The Largest Osteochondral Fracture of Patella, Case Report

Case Report

Austin J Orthopade & Rheumatol. 2014;1(1): 2.

The Largest Osteochondral Fracture of Patella, Case Report

Meric Unal1*and Hasan Tatari2

1Isparta Sifa Hospital Department of Orthopaedics and Traumatology, Turkey

2Dokuz Eylül University Faculty of Medicine Department of Orthopaedics and Traumatology, Turkey

*Corresponding author: Meric Unal, Department of Orthopedics, Dokuz Eylül University, Izmir, Turkey. Email:

Received: September 29, 2014; Accepted: October 24, 2014; Published: October 30, 2014


Fractures of the patella, generally occuring by direct trauma, constitute 1% of all fractures. The most comprehensive classification of the patella fractures is the Orthopaedic Trauma Association (OTA) classification. This is a report of a 15-year-old male patient examined after falling down and sufferred from a patella fracture. The fracture could not be classified by the current classifications. At the operation, the extensor mechanism was normal and the medial joint surface of the patella was displaced superiorly. The fragment was considered as a very big osteochondral fragment and two headless full-threaded compression screws were used for fixation.


Patella is the biggest sesamoid bone in the body [1] that is necessary for the extensor mechanism of the knee. Fractures of the patella constitute approximately 1% of all fractures [1,2] generally occuring after direct trauma. Indirect trauma by pulling the tendon is another mechanism. Most prominent effects of patellar fracture are the loss of extensor mchanism and irregularity of the patellofemoral joint [3,8]. Osteochondral fractures are generally seen after patellar dislocation [4].

Patellar fractures are basicly classified as displaced and nondisplaced [5]. Displaced fractures have some subtypes like; transverse, vertical, lower and upper pole, comminuted and osteochondral [5]. The most comprehensive classification for patellar fractures is OTA classification [1]. In this classification there are three types basicly distinguished with joint involvement. Type-1 is extra-articular, type-2 is particularly articular and type-3 is completely articular [6]. Type 1 and 2 have two subtypes and type-3 has three subtypes [6]. The fractures, those are just intraarticular and do not destroy the extensor mechanism, are very rare and can not be classified with current classifications. These types of fractures may be recognized as osteochondral fractures of the patella.

In this article, a different type of patella fracture case, that is not classified by current classifications, is presented.


A 15-year-old male patient was consulted to us with a pain in his left knee after falling down during running. Physical examination demonstrated tenderness over the patella, minimal effusion and locking. Neurovascular examination was normal.

For radiological examination, direct anteroposterior (AP) and lateral views of the knee were taken and the fracture of the patella was diagnosed (Figure 1A,1B). Open reduction and internal fixation was planned.