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Patella in the knee
The patella is a small bone (patella) resembling a triangle with rounded edges, located at the front of the knee joint - where the femur meets the tibia. It connects the muscles of the front of the thigh via the terminal tendon of the quadriceps muscle to the tibia. The back side of the patella, along with the ends of the femur, is covered with articular cartilage, which helps the bones slide easily over each other as the knee moves.
What is a fracture of the patella?
A fracture of the patella is a traumatic injury to the patella caused by a direct blow or a violent contracture of the quadriceps muscle of the thigh when the knee is bent, which can lead to a loss of the knee's upright mechanism. The diagnosis can be made on the basis of clinical examination and confirmed by X-rays of the knee. Treatment of a fractured patella involves immobilization of the limb in the knee joint or surgical fusion, depending on the displacement of the fracture. Patients often refer to this injury as a patella fracture, although in medical nomenclature it is referred to as a patella fracture.
Types of fractures of the patella
Stable fracture - this is a fracture of the patella without displacement, where the pieces of the bone may remain in contact with each other or be separated by only a millimeter or two.
Displaced fracture - this is a typical fracture of the patella, where the broken ends of the bones are separated and part of the patella does not line up properly, and the smooth surface of the joint may be disrupted.
Multipart fracture - this is a fracture of the bone in which we had a clear injury and the patella breaks into three or more pieces.
Open fracture - in this type of fracture of the patella, the bone breaks in such a way that fragments of the bone protrude through the skin, which carries an additional risk of infection of both the wound and the bone.
What are the symptoms of a patella fracture?
- pain on the front of the knee,
- severe pain and tenderness localized to the patella,
- appearance of a hematoma at the front of the knee,
- sometimes with a fracture with displacement - there is a palpable space between the patella fragments,
- inability to straighten the knee due to interruption of the knee joint's upright apparatus,
- severe pain when bending the knee due to the displacement of bone fragments from each other.
Fracture of the patella - diagnosis
The orthopedic doctor begins the diagnostic examination with a clinical examination. The primary imaging test is an x-ray (X-ray) of the entire knee joint. If there is a suspicion of other pathology, such as damage to the attachments of the quadriceps tendon of the thigh to the patella or damage to the patellar ligament, the test that will best visualize these soft tissues is ultrasound.
How is a fracture of the patella treated?
If there is a fracture with displacement, that is, the bony fragments separate, then we opt for surgical treatment, followed by rehabilitation. If surgery cannot be performed immediately after the injury, then the limb is immobilized with a plaster dressing, if this is done in an emergency department setting. Otherwise, if the patient undertakes treatment in an orthopedic clinic, then an orthosis covering the thigh and shin is placed - rigidly, without any movement.
When the patella is broken as a result of trauma, but there is no displacement of any fragments, then it is possible to proceed to non-operative - conservative treatment. What follows is the stiffening of the limb in extension with the use of a plaster shell called a longette, or using an orthosis positioned in extension. The stiffening of the limb lasts about 6 weeks. After this period, rehabilitation begins.
Rehabilitation after patella fracture
A visit to a physiotherapist should begin even earlier than the aforementioned six weeks after the removal of the bracing. During this earlier period, manual therapy and exercises of other joints are indicated, so that the limb with this immobilization does not lose its function. A return to full function occurs approximately three months after the patella fracture. A return to sports is possible when we have a complete fusion of the patella and after a period of rehabilitation - that is, restoration of full mobility and strength in the lower limb.
Related articles:
Learn about other possible injuries to the knee joint.
Bibliography:
- Ortho Bullets - Patella Fracture - Devon Myers DO - 2022
- OrthoInfo - Patellar (Kneecap) Fractures - Jason A. Lowe, MD, Robert P. Dunbar, MD - 2017
- Physiopedia - Patellar Fractures - Rachael Lowe
- Patellar Fractures - Anatomy, Mechanics, and Surgical Management - Howatt, Jonathan MD1; Liew, Allan S. MD, FRCSC1; Wilkin, Geoffrey MD, The Journal of Bone and Joint Surgery 103(23):p 2237-2246, December 1, 2021. | DOI: 10.2106/JBJS.20.01478
- National Library of Medicine - Patella Fractures - T David Luo; Dominic V. Marino; Holly Pilson. - 2022
