title: Bilateral sleeve fractures of the patella in a 12-year-old boy with hereditary spastic paraparesis and crouch gait.
abstract: This is the first reported case of bilateral sleeve fractures of the patellae in a child with crouch gait. A 12-year-old boy with hereditary spastic paraparesis (HSP), who was found to have mid-stance crouch of 20° on previous gait analysis, presented with pain of gradual onset and limited mobility. There was no history of trauma. Three-dimensional gait analysis showed that extensor mechanism function during loading response was intact, but knee flexion in swing was significantly reduced, indicating protective guarding by rectus femoris. X-rays showed bilateral minimally displaced sleeve fractures of the patellae. These were treated with immobilisation in cylinder casts in extension for 4 weeks. Follow-up X-rays showed that the fractures had successfully united and the patient progressed to full weight bearing and mobility as tolerated.
authors.affiliation: Central Remedial Clinic, Dublin, Ireland.
authors.forename: Ailish
authors.initials: A
authors.lastname: Malone
authors.forename: Damien
authors.initials: D
authors.lastname: Kiernan
authors.forename: Tim
authors.initials: T
authors.lastname: O Brien
mesh_terms: D002370:Casts, Surgical; D002648:Child; D003937:Diagnosis, Differential; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D020233:Gait Disorders, Neurologic / Q000150:complications*; D006801:Humans; D008297:Male; D020336:Paraparesis, Spastic / Q000150:complications* / Q000235:genetics; D010329:Patella / Q000293:injuries*; D011859:Radiography; D016059:Range of Motion, Articular; D016896:Treatment Outcome