A patella fracture is what many people know as a broken knee cap. This injury is relatively common and usually caused by a direct blow (i.e., a motor vehicle crash (MVC) where your knee is driven into the dashboard) or a direct fall onto the small round bone sitting in front of the knee.
There is variability with the fractures as the patellar can be anywhere from just cracked to completely shattered. Depending on the severity, there is also variability in the presenting symptoms, diagnostic findings, treatment options, and recovery time.
If you have had a recent injury to the knee and wonder whether you have a patella fracture, schedule a consultation with our highly skilled team at OrthoNeuro. Our expert orthopedic surgeons have dealt successfully with patients with patella fractures over the years and can also assist you. Call us or schedule an appointment online today!
The patella is the small bone sitting just in front of the knee joint. Its primary role is to protect the internal knee joint, the patellar tendon, and the cartilage of the knee. It also connects the thigh muscles (quadriceps muscle) to the shin bone (tibia) and can even act as a pulley system, increasing the strength of knee extension (straightening) by 30-50% [1]. The cartilage on the underside of the patella allows for smooth gliding throughout the joint. Disruption to this cartilage leads to arthritis.
Typical symptoms of patellar fractures include:
Bruising
Difficulty walking
Difficulty straightening (extending) the knee or maintaining extension
The first and sometimes most important diagnostic is the physical exam conducted by the medical professional. This exam will include:
Looking for open wounds/fractures
Palpation: You can usually feel the borders of the fracture through the skin. Can also tell whether the fracture is displaced or not (can feel a gap between bones)
Examining the range of motion in the ability to extend the knee straight
Radiographic imaging is usually performed to confirm a diagnosis to build off the presenting symptoms and physical exam. This imaging includes:
X-rays – identify the location and severity of the fracture
CT Scan – can provide more details possibly required for surgery
Depending on the severity and patterning of the fracture, non-operative treatment is a viable option. For instance, if a stable fracture occurs and it is perfectly aligned, there is no gapping (displacement) between the fractured segments, and you can straighten your knee without difficulty, then you most likely can be treated non-operatively.
Non-surgical treatment is typically carried out with a combination of different techniques, including:
Immobilization – using splints, casts, standard knee braces, or hinged braces to stabilize the bones (fractured bone ends) as they heal
Depending on the fracture severity, walking (with the use of the immobilizer) is an option. If not, crutches or walkers can be utilized in a non-weight-bearing fashion
Ice, elevation, NSAIDs – aid in pain and swelling/inflammation. Additional, stronger pain medication may be prescribed if deemed necessary.
After completing all treatment options, surgical or non-surgical, rehabilitation will need to be utilized. Coming out of your immobilizer (typically 3-6 months), there will be atrophy (breakdown and loss of muscle mass), weakness, stiffness, and a decrease in the overall range of motion due to the time of non-use. Rehab will be instrumental in gaining back these lost qualities.
If the fracture is severe enough, surgery may be required for healing. This typically includes a displaced fracture (bones are no longer aligned) such as a comminuted fracture, transverse fracture, or if the knee is not extendable. It is usually advised to have the surgical reconstruction within one to two weeks after the initial injury occurred.
Surgical treatment options include:
Tension banding – using a combination of metal wiring (K wire) in a figure eight structure over the patella, pins, and screws
Internal fixation – using plates and screws
Patellectomy – partial or complete removal of the patella. Rare, but sometimes indicated for a shattered patella to relieve symptoms
Infection – No matter how big or small surgery is, this is always one of the significant risk factors. Antibiotics will be provided, and sterile equipment will be used for maximum prevention.
Neurovascular damage – Several different arteries, veins, and nerves coursing in and around the knee joint. The patella itself is not in a particularly dangerous location close to any major structures, but there is always the possibility of damage.
Nonunion – possibility of the fracture not healing. This is typically due to patient non-compliance, diabetes, or tobacco use.
The outcomes of patella fracture surgery are typically very good. Most patients can return to full function and capability within three to six months, depending on the severity of the fractured bone.
If you’re wondering whether you have a patella fracture due to a recent knee injury, schedule an appointment to see a healthcare professional at OrthoNeuro. Our specialists will give you an accurate diagnosis and a treatment plan that is tailored to you. Call us today and book an appointment!
Neumann DA. Kinesiology of the musculoskeletal system: Foundations for Physical Rehabilitation.2nd Ed.Elsevier Health Sciences;2009
