Vol 68, No 3 (2017)
Case report
Published online: 2017-09-27

open access

Page views 2536
Article views/downloads 4146
Get Citation

Connect on Social Media

Connect on Social Media

Non-operative management of a patella fracture: environmental considerations in the Subantarctic

Fraser John Gould1
Pubmed: 28952661
IMH 2017;68(3):159-162.


Injuries occurring in the remote environment present particular challenges to healthcare professionals, and decisions need to be carefully made on an individual basis. This report describes the successful management of a patella fracture sustained on the Subantarctic island of South Georgia. A 36-year-old boating officer presented to the island surgery after sustaining an isolated closed injury to his left knee. On physical examination there was a large effusion palpable within the joint, and on subsequent radiography an undisplaced transverse fracture of the patella was apparent. The patient had an intact and competent extensor mechanism, and fulfilled indications for non-operative management. His clinical case was discussed with supervising consultants at the British Antarctic Survey Medical Unit in the United Kingdom, and radiographs forwarded electronically for an orthopaedic review. The decision was made to undertake medical evacuation of the patient. There were additional environmental factors to be considered in this situation. The terrain on South Georgia is rugged and unforgiving, there is a risk of injury posed by the local fauna (Arctocephalus gazella) during summer months, and emergency evacuation from the base would be difficult for any person with restricted mobility. A planned retrieval enabled our patient to continue rehabilitation and physiotherapy in the preferrential setting of his home country, without causing undue delay in time taken returning to work in this remote location.  


  1. Stiell IG, Greenberg GH, Wells GA, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995; 26(4): 405–413.
  2. Boström A. Fracture of the patella. A study of 422 patellar fractures. Acta Orthop Scand Suppl. 1972; 143: 1–80.
  3. Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg. 2011; 19(4): 198–207.
  4. McGaughey I, Sullivan P. The epidemiology of knee and ankle injuries on Macquarie Island. Injury. 2003; 34(11): 842–846.
  5. Boyd IL. Pup production and distribution of breeding Antarctic fur seals (Arctocephalus gazella) at South Georgia. Antarctic Science. 1993; 5: 17–24.
  6. Kouliev T, Cui V. Treatment and prevention of infection following bites of the Antarctic fur seal (Arctocephalus gazella). Open Access Emerg Med. 2015; 7: 17–20.
  7. Government of South Georgia & the South Sandwich Islands. Annual Tourism and Visitor Report 2015–16. http://www.gov.gs/docsarchive (2015).
  8. Council of Managers of National Antarctic Programmes (COMNAP). Understanding Risk to National Antarctic Program Operations and Personnel in Coastal Antarctica from Tsunami Events. http://www.ats.aq/index_e.htm (2011).