"Pediatric Patella fractures - A Systematic review"
Sajid Ansari1, Saptarshi Barman2, Balgovind S Raja3
1Department of Orthopeaedics, All India Institute of Medical Sciences, Rishikesh, India.
Insights
Pediatric patella fractures present diagnostic and treatment challenges. This review suggests surgical intervention is often the primary treatment for pediatric patella fractures and osteochondral fractures.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Traumatology
Background:
- Patella fractures in children pose diagnostic and treatment dilemmas.
- Clear guidelines for conservative vs. surgical management during growth are lacking.
- This review addresses morphological types, treatments, outcomes, and complications.
Purpose of the Study:
- To establish a consensus on managing pediatric patella fractures.
- To clarify indications for conservative and surgical interventions.
- To review outcomes and complications of pediatric patella fracture treatments.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Inclusion of English articles on patellar and osteochondral fractures in patients <18 years.
- Exclusion of incomplete data, case reports, and non-English studies.
Main Results:
- 18 articles and 288 pediatric patients were included.
- Average patient age ranged from 9.6 to 16 years.
- 83 patients underwent surgical fixation, while 101 received conservative casting/immobilization.
Conclusions:
- Pediatric patella fractures and osteochondral fractures are rare but significant.
- While conservative management is an option, surgical intervention is recommended as the primary treatment.
- Early diagnosis and appropriate management are crucial for optimal outcomes.
Background:
Patella fractures in the pediatric age group often have a dilemma in their ease of diagnosis and treatment required. Indications for conservative management or surgical intervention in the pediatric population during growth phase are not clearly defined. The current systematic review aims to provide a consensus on the morphological types, treatment options, indications, the outcomes expected and complications and their management.
Methods:
The review was conducted as per the PRISMA guidelines. Inclusion criteria were (a).Articles published in English, (b) Age <18 years, (c) Patellar fractures including osteochondral fractures. Exclusion criteria includes articles with incomplete data, case reports, biomechanical studies, case series with sample size <2, biomechanical studies, reviews, letter to the editor, or editorials and Non-English language.
Results:
The review search yielded a total of 18 articles. A total of 288 patients with patellar fractures were included in the review. The average age ranged from 9.6 years to 16 years. The follow-up period ranged from 3 months to 20 years. In total, 49 individuals underwent immobilization with cast or brace application, 4 with spica cast application and 48 with cylindrical cast in extension. Overall, 83 patients in 13 studies underwent surgical fixation most of which underwent wiring.
Conclusion:
Pediatric patella fracture/dislocations or Osteochondral fractures (OCF) although being a rare event, may be associated with a child with knee injury and swelling. Conservative management in terms of casting and immobilization may be an alternative but surgical intervention should be the primary mode of treatment in such cases.
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