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📌 Patellar Sleeve Fracture
- Peak incidence at 12.7 years, ranging from 8 to 16 years.
- Most cases involve the inferior patellar pole, but bilateral and superior pole fractures are also reported.
- These fractures may occur in the entire circumference of the patella and are described as superior, inferior, medial, and lateral avulsions.
✅ Pathophysiology
- This occurs due to the patella's hypermobility and the high cartilage-bone ratio at the transformation zone, which makes it vulnerable to acute and chronic eccentric loads and shear forces.
- The cartilage blends directly with the tendon collagen rather than through distinct Sharpey fibers found in adults.
✅Plain Radiographs
- Demonstrate a small bone fragment inferior to the lower pole of the patella, patella alta, and joint effusion.
- Avulsed ossified fragments are associated with prepatellar swelling and may extend posteriorly to involve the articular surface.
- Radiographs often underestimate the extent of injury at the non-mineralized cartilage and perichondrium.
✅ MRI Findings
- Shows an avulsed bone fragment, increased signal intensity of the surrounding soft tissues, and bone marrow edema of the patella.
- MRI can demonstrate a nondisplaced osteochondral fracture if no bone fragment is avulsed.
- A joint effusion may be present if the fracture extends into the joint.
✅ Differential Diagnosis
- Shares imaging features with Sinding-Larsen-Johansson syndrome but has a different clinical manifestation, with an acute onset after a single episode of trauma.
References
- Radiographics. 2009 May-Jun;29(3):877-86
- Radiol Clin N Am 51 (2013) 393–411
- BMC Musculoskelet Disord. 2020 Apr 23;21(1):267
- Knee. 2005 Jan;12(1):3-7
- RadioGraphics 2018; 38:2069–2101
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#PatellarFracture, #PediatricOrthopedics, #MusculoskeletalRadiology, #AvulsionFracture, #Patella, #Radiology, #MRI, #OrthopedicInjuries, #ChildrensHealth, #TraumaImaging
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