood, at least yearly physical examinations, and a knee ultrasonography or magnetic resonance imaging study performed. Patellar position was determined, and the cartilaginous femoral sulcus angle, as well as the osseous femoral sulcus angle, was measured. Clinically, none of patella in any of the patients could be palpated before surgery. The patella was displaced superiorly and laterally in 16/16 knees as seen on ultrasonography. Magnetic resonance imaging also showed the patella to be displaced superior and laterally. All patients in our series with extension contracture of the knee and type 1 arthrogryposis had a patella that was superior and lateral to the patellar groove. We found that quadricepsplasty and relocation of the patella improved knee flexion. All patients regained active knee extension in 6 months postsurgery. Level III-diagnostic.

Sleeve Fracture of the Patella in Children

To report the diagnosis, treatment, and outcomes of sleeve patellar fractures in children. Records of a consecutive series of patients with sleeve patellar fractures were retrospectively reviewed. Of the 11 children (8 boys and 3 girls; mean age, 12 years), 6 had minimally displaced fractures (1-2 mm) and were managed by cylindrical plaster of Paris immobilisation, whereas the other 5 with severely displaced fractures underwent open reduction with tension band wiring. The mean follow-up period was 10 (range, 3-36) months. All patients obtained full extension of the knee except one (with an extension lag of 10 degrees). No patient complained of pain or discomfort of the involved knee. Sleeve patellar fractures in children are uncommon. Diagnosis can be missed, especially in those with a very small avulsed bony fragment. For undisplaced fracture, conservative management can achieve good results. For severely displaced fractures, early surgical intervention is effective.

The ‘four-in-one’ procedure for habitual dislocation of the patella in children

We describe our experience with the 'four-in-one' procedure for habitual dislocation of the patella in five children (six knees). All the patients presented with severe generalised ligamentous laxity and aplasia of the trochlear groove. All had a lateral release, proximal 'tube' realignment of the patella, semitendinosus tenodesis and transfer of the patellar tendon. The mean age at the time of the operation was 6.1 years (4.9 to 6.9), and the patients were followed up for a mean of 54.5 months (31 to 66). The clinical results were evaluated using the Kujala score. There has been no recurrence of dislocation. All the patients have returned to full activities and the parents and children were satisfied with the clinical results. The mean Kujala score was 95.3 (88 to 98). Two patients had marginal skin necrosis which healed after debridement and secondary closure. These early results in this small group have shown that the 'four-in-one' procedure is effective in the treatment of obligatory dislocation of the patella in children with severe ligamentous laxity and trochlear aplasia.

Hematogenous Osteomyelitis of the Patella in a Child

The early diagnosis of osteomyelitis of the patella in children is difficult due to rarity of this infection and lack of radiologic signs in the early stage. The authors report a case of hematogenous osteomyelitis of the patella in an 8-year-old boy and review the literature. The disease should be highly suspected in a patient with persistent pain and swelling of the knee that does not respond to conventional management. Surgical debridement is the treatment of choice when the diagnosis has been delayed or there is a sequestrum in the image study. The diagnosis should be differentiated with septic arthritis of the knee. Arthrotomy is not necessary in osteomyelitis of the patella and may produce infection into the joint.

The "Four-in-One" Procedure for Habitual Patellar Dislocation in Children with Formation Failure of Femoral Trochlea and Generalized Ligamentous Laxity - A Preliminary Report -

Purpose : To evaluate the clinical results of a Four-in-One procedure for a habitual dislocation of the patella in children with generalized ligamentous laxity and formation failure of the femoral trochlea. Materials and Methods : Five knees in 4 patients were included in this study. The average age of the patients at the time of surgery was 5.9 years and the subjects were followed up for an average of 41.6 months postoperatively. The clinical results were evaluated using the criteria of the Kujala's scoring system as well as a physical examination and radiological findings. Results : During the follow-up period, there were no recurrent dislocations, knee joint pain, limitations of motion or gait disturbances in any of the cases. The mean Kujala score was 96.8. Two cases had complications related to wound healing but they healed eventually. Conclusion : The Four-in-One procedure, which include the lateral retinacular release, medial vector augmentation, semitendinosus tenodesis, and patellar tendon transfer is recommended for a habitual dislocation of the patella in children with generalized ligament laxity and formation failure of the femoral trochlea.

The mechanism and diagnosis of a sleeve fracture of the upper pole of the patella in children

Sleeve fracture is one of the commoner types of patellar fracture in children. It is an avulsion of an osteochondral fragment at the periphery of the immature patella due to trauma associated with rapid quadriceps muscle contraction. It occurs usually at the inferior pole of the patella, but rarely the superior pole of the patella is affected. The sleeve fracture may be occult on plain X-ray, especially if the ossification centre is small and only a cartilaginous avulsion occurred, yet if not diagnosed and treated at the time of the injury it may cause permanent disability. A case of superior pole sleeve fracture is presented with a review of the previously reported cases in the literature. Our objective was to look for a pattern (in terms of mechanism of injury and clinical features), which may predispose to superior pole sleeve fracture and to provide insight in the radiological signs, which may be helpful to diagnose a sleeve fracture soon after injury. We found that the sleeve fracture of the superior pole of the patella occurs in the under 16's. The mechanism of injury is a rapid quadriceps contraction with the knee in a certain degree of flexion, for example forced flexion due to a fall. In all cases the plain X-ray showed abnormalities, although these were initially missed in half of the cases. The key radiological features are a joint effusion; anterior tilt of the patella and a shell of bone lying proximally to the patella. Ultrasound is very helpful in diagnosing a sleeve fracture of the patella, differentiating it from a quadriceps rupture and in the follow-up of a sleeve fracture.

Diagnosis and treatment of 7 cases of lacerated fractures of the inferior patella in children

目的 分析儿童髌骨下极撕脱骨折的诊治。方法 1989年以来共有7例髌骨下极撕脱骨折儿童行手术治疗，年龄8～15岁，伤后就诊时间1h-6d。3例采用克氏针钢丝张力带固定，4例用可吸收线“8”字缝合，按膝关节疗效标准进行疗效评价。结果 术后摄片复查骨折完全愈合，随访1～4年，疗效均达到优。结论 在缺乏磁共振(MR)检查时，根据病史、症状、体征及髌骨位置测量a．b／b、d值。线位置综合分析，经手术检查证实，可以确诊髌骨下极撕脱骨折。