Patella kırığı

Özet

Patella kırığı doğrudan ön diz darbesiyle, kuvvetli kuadriseps kasılmasıyla veya ikisinin birleşimiyle gelişebilir. Patella kırığında ekstansör mekanizma bütünlüğü, fragman deplasmanı ve eklem yüzü uyumu değerlendirilmelidir. İnce kesit kontrastsız BT, özellikle parçalı alt kutup kırıklarında grafilerin gösteremediği küçük fragmanları ve eklem yüzü uzanımını haritalar. Deplase patella kırıklarında retinaküler ve ekstansör mekanizma yaralanması olasılığı göz önünde bulundurulmalıdır.

Faz ve pencere

Kontrastsız tanısal

Patella korteksindeki kesinti, kırık hattının transvers/vertikal/oblik yönü, eklem yüzü basamağı, ayrılmış fragmanlar ve komşu yumuşak dokudaki şişlik değerlendirilir; kemik kırığını göstermek için intravenöz kontrast gerekmez.

Kemik algoritması tanısal

BT, parçalı distal kutup kırıklarını konvansiyonel radyografiden daha doğru değerlendirebilir ve kırık örüntüsünün daha iyi belirlenmesini sağlayabilir.

Önerilen pencereler: Kemik (G 1800 / M 400), Yumuşak doku (G 400 / M 40).

BT bulguları

• Transvers patella kırıkları indirekt, uzunlamasına kuvvetlerle ilişkili olabilir.
• Vertikal kırıklar sıklıkla lateral faseti tutar ve AP grafide kolayca gözden kaçabilir. AP grafide gözden kaçabilir.
• Eklem yüzü basamağı, patella kırığında eklem yüzü uyumsuzluğu olarak değerlendirilir.
• Fragman ayrışması — kırık parçaları arasında ölçülebilir aralık bulunur; deplasman retinaküler hasar şüphesini artırır.
• Alt kutup parçalanması — küçük distal kemik parçaları patellar tendon yapışmasına komşudur; ince kesitler parçalanmanın yaygınlığını gösterir.
• Patellar çıkık sonrasında medial patella fasetinden veya lateral femoral kondilden kopmuş osteokondral fragmanlar görülebilir.
• Ön diz hematomu ve şişliği — patella önündeki yumuşak dokuda kalınlaşma ve sıvı yoğunluğu travmayı destekler, ancak ekstansör tendon bütünlüğünü BT kesinleştirmez.

Ölçütler ve sınıflamalar

Parçalar arası ayrışma ve eklem yüzü uyumsuzluğu için yayımlanmış deplasman tanımı

>3 mm fragman ayrışması ve/veya >2 mm eklem yüzü uyumsuzluğu

AO/OTA 34

34-A eklem dışı; 34-B kısmi eklem içi; 34-C tam eklem içi kırıkları ayırır. Alt gruplar kırık hattı ve parçalanma biçimini daha ayrıntılı tanımlar.

Morfolojik tanımlama

Patellar kırıklar morfolojik örüntülerine ve deplasman derecelerine göre sınıflandırılır.

Normalde

Normal patellanın ön yüzü eklem dışıdır; arka eklem kıkırdağı medial ve lateral fasetlere ayrılır. Normal patellanın ön yüzü eklem dışıdır; arka eklem kıkırdağı medial ve lateral fasetlere ayrılır.

Ayırıcı tanı

Bipartit patella

çoğunlukla superolateral yerleşimli aksesuar parça düzgün ve tamamen kortike kenarlıdır.

Çocuklarda patellar sleeve avulsiyonunda kıkırdak kılıf ayrılabilir ve küçük ossifik fragmanlar eşlik edebilir; patella alta tanıya ipucu sağlar.

Patellofemoral çıkık sonrası osteokondral kırık

medial patella faseti veya lateral femoral kondilde yüzeysel eklem defekti ve eklem içi parça vardır.

Sinding-Larsen-Johansson sendromu, patellanın alt kutbunu etkileyen bir osteokondroz olup ossikül oluşumuyla ilişkili olabilir.

Tuzaklar

• Vertikal patella kırıkları AP grafide kolayca gözden kaçabilir; değerlendirmede skyline görünümü de kullanılmalıdır.
• Küçük patellar avulsiyon fragmanlarını değerlendirirken kuadriseps veya patellar tendonda eşlik eden yumuşak doku yaralanması olabileceğini göz önünde bulundurun.
• Patella önündeki subkutan ödem doğrudan travmayla ilişkili olabilir.
• Kemik BT'sini retinakulum veya tendon yırtığı için yeterli kabul etme; bu yumuşak doku yapılarının bütünlüğü BT'de sınırlı değerlendirilir.

Kendini dene

1. Kaynağa göre patella kırıkları hangi özelliklere göre sınıflandırılır?

   • Morfolojik örüntü ve deplasman derecesi
   • Hastanın yaşı ve cinsiyeti
   • Diz fleksiyon açısı ve eklem efüzyonu
   • Patellar tendon kalınlığı ve patella yüksekliği
   Cevabı göster

   Morfolojik örüntü ve deplasman derecesi. Kaynak, patella kırıklarının morfolojik örüntüleri ve deplasman derecelerine göre sınıflandırıldığını belirtir.

2. Patella kırıkları kaynakta hangi özelliklere göre sınıflandırılıyor?

   • Morfolojik örüntü ve deplasman derecesi
   • Hastanın yaşı ve cinsiyeti
   • Diz fleksiyon açısı ve eklem efüzyonu
   • Patellar tendon kalınlığı ve patella yüksekliği
   Cevabı göster

   Morfolojik örüntü ve deplasman derecesi. Kaynağa göre patella kırıkları morfolojik örüntüleri ve deplasman dereceleri temelinde sınıflandırılır.

İlgili konular

• Diz lipohemartrozu
• Tibia platosu posterior shear/kolon kırığı
• Segond avulsiyon kırığı

Kaynaklar

Bu sayfadaki 39 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 19 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Imaging of patellar fracturespmc.ncbi.nlm.nih.gov
2. Magnetic resonance imaging of the extensor mechanism.pubmed.ncbi.nlm.nih.gov
3. Management of first-time patellar dislocation: The ESSKA 2024 formal consensus-Part 1.pubmed.ncbi.nlm.nih.gov
4. Patella fracture after medial patellofemoral ligament reconstruction using suture anchors.pubmed.ncbi.nlm.nih.gov
5. The Extensor Mechanism: Imaging and Intervention.pubmed.ncbi.nlm.nih.gov
6. Computer-assisted patellar resection for total knee arthroplasty.pubmed.ncbi.nlm.nih.gov
7. Total patellectomy with extensor mechanism reconstruction following pathological fracture due to patellar Ewing's sarcoma.pubmed.ncbi.nlm.nih.gov
8. Pediatric Patellar Injuries.pubmed.ncbi.nlm.nih.gov
9. Comminuted inferior pole fracture of patella can be successfully treated with rim-plate-augmented separate vertical wiring.pubmed.ncbi.nlm.nih.gov
10. Quantitative and qualitative assessment of bone perfusion and arterial contributions in a patellar fracture model using gadolinium-enhanced magnetic resonance imaging: a cadaveric study.pubmed.ncbi.nlm.nih.gov
11. Effect of computerized tomography on classification and treatment plan for patellar fractures.pubmed.ncbi.nlm.nih.gov
12. Irreducible Lateral Patellar Dislocation: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
13. Augmentation of Patellar Tendon Repair With Autologous Semitendinosus Graft-Porto Technique.pubmed.ncbi.nlm.nih.gov
14. [Treatment of patellofemoral instability in adolescent by anatomical double-bundle medial patellofemoral ligament reconstruction with double suture anchor technique].pubmed.ncbi.nlm.nih.gov
15. [Patellar osteochondral injury as onset of patellar instability].pubmed.ncbi.nlm.nih.gov
16. Augmented Repair of an Acute Midsubstance Patellar Tendon Rupture Using Suture Anchors, InternalBrace™, and Achilles Tendon Allograft: A Case Report.pubmed.ncbi.nlm.nih.gov
17. Inferior patella dislocation in an elderly patient after a fall: A case report.pubmed.ncbi.nlm.nih.gov
18. Arthroscopic Treatment of a Large Traumatic Morel-Lavallée Lesion of the Knee in a Young Female Athlete: A Case Report.pubmed.ncbi.nlm.nih.gov
19. Biomechanical Comparison of Patellar Fixation Techniques in Medial Patellofemoral Ligament Reconstruction: A Pediatric Cadaveric Study.pubmed.ncbi.nlm.nih.gov
20. Low early fixation failure rates with variable-angle locking plate fixation of AO/OTA 34 C patella fractures: a retrospective cohort study.pubmed.ncbi.nlm.nih.gov
21. A Modified Lag Screw and Cerclage Wire Technique for the Management of Sagittal Patellar Fractures: A Case Report.pubmed.ncbi.nlm.nih.gov
22. Glossary of terms for musculoskeletal radiology.pubmed.ncbi.nlm.nih.gov
23. A Krackow-based suture technique as a novel alternative for feline patellar fracture repair: a biomechanical comparison.pubmed.ncbi.nlm.nih.gov
24. Are new implants for patellar fractures reasonable? A biomechanical comparison of intramedullary locking nails versus tension-band osteosynthesis.pubmed.ncbi.nlm.nih.gov
25. A biomechanical comparison of antegrade versus retrograde cannulated screw direction in suture-based tension band fixation of transverse patella fractures.pubmed.ncbi.nlm.nih.gov
26. A rare traumatic triad: Open bicondylar non-conjoint Hoffa fracture with partial tibial tubercle and medial epicondyle avulsions - A case report and biomechanical analysis.pubmed.ncbi.nlm.nih.gov
27. Fully automated 3D MRI assessment of isolated chondral fracture of the knee in an adolescent athlete: A case report.pubmed.ncbi.nlm.nih.gov
28. Imaging of pediatric musculoskeletal trauma: Age-specific considerations and challenges.pubmed.ncbi.nlm.nih.gov
29. MRI of Knee Joint Lesions: An Observational Study of Traumatic, Degenerative, Cystic, and Neoplastic Pathologies.pubmed.ncbi.nlm.nih.gov
30. Clinical outcomes and complications after proximal tibial detorsional osteotomy for patellar luxation in dogs: A multicenter retrospective study.pubmed.ncbi.nlm.nih.gov
31. Traumatic Separation of a Bipartite Patella With Concurrent Quadriceps Tendon and Retinacular Injury: A Report of a Rare Case.pubmed.ncbi.nlm.nih.gov
32. Modified Multi-Strand Nice Knot Suture Construct Combined with Suture Anchor Fixation Versus Conventional Kirschner Wire Tension Band Fixation for Inferior Patellar Pole Fractures: A Retrospective Comparative Study.pubmed.ncbi.nlm.nih.gov
33. Treatment of inferior pole patellar fractures with an integrated titanium cable-net construct: a retrospective case series.pubmed.ncbi.nlm.nih.gov
34. Application of biodegradable implants in pediatric orthopedics: shifting from absorbable polymers to biodegradable metals.pubmed.ncbi.nlm.nih.gov
35. Basic Differences and Most Common Findings in Ultrasound Examinations of Musculoskeletal System in Children: A Narrative Literature Review.pubmed.ncbi.nlm.nih.gov
36. Osteochondritis Dissecans: Etiology, Pathology, and Imaging with a Special Focus on the Knee Joint.pubmed.ncbi.nlm.nih.gov
37. Musculoskeletal ultrasound in the emergency department: a narrative review for general radiologists.pubmed.ncbi.nlm.nih.gov
38. Patellar Non-Traumatic Pathologies: A Pictorial Review of Radiologic Findings.pubmed.ncbi.nlm.nih.gov
39. Imaging findings of intra-articular tumor/tumor-like lesions based on pathologic correlation.pubmed.ncbi.nlm.nih.gov
40. Conservative Treatment of Pediatric Fractures-Narrative Review of Acceptable Deformity and Remodeling Potential.pubmed.ncbi.nlm.nih.gov
41. Association between articular surface depression and functional outcomes after ORIF of tibial plateau fractures: a retrospective cohort study.pubmed.ncbi.nlm.nih.gov
42. Approach to Patellar Dislocation Treatment: Review and Prospects.pubmed.ncbi.nlm.nih.gov
43. Repurposing traditional cerclage and suture techniques for the reduction of comminuted patellar fractures.pubmed.ncbi.nlm.nih.gov
44. Periprosthetic Fractures After Total Knee Arthroplasty-A Two-Center Study and Systematic Review of the Literature.pubmed.ncbi.nlm.nih.gov
45. Patellar Fractures: A Clinical Narrative Review.pubmed.ncbi.nlm.nih.gov
46. Use of metatarsal hook plates in the treatment of multifragmentary patellar fractures - A case series.pubmed.ncbi.nlm.nih.gov
47. "Pediatric Patella fractures - A Systematic review".pubmed.ncbi.nlm.nih.gov
48. Tripartite Patella: A Rare Case Report.pubmed.ncbi.nlm.nih.gov
49. Painful knee.pubmed.ncbi.nlm.nih.gov
50. Embryonic and fetal development of the human knee with an emphasis on the posterior cruciate ligament: a literature review.pubmed.ncbi.nlm.nih.gov
51. Ultrasound Applications in Pediatric Orthopedics.pubmed.ncbi.nlm.nih.gov
52. Avulsion injuries: an update on radiologic findings.pubmed.ncbi.nlm.nih.gov
53. Risk Factor Evaluation for Loose Body Following First-Time Patellar Dislocation in Pediatric Patients.pubmed.ncbi.nlm.nih.gov
54. Morphological and postoperative functional comparison of patellar dislocation with or without avulsion fracture of the medial inferior border of the patella.pubmed.ncbi.nlm.nih.gov
55. Patellar Instability: A Narrative Review with an Integrated Treatment Algorithm.pubmed.ncbi.nlm.nih.gov
56. Sinding-Larsen-Johansson disease. Clinical features, imaging findings, conservative treatments and research perspectives: a scoping review.pubmed.ncbi.nlm.nih.gov
57. Clinics in diagnostic imaging (202). Osgood-Schlatter disease (OSD).pubmed.ncbi.nlm.nih.gov
58. A Systematic Approach to the Evaluation of Acute Musculoskeletal Injuries in the Emergency Department.pubmed.ncbi.nlm.nih.gov
59. Hoffa fracture combined with rotational dislocation of the knee joint: A novel case report.pubmed.ncbi.nlm.nih.gov
60. Overlooked Hoffa Fracture in a Patient With Neurofibromatosis-1.pubmed.ncbi.nlm.nih.gov
61. Anatomical and clinical significance of the Cyrano long-nosed patella in combination with patellofemoral instability: a case report and review of literature.pubmed.ncbi.nlm.nih.gov
62. Narrative Review - Knee Pain in the Pediatric Athlete.pubmed.ncbi.nlm.nih.gov
63. Consensus Guidelines on Interventional Therapies for Knee Pain (STEP Guidelines) from the American Society of Pain and Neuroscience.pubmed.ncbi.nlm.nih.gov
64. Beyond Palmer: a topographic classification of non-Palmer triangular fibrocartilage complex injuries.pubmed.ncbi.nlm.nih.gov
65. Ultrasound Imaging of Ankle Retinacula: A Comprehensive Review.pubmed.ncbi.nlm.nih.gov
66. Clinical and MRI Restoration of ACL Continuity Following Functional Complete ACL Rupture in an Adolescent Athlete: A Case Report.pubmed.ncbi.nlm.nih.gov
67. Comparison of Tibial Nail Entry Point Location Among Infrapatellar, Suprapatellar, and Lateral Parapatellar Approaches Using Postoperative 3D-CT.pubmed.ncbi.nlm.nih.gov
68. Sagittal biplanar 'L'-shaped tibial osteotomy associated with osteochondral allograft for symptomatic varus knee and low patella.pubmed.ncbi.nlm.nih.gov
69. Treatment Options for Patellofemoral Arthritis.pubmed.ncbi.nlm.nih.gov
70. "Net cage" technique in the treatment of inferior pole patella fracture.pubmed.ncbi.nlm.nih.gov
71. Patellar Fracture Risk Is Not Affected by Harvest Length During Bone-Patellar Tendon-Bone Harvest: A Biomechanical and Ultimate Load-to-Failure Analysis.pubmed.ncbi.nlm.nih.gov
72. A good option for patella fracture treatment: the use of the fixed angle mini-fragment plate with a circular cerclage wire.pubmed.ncbi.nlm.nih.gov
73. Biomechanical Evaluation of Suture Tape Versus Metallic Wire With Cannulated Screws Tension Band Fixation For Transverse Patella Fractures: A Biomechanical Study.pubmed.ncbi.nlm.nih.gov
74. Trauma-related postoperative redisplacement after tension-band fixation for patellar fracture in Parkinson's disease: a case report and focused literature review.pubmed.ncbi.nlm.nih.gov
75. 3D printing for the treatment of pathological fracture associated with patellar osteoblastoma: case reports.pubmed.ncbi.nlm.nih.gov
76. Combined Tibial Tubercle Fracture and Patellar Tendon Rupture in Adolescents: A Report of Three Cases Highlighting Fragment Rotation as a Diagnostic Clue.pubmed.ncbi.nlm.nih.gov
77. Multiligament-injured knee: what the general orthopedic surgeon should know.pubmed.ncbi.nlm.nih.gov
78. Association of Elevated Body Mass Index with Tibial Tuberosity Avulsion Fractures in Pediatric Athletes: A Pilot Retrospective Study.pubmed.ncbi.nlm.nih.gov
79. Chronic Pain and Stiffness After Total Knee Arthroplasty: A Comprehensive, Phenotype-Based Review of Mechanisms, Diagnosis and Management.pubmed.ncbi.nlm.nih.gov
80. Predictive value of a preoperative computed tomography-derived perifracture soft-tissue envelope index for fracture-related infection after open reduction and internal fixation of tibial plateau fractures.pubmed.ncbi.nlm.nih.gov
81. Clinical application of cannulated screws tension band and cerclage fixation for displaced patellar fractures based on fracture morphological classification.pubmed.ncbi.nlm.nih.gov
82. Patellar fracture mapping: characteristics of fracture line distribution and risk factors for postoperative malposition.pubmed.ncbi.nlm.nih.gov
83. Spiked Washer-Augmented Screw Fixation for Bilateral Tibial Tuberosity Avulsion Fractures in an Adolescent: A Case Report.pubmed.ncbi.nlm.nih.gov
84. Treatment of Failed Patella ORIF With Novel Patella Tension Band Plate and Suture Construct: A Case Report.pubmed.ncbi.nlm.nih.gov
85. Clinical and functional outcomes of fracture pattern-driven plate osteosynthesis technique for comminuted patellar fractures using multiple miniplates.pubmed.ncbi.nlm.nih.gov
86. The Impact of Football Boot Design on Lower Limb Injury Risk: A Systematic Review.pubmed.ncbi.nlm.nih.gov
87. Patellar Dislocation: Workup and Decision-Making.pubmed.ncbi.nlm.nih.gov
88. Coronal and Transverse Malalignment in Pediatric Patellofemoral Instability.pubmed.ncbi.nlm.nih.gov
89. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
90. Imaging of patellar fractures.pubmed.ncbi.nlm.nih.gov
91. Arthroscopy strategy to obtain surgical access to peripheral lateral tibial plateau for arthroscopic assisted reduction & internal fixation of fractures.pubmed.ncbi.nlm.nih.gov
92. Management of Bone Loss in Revision Total Knee Arthroplasty: An International Consensus Symposium.pubmed.ncbi.nlm.nih.gov
93. Natural Biomaterials for Osteochondral Repair: From Source to Strategy.pubmed.ncbi.nlm.nih.gov
94. Bone lesions of the tibia: Multimodal iconographic review and diagnostic algorithms, Part 2: Metaphyseal and epiphyseal lesions.pubmed.ncbi.nlm.nih.gov
95. Patellar instability: current approach.pubmed.ncbi.nlm.nih.gov
96. The first case report of osteochondroma in a tetraplegic patient after spinal injury.pubmed.ncbi.nlm.nih.gov
97. Fluoroscopic-guided procedures of the lower extremity.pubmed.ncbi.nlm.nih.gov
98. Fracture Risk Evaluation of Trochlear Groove Depth in Toy and Small-Breed Dogs Under Gait-Based Loading: A Finite Element and Fatigue Analysis Study.pubmed.ncbi.nlm.nih.gov
99. Compression fracture of the T12 vertebra combined with diaphragmatic hernia after low-energy trauma: a case report and literature review.pubmed.ncbi.nlm.nih.gov
100. Management of inferior patellar sleeve fracture by ORIF with ortho cord suture: A case report.pubmed.ncbi.nlm.nih.gov
101. Comparative study of twin-perforated orthopedic pin with metal cable versus ao tension band wiring in patellar fracture management.pubmed.ncbi.nlm.nih.gov
102. Paediatric Patella Tendon Rupture: A Systematic Review.pubmed.ncbi.nlm.nih.gov
103. A Rare Combination of Patellar Sleeve Fracture, Tendon Avulsion, and Retinacular Disruption in a Child: Diagnostic and Operative Insights.pubmed.ncbi.nlm.nih.gov
104. A "Suture Staple" Knotless Anchor Technique for Fixation of Tibial Tubercle Avulsion Fractures in Pediatric Patients.pubmed.ncbi.nlm.nih.gov
105. Beyond conservative management: Surgical excision for symptomatic Sinding-Larsen-Johansson syndrome: A case report and literature review.pubmed.ncbi.nlm.nih.gov
106. Osteotomies: Indications, Imaging Appearance, Surgical Techniques, and Complications.pubmed.ncbi.nlm.nih.gov
107. Tibial Tubercle Osteotomy: Indications, Outcomes, and Complications.pubmed.ncbi.nlm.nih.gov
108. Traumatic Midsubstance Patellar Tendon Ruptures: A Unique Surgical Repair Technique in the Setting of Poor Tissue Quality.pubmed.ncbi.nlm.nih.gov
109. Knee Dislocation as a Result of a Ski Injury.pubmed.ncbi.nlm.nih.gov
110. Early Results of a Patient-Specific Total Knee Arthroplasty Implant Cast From a 3D-Printed Mold.pubmed.ncbi.nlm.nih.gov
111. Patellofemoral Instability in the Adolescent Age Group.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.