Tsubosaka Masanori, Makino Takeshi, Kishimoto Shin-Ichiro, Yamaura Kohei
Department of Orthopaedic Surgery, Rokko Island Konan Hospital, 2-11, Koyo-Cho Naka, Higashinada-Ku, Kobe, 658-0032, Japan.
J Orthop Case Rep. 2016 Nov-Dec;6(5):24-27. doi: 10.13107/jocr.2250-0685.614.
Sleeve fractures of the patella are rare fractures that only occur in children. The diagnosis is difficult both clinically and radiologically since the distal bony fragment may be too small to be detectable by radiography. A high-riding patella and hemarthrosis are important signs of sleeve fractures.
A 12-year-old boy was admitted to the emergency room after having felt a severe pain in his left knee on kicking the ground while skateboarding earlier that day. Knee swelling, tense hemarthrosis, and periarticular tenderness were noted. On physical examination, an extension lag of 15 was observed. The active range of motion of the injured knee was 45-90° of flexion. Radiography showed an avulsion fracture of the lower pole of the patella and a high-riding patella. At the next day after the injury, we performed open reduction and internal fixation surgery. Open reduction with transosseous tunneling and cerclage wiring was performed because the distal bony fragment was too small for tension band wiring to be used. At 9 months after surgery, there was no extension lag, and the active range of motion of the injured knee was 0-140° of flexion. Callus formation over the fracture site and bone union was confirmed, and the cerclage wire was removed. To date, he had no further symptoms and has been able to carry out all types of physical activities, including skateboarding.
Although sleeve fractures in children are uncommon, it should be considered a possibility in children with a chief complaint of pain around the knee. Open reduction and internal fixation was effective in the treatment of sleeve fracture of the patella.
髌骨袖状骨折是仅发生于儿童的罕见骨折。由于远端骨块可能过小而无法在X线片上显影，因此在临床和放射学上诊断都很困难。高位髌骨和关节积血是袖状骨折的重要体征。
一名12岁男孩在当天早些时候滑板时踢地后左膝感到剧痛，随后被送往急诊室。检查发现膝关节肿胀、关节积血紧张和关节周围压痛。体格检查时，发现伸直滞后15°。受伤膝关节的主动活动范围为屈曲45 - 90°。X线片显示髌骨下极撕脱骨折和高位髌骨。受伤后第二天，我们进行了切开复位内固定手术。由于远端骨块过小无法使用张力带钢丝固定，因此采用经骨隧道和环扎钢丝进行切开复位。术后9个月，无伸直滞后，受伤膝关节的主动活动范围为屈曲0 - 140°。骨折部位有骨痂形成且骨已愈合，环扎钢丝已取出。迄今为止，他没有进一步的症状，并且能够进行包括滑板在内的所有类型的体育活动。
虽然儿童袖状骨折并不常见，但对于以膝关节周围疼痛为主诉的儿童应考虑这种可能性。切开复位内固定治疗髌骨袖状骨折有效。
