Treatment of Patellar Fracture from Slip and Fall

Initial Diagnostic Approach

• The American College of Radiology recommends obtaining standard knee radiographs immediately as the first-line imaging modality when a patient presents with focal tenderness, effusion, or inability to bear weight after acute knee trauma, including anteroposterior, lateral, and patellofemoral views 1, 2
• A minimum of two views (anteroposterior and lateral) should be obtained, with the lateral view at 25-30 degrees of flexion to visualize the patella in profile, and a patellofemoral view should be added specifically for suspected patellar fractures to better characterize the fracture pattern and assess for subluxation or dislocation 1, 2
• A cross-table lateral view with horizontal beam can visualize lipohemarthrosis, which is frequently seen with intra-articular fractures 2
• If radiographs are negative but clinical suspicion remains high for occult fracture, CT or MRI can detect radiographically occult fractures, though these are not routinely used as initial imaging 1, 2