Whether a patellar fracture needs fixation turns less on the radiograph than on whether the patient can straighten the knee. Ask for an active straight-leg raise and look for an extension lag.
If pain prevents a fair test, aspirate the haemarthrosis and instil local anaesthetic, then test again. An intact extensor mechanism with minimal displacement can often be managed without surgery.
- Ask for an active straight-leg raise and note any extension lag.
- Aspirate and instil local anaesthetic if pain prevents a reliable test.
- Look for a palpable gap at the fracture or tendon.
- Get a lateral radiograph to judge displacement and articular step.
Why it matters
Displacement on a film is only half the decision; extensor function is the other half.
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