Working Diagnosis:
Stress fracture of the right patella

Treatment:
The patient was braced in extension and remained non-weight bearing for 4 weeks. Through the following 2 weeks, he was limited to walking/ADLs while wearing his protective brace. After 6 weeks of rest, the patient was pain-free and resumed activities/PT as tolerated without bracing.

Editor's Comments:
Patella stress fractures are considered high risk stress fractures. Risk factors include bipartite patella and cerebral palsy. Given this patient's previous neurological condition, it is reasonable to suggest that his decreased VMO size places him at more risk for patella stress fractures. Since the VMO absorbs the majority of the force in the lower extremity and given his slight in-toeing during his gait, the force distribution across the lower extremity may prove to be too much to handle for his smaller patella. Treatment for patella stress fractures are individualized. For displaced fractures or with non-union, ORIF often is required. If the stress fracture is not displaced, conservative therapy including restriction of activity. Bracing may be indicated as well.

References:
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15. Boden BP and Osbahr DC. High Risk Stress Fractures: Evaluation and Treatment. J Am Acad Orthop Surg 2000; 8:344-353.

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