Splintered pathologic fracture of the patella secondary to gout tophi treated by total patellectomy

Fracture of the patella is relatively common, accounting for approximately 1% of all fractures. Trauma is a common reason for the fracture; pathologic fracture of the patella, including infections, tumors, degenerative conditions, and metabolic disorders, is much less common. Gout tophi are often found in the auricular cartilage or in the big toe, but rarely in the patella. As far as we are aware, few papers have reported that tophi sometimes induce pathological patella fracture, because deposition of crystals in joints and bones leads to arthritis and subsequent bone destruction [1-4]. In most of these cases satisfactory resolution was obtained by treatment with osteosynthesis or partial patellectomy. In this paper we report a case of gout tophi in the left patella and surrounding soft tissue, the severe splintered fracture resulting from relatively minor trauma. We preformed total patellectomy, excising the mass and the fragments together. At three years follow-up the patient is doing well postoperatively, and has recovered enough function to be reinstated in his former work.