Intra-Articular Dislocation of patella with Femoral Impactio
A 66-year-old female presented to the emergency department after sustaining a mechanical fall earlier that day. She reported that she had missed a step on the sidewalk, which resulted in a twisting movement to her left knee and direct impact on the floor. On examination, her left knee was found to be locked in approximately 60 degrees of flexion and upper pole of the left patella was not palpable. The patellar tendon was intact on palpation, but the quadriceps tendon was not easily palpable. Radiographs of the left knee revealed an intra-articular dislocation of the patella with possible impaction into the distal femur.

An unsuccessful closed reduction under procedural sedation was performed in the emergency department. During this maneuver, an attempt was made to reduce the patella with the knee in both extension and flexion but was unsuccessful. A CT of the left knee was obtained following this attempt, which confirmed impaction of the patella into the distal femur. The patient was then consented for a left patella closed vs open reduction in the operating room. A pre-operative MRI of the left knee confirmed an intact quadriceps tendon. She was placed in a zimmer (extension) splint for comfort while waiting for the operation.

The patient was re-examined on the orthopaedic floor on the following day and was found to have spontaneously reduced while she was on the zimmer splint. Post reduction radiographs were obtained to confirm this. Patient was advised to walk weight-bearing as tolerated in the zimmer (extension) brace for 2 weeks, and has since returned to preinjury mobility.

Source: International Journal of Surgery case reports

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