The tiny bone in front of your knee, the patella, also known as the kneecap, can shatter and cause a patellar fracture. The patella shields your knee joint, rendering it vulnerable to fracture if you fall directly on it or hit the dashboard during a vehicle accident. A significant injury, a patellar fracture, can make walking or straightening your knee difficult or even impossible.
Straightforward patellar fractures can be successfully treated by placing the patient in a cast or splint while the bone heals. The majority of patellar fractures, however, result from an injury that causes the bone pieces to move out of place. In these more severe fractures, surgery is necessary to stabilize and heal the kneecap and restore function. To assist in safeguarding your knee and avert future issues, your doctor could recommend certain lifestyle modifications. Avoiding repeated deep knee bending or squatting may be one way to do this. People who are injured or at risk of injury should also avoid using ladders or steps.
The thighbone (femur) and shinbone (tibia) connect at the patella, a tiny bone in front of the knee joint. It links the muscles at the front of the thigh to the tibia and safeguards the knee.
Articular cartilage, a smooth material, covers the ends of the femur and the undersides of the patella. When you move your knee, the cartilage allows the bones to flow smoothly past one another.
The knee joint is covered and shielded by the patella.
Numerous factors can cause a patellar fracture. A fracture might involve a single, clean, two-piece break in the bone or several fragments.
The top, middle, or bottom of the bone are all potential locations for a break. Multiple kneecap fractures can occasionally take place.
X-ray shows three fractures in the kneecap.
This side view x-ray of a knee reveals a broken patella in three locations.
Patellar Fractures: Types
Stable fracture.: Nondisplaced fracture describes this kind. The bone fragments may still be near one another or only a few millimeters apart. The bones often remain in place throughout healing in a stable fracture.
Displaced fracture. The shattered ends of the bone are separated and do not line up correctly in a displaced fracture. It’s possible to disturb the typically smooth joint surface. Surgery is frequently necessary for this kind of fracture to reunite the broken fragments of bone.
Comminuted fracture.. The bone breaks into three or more fragments when it sustains this fracture. A comminuted fracture can be either stable or unstable, depending on the precise pattern of the fracture.
An open fracture: When a bone fractures in such a way that bone fragments poke through the skin, or when a wound encircles the bone, this is known as an open fracture. In the immediate location, an open fracture typically causes soft tissue damage and may take longer to heal.
Since there is a larger chance of infection in the wound and the bone after the skin is broken, open fractures are particularly dangerous. To avoid infection, therapy must be started right away.
The most frequent causes of patellar fractures include:
- Tripping and landing on my knees
- Sustaining a severe knee injury, such as if your kneecap is slammed into The dashboard during a head-on car crash
- Also possible is an indirect fracture of the patella. For instance, the patella can be pulled apart by a rapid quadriceps muscle contraction in the knee.
The front of the knee’s discomfort and swelling are typical signs of a patellar fracture. Other signs can include:
- inability to maintain a straight leg, elevate or straighten the knee
- being unable to walk
Your doctor will check your knee after discussing your symptoms and medical background. Especially if the fracture is displaced, the fracture’s edges can frequently be felt through the skin.
Your doctor will examine you and look for hemarthrosis. Blood from the broken bone ends accumulates inside the joint area in this situation, resulting in uncomfortable swelling. Your doctor could remove a lot of blood from your knee to aid in pain management.
To properly diagnose your fracture, your doctor will also need x-rays.
fracture of the patella with considerable displacement
This patient’s fracture has been significantly displaced, leaving a sizable space between the bones.
Reproduced from Orthopaedic Knowledge Update: Trauma 5 (eds. Ricci WM, Ostrum RE). American Academy of Orthopaedic Surgeons, Rosemont, IL, 2016, pp. 507–521.
Images of dense things, like bone, are produced by X-rays. To check for a fracture and see how the bones are aligned, your doctor will request x-rays from various angles.
Even though it’s uncommon, a newborn may have additional patellar bones that haven’t fused. Bipartite patella is the condition’s name, which might be misinterpreted as a fracture. The bipartite patella can be identified using X-rays. Your doctor may also order an x-ray of your second knee because many patients with the ailment have it in both knees.
Patellar fracture on x-ray showing considerable displacement
Surgical Alternatives to Treatment
You might not require surgery if the bone fragments are not displaced. Your doctor may use a cast or splint to keep your knee straight and lessen leg mobility. This will maintain the normal alignment of the shattered bone ends while they recover.
You could be permitted to put weight on your leg while it’s in a cast or brace, depending on the details of your particular fracture. However, weight-bearing may not be permitted for 6 to 8 weeks after certain fractures. You will discuss weight-bearing limitations with your doctor.
You’ll probably require surgery if the bones are dislocated or out of alignment. Often patellar fractures that are not close to one another will not heal or heal very slowly. Strong thigh muscles that connect to the patella’s top can pull the shattered fragments out of their proper positions throughout the healing process.
Surgery’s timing. Your doctor could advise delaying surgery until any abrasions have healed if the skin around your fracture has not broken.
However, since they are more likely to get infected, open fractures are scheduled for surgery as quickly as possible, generally within hours. The surfaces of the bone and the injury’s wounds are carefully cleansed during surgery. Usually, the bone will be mended simultaneously with the procedure.
The treatment used will frequently be determined by the kind of fracture you have. Your surgeon will review the procedure and any potential issues with you before the operation.
Longitudinal fracture. Most frequently, screws, pins, wires, and tension bands in a “figure-of-eight” design are used to secure these two-part fractures. The two sections are pressed together by the figure-of-eight band.
Fractures close to the patella’s core respond well to this technique. For this treatment, fracture fragments near the extremities of the kneecap are too tiny. The tension band may overcompress breaks that are fragmented.
Another method for treating a transverse fracture is to fasten the bones together with tiny screws or tiny screws and tiny plates.
Fracture with fragments. In certain fractures, the patella’s top or, more frequently, its bottom is split into several tiny fragments. This kind of fracture happens when the patient falls on the injured kneecap, which has already been torn apart by the injury. Your doctor will remove the bone pieces since they are too tiny to be returned. The physician will reattach the loose patellar tendon to the remaining patellar bone.
Your doctor could use a mix of wires and screws to repair the kneecap if it has been shattered in several parts in the center and the pieces have been separated. Small sections of the kneecap that cannot be repaired may be removed with success. Kneecap removal in its entirety is the last option for comminuted fractures.
Treatment of Pain in Recovery
Most fractures pain somewhat for a few days to a few weeks. Many people discover that all required to ease the pain are applying ice, elevating the afflicted limb, and using straightforward, over-the-counter painkillers.
Your doctor might advise using an opioid or another prescription-strength drug for a few days if your pain is severe.
Even while opioids can help with post-operative pain relief, opioid use and overdose have become serious public health concerns. Opioids are often administered for a brief amount of time because of this. It’s vital to only use opioids according to your doctor’s instructions. Stop using opioids as soon as your pain begins to subside.
Rehabilitation is essential to return to regular activities after either surgery or nonsurgical therapy.
Your knee may become rigid, and your thigh muscles may weaken due to the prolonged immobilization of your leg during treatment for a patellar fracture.
You will be given particular exercises to perform as part of your rehabilitation by your physician or a physical therapist to help:
- Boost the muscles in your legs.
- Increasing knee range of motion
- Decrease in rigidity
Ability to Support Your Weight
Your doctor will let you know when you can start putting weight on your leg. Typically, the first weight-bearing exercise involves gently touching your toe to the floor. You will progressively be able to put greater weight on your leg as your injury heals and your muscles get stronger.
Complications with patellar fractures
Some individuals with patellar fractures may face long-term difficulties even after receiving effective treatment.
Arthritis after Trauma/Injury – Posttraumatic Arthritis
A kind of arthritis known as posttraumatic arthritis occurs after an accident. Even when your bones heal correctly, the articular cartilage that covers them might be damaged, which can cause pain and stiffness over time. A tiny fraction of individuals with patellar fractures develops severe arthritis. More people get chondromalacia patella, a mild to moderate form of arthritis.
Muscle Weakness Atrophy
After a fracture, the quadriceps muscle in the front of the leg may become permanently weak in certain people. It’s also typical to have some knee mobility loss, including flexion and extension. Usually, this lack of mobility is not incapacitating.
With patellar fractures, the front of the knee frequently experiences chronic discomfort. Although the exact etiology of this discomfort is unknown, it is most likely connected to posttraumatic arthritis, stiffness, and muscular weakening. Wearing a knee brace or support may be more comfortable for certain people.
Following a patellar fracture, recovery time will vary depending on a variety of variables, such as:
- The extent of your harm
- Whether you had surgery or nonsurgical therapy
- The length of time required for recovery
Within three to six months, most patients can resume their regular routines. It could take longer for people with serious fractures to resume their normal activities.
To assist in safeguarding your knee and avert future issues, your doctor could recommend certain lifestyle modifications. Avoiding repeated deep knee bending or squatting may be one way to do this. The use of ladders or steps should also be avoided.
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