The patella is one of three bones that make up the kneecap. It is covered in cartilage on the underside and is important in maintaining the strength of straightening the knee joint. A fracture is a break in the bone. A fracture usually happens when there is a direct fall onto the kneecap.
A fracture like this can also damage the underlying soft tissue and the skin and result in an open fracture. A fracture can also occur when the quadriceps muscles contract but the knee is straight. When the muscle pulls forcefully the patella can fracture.
Sometimes the patella can fracture with a minor injury, but this is often a result of weak bones which can be caused by osteoporosis.
Names of fractures include:
- open fracture
Patella fractures can be severely painful and make it difficult to walk.
Signs of a patella fracture include:
- severe pain
- swelling and bruising on the front of the knee. After a few days, swelling and bruising may extend down the leg.
- Inability to lift foot; straight leg lift is used in diagnosing this injury.
- With palpation a break is felt; This may not be possible if there is considerable swelling.
Treatment includes an exam in the emergency room and an x-ray to determine how bad the break is, as well as, determine the type of break. One critical factor is the ability to do a straight leg raise from a laying position.
This tests the quadriceps muscle and its attachment to the shin bone (tibia). A separation of the quadriceps tendon, patella and/or the patella tendon cause the inability to lift the leg. If the leg can be lifted then non-surgical treatment could be possible in order to set the fracture.
Knee swelling is common and is from the bleeding from the fractured ends of the bone. If there is a large amount of bleeding then an aspiration would be done to remove the blood resulting in pain relief. In addition, a knee immobilizer will decrease the discomfort from the injury.
Minimally displaced fractures or non-separated fractures can usually be treated without surgery. An immobilizer or a straight leg cast may be sufficient treatment.
Surgical intervention is necessary for displaced separated fractures. The process involves:
- an incision over the front of the knee
- the fractured ends are realigned
- pins, screws or wires are used to hold it in place
- in some cases, a piece can be removed ( a smaller fracture or fragments)
A common complication of patella fracture surgery is the metal implants can become painful especially when able to kneel. Often there is a second surgery to remove the hardware. This can be done a year after the first surgery.
An important aspect of surgery is to repair the cartilage to prevent the development of arthritis of the knee joint. Damage to the knee joint cartilage can result in a higher chance of arthritis in the joint.
Other possible complications may include:
- failure of the hardware to hold pieces in place
- the fracture does not heal
- kneecap pain
- possibly knee arthritis
Rehab will be needed once the kneecap has healed sufficiently as the knee is kept straight initially to allow healing. Being able to move the knee will depend on the strength of the repair but gentle movement may begin within the first few weeks after surgery.
FXRX INC has experience in fixing fractures of all types. For consultation – contact the office at 480-449-FXRX (3979)
1215 W. Rio Salado Parkway
Tempe, AZ 85281