Module 13, Pediatric Orthopaedist Level

This is a 14 year old male who presented to the emergency room complaining of left knee pain after falling off his bicycle. Examination reveals a swollen left knee. The skin was intact. There was tenderness to palpation diffusely about the knee. Valgus stress at full extension and at 30 degrees revealed an increased laxity on the left. Anterior draw and Lachman tests were also asymmetric with an increased excursion on the left. Neurovascular exam was unremarkable.

Question 13A

This fracture is best managed by an open reduction and internal fixation.

Question 13B

If the joint is opened, the fragment should be debrided in such a way that it will sink lower than it was before the injury, This reduction will yield the best functional outcome.

Question 13C

Internal fixation is best obtained with two large screws.

Question 13D

Casting these fractures in full or hyper knee extension can result in severe complications.

Question 13E

The above history and x-ray could be consistent with a patellar dislocation.