A 40-year-old man sustains a direct blow to his knee in a motorcycle accident. He has a transverse patellar fracture with a 4 mm separation of the fragments and inability to perform a straight leg raise. The treatment of choice is:

• A Cylinder cast immobilization for 6 weeks
• B Arthroscopic-assisted percutaneous screw fixation
• C Total patellectomy
• D Open reduction with tension band wiring through two parallel K-wires ✓

Explanation

Displacement greater than 2 to 3 mm with disruption of the extensor mechanism (inability to straight leg raise) is the accepted indication for surgery. A transverse pattern with an intact articular surface is ideal for the modified anterior tension band construct using two parallel K-wires with figure-of-eight cerclage wire. Patellectomy is reserved for severely comminuted non-reconstructible fractures and sacrifices extensor lever arm strength.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.