A patella fracture is a break in the kneecap, the small bone in front of the knee. The patella can be fractured if it falls directly on the knee or hits the dashboard in a car accident because it acts as a shield for the knee joint. A patella fracture is a serious knee injury that makes it difficult or impossible to open the knee or walk normally. Casts or splints can treat some mild patella fractures of the knee while the bone heals. In most patella fractures, however, bone fragments become dislodged as a result of the injury. Surgery is required to repair and stabilize the knee’s patella and allow the function to return in these more complicated fractures.
Anatomy of the Patella of the Knee
The knee’s patella is a piece of cartilage that covers and protects the knee joint. The knee’s patella is a tiny bone that connects the femur and tibia in front of the knee joint. The patella protects the knee while connecting the front thigh muscles to the tibia. A soft substance called articular cartilage covers the end of the femur and the lower part of the patella. As the knees move, the cartilage allows the bones to slide comfortably.
What Is a Patella Fracture of the Knee?
The patella (knee cap) can be shattered in various ways. A fracture might be a simple, visible fracture in which the bone splits into two pieces or a complex fracture in which the bone splits into many fragments. Fractures can develop in any region of the bone, including the upper, middle, and lower portions. Fractures in more than one location of the knee are not uncommon.
Types of Patella Fractures of the Knee
This type of fracture is in place. The pieces of bone remain in contact with each other or are only one or two millimetres apart. In permanent fractures, the bones generally remain in place as they heal.
In a displaced fracture, the broken end of the bone separates and does not line up properly. The usually smooth surface of the joint may also crack. This type of fracture often requires surgery to put the pieces of bone back together.
Shredded Fracture (Cracked)
In this fracture type, the bone splits into three or more parts. Depending on the specific fracture pattern, the fracture may be stable or unstable.
In an open fracture, the bone is broken so that pieces of bone protrude from the skin or damage the bone. Open fractures often involve damage to the surrounding soft tissues, and it takes longer to heal. Open fractures are very serious because the risk of infection in wounds and bones is higher when the skin is torn. Immediate treatment is needed to prevent infection.
Cause of Patella Fracture of the Knee
The following are common causes of patellar fractures:
- Falling straight to your knees
- A severe knee injury, such as a sudden collision of the kneecap with the instrument panel in a connected car accident.
The patella is also broken indirectly. For example, a sudden contraction of the quadriceps muscle in the knee can separate the patella.
Physician Examination of Patella Fracture of the Knee
After discussing the symptoms and medical history, the doctor examines the knee. The doctor will check for hemarthrosis (bleeding inside the joint) during the examination. In this case, blood collects from the end of the broken bone in the joint space, causing painful swelling. The edges of the fracture can often be touched through the skin, especially if the fracture is displaced. If there is a lot of blood in your knee, your doctor will drain it to help relieve your pain. Your doctor will also order an x-ray to diagnose your fracture.
Radiographs provide images of dense structures, including bone. Your doctor will order radiographs from different angles to look for fractures and align the bones. Although this is rare, a person may be born with extra bones in the knee patella that has not grown together. This condition is called a patchy patella and may be confused with a fracture. Radiography helps to identify the patella. Because many people have the disease in both knees, the doctor will do x-rays of the other knee.
Treatment of Patella Ruptures of the Knee
If parts of the bone are in place (not displaced), you may not need surgery. The doctor uses a cast or splint to keep the knee straight and prevent movement in the leg. This puts the broken end of the bone in the correct position when it heals. Depending on your particular fracture, you may be able to place the weight of your foot on a cast or a brace. Despite some fractures, you should not put your weight on a broken leg for 6 to 8 weeks. Your doctor will talk to you about the restrictions on dropping weight on your feet.
Surgical Treatment of Patella Fracture of the Knee
If the bone fragments are not in place (displaced), you will most likely need surgery. Broken patella bones that are not close together often have difficulty healing or may not heal. The thigh muscles attached to the top of the patella are very strong and can pull the broken parts out of place when they heal. Time of surgery: If the skin around your fracture is not torn, your doctor will advise you to wait before the operation to heal any scratches. However, open fractures have a higher risk of infection, and the patient prepares for surgery as soon as possible, usually within a few hours. During surgery, the incision from the injury and the bone surfaces are thoroughly cleaned. The bone is usually repaired during the same surgery.
The type of surgery performed often depends on the type of fracture you have. Before the operation, your doctor will discuss the procedure and any possible side effects.
These two-part fractures are often fixed with screws or rods and wires and a “figure eight” brace. Figure 8 fuses the two parts. This method is great for treating fractures near the center of the patella but is not suitable for very small fractures at the end of the kneecap. Bandages cause too much compression of a bone. Another method for transverse fractures is to fasten the bones together using small screws or small screws and small plates.
In some fractures, the patella above or below the patella is divided into several small pieces. This type of fracture occurs when the knee’s patella is first removed from injury and then shatters when the patient falls on it. Because the broken pieces of bone are so small that they cannot be fixed in place, the doctor will remove them. Then, the loose patellar tendon connects the knee to the particular remaining bone. If the knee’s patella has many fractures in the center and parts of the bone are separated, the doctor will use a combination of wires and screws to repair it. Removing small parts of the patella that cannot be rebuilt will also have satisfactory results. Complete removal of the patella is the last resort in treating crushed fractures.
Symptoms of a Patella Fracture of the Knee
The most common symptoms of a patella fracture are pain and swelling in the front of the knee. Other symptoms include:
- Inability to straighten the knee or keep it open when lifting the leg straight and at once
- Inability to walk.
Healing patellar fractures of the knee
Most fractures hurt on average from a few days to a few weeks. Many patients find it necessary to use ice, hold the injured foot up, and use simple, over-the-counter medications to relieve knee pain. If your pain is severe, your doctor may prescribe stronger medications such as opioids for a few days. Although opioids help relieve postoperative pain, opioid dependence and overdose have become an important public health issue. For this reason, opiates are usually prescribed for a short time. Stop taking opiates as soon as the pain goes away. You should only use opioids as prescribed by your doctor.
Whether your treatment is surgical or non-surgical, rehabilitation plays an important role in returning to your daily activities. Because treating a patella fracture sometimes requires keeping your foot still in the cast for a long time, your knees may become stiff, and your thigh muscles may weaken. During rehabilitation, your doctor or physiotherapist will offer specific exercises to help you with the following:
- Improve range of motion in your knee
- Strengthen leg muscles
- Reduce stiffness.
Drop weight on the injured knee
Initial weight-bearing exercises are usually limited to gently touching your toes on the floor. By healing the injury and strengthening the muscles, you will gradually be able to put more weight on your feet. Your doctor will tell you when you can put your weight on your feet.