Recurrent Patellar Fracture in a Healthy Collegiate Basketball Player: An Exploration Clinical Case Report


Purpose: Patellar fractures only account for approximately 1% of all skeletal injuries. Patellar fractures usually result from direct trauma (i.e. falling on the knee, dashboard injury, etc.), or, less frequently, occur as a combination of direct and indirect mechanism (i.e. receiving a direct blow while contracting the quadriceps). While indirect trauma is the least common mechanism, it usually occurs due to an extensor mechanism failure during eccentric loading such as landing. Method: Case report, Level 3: Exploration Clinical Contribution to the Available Sources of Evidence (CASE) Report. Results: A 21-year-old Division I collegiate basketball athlete sustained two separate transverse patellar fractures via non-contact mechanisms in the same knee over a 21-month period. The patient had no prior history of knee injury nor predisposing risk factors for fractures; delayed union or nonunion. Conclusion: The uniqueness of this case is twofold: 1) The rareness of this injury among a healthy athletic population; and 2) The unusual non-contact mechanism of the injury. Patellar injuries are extremely rare in athletics. In NCAA Division I men’s basketball, patellar injury accounts for only 2.4% of all injuries during games and 3.7% during practice. Recommendations: Although rare, it is important for athletic trainers to recognize traumatic high-impact injuries can occur during non-contact activity in a healthy population. In addition, athletic trainers should be mindful to suspect fracture without associated defect when a patient sustains a subsequent injury with an analogous mechanism even following successful rehabilitation.

Figure 1. Radiograph demonstrating initial patellar fracture..jpg (542 kB)
Figure 1. Radiograph demonstrating initial patellar fractgure.

Figure 2. Radiograph taken following initial surgery..JPG (20 kB)
Figure 2. Radiography taken following initial surgery.

Figure 3. Timelines for the patellar fractures..PNG (32 kB)
Figure 3. Timelines for the patellar fractures

Figure 4. Radiograph following second fracture.JPG (22 kB)
Figure 4. Radiograph following second fracture.

FIGURE~1.JPG (28 kB)
Figure 5A. Radiograph from second patellar fracture with cannulated screws.

FIGURE~2.JPG (806 kB)
Figure 5B. Anterior-posterior radiograph following the second surgery.