In a patellar fracture, the decision to operate turns on whether the patient can straight-leg raise against gravity, not only on displacement. An intact extensor mechanism with minimal displacement can be managed non-operatively. Aspirating a tense haemarthrosis and injecting local anaesthetic makes the test reliable in a painful knee.
- Test straight-leg raise after aspiration and local anaesthetic if pain prevents it.
- Measure articular step and fragment gap on a true lateral radiograph.
- Look for comminution on CT if planning fixation.
- Document skin condition — anterior knee skin tolerates swelling poorly.
Why it matters
The extensor mechanism, not the radiograph alone, decides whether surgery is needed.
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