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by Cresse M

Patella Fracture

(Broken Kneecap; Fracture, Patella; Kneecap Fracture; Patellar Fracture)

Definition

A patella fracture occurs when there is a break in the patella, better known as the kneecap. The patella is a large, movable bone at the front of the knee.
The Kneecap
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Causes

Some common causes of this injury include:
  • Sharp blow to the knee
  • Excessive stress on the knee

Risk Factors

Factors that may increase your risk of a patella fracture include:
  • Increased age
  • Postmenopause
  • Decreased muscle mass
  • Decreased bone mass— osteoporosis
  • Participation in contact sports such as football and soccer
  • Obesity , which places strain on muscles, bones, tendons, and ligaments
  • Violence, such as car or car-pedestrian accidents

Symptoms

Patella fracture may cause:
  • Sudden, excruciating pain in the kneecap
  • Swelling, bruising, and tenderness
  • Inability to extend the knee
  • Difficulty walking

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. The doctor will look closely at the knee to see if there are signs of fracture. A straight leg test may be done.
Images can evaluate your knee and surrounding structures. These may include:

Treatment

Treatment options include the following:

Nonsurgical Approach

After the tests, the doctor will determined whether surgery is needed. If the patella is not badly injured, the doctor will place the knee in a cast . This cast may need to be worn for 6 weeks. After that, a knee brace and physical therapy will be needed. A cane or crutches may be needed.
Medication will be advised to reduce swelling and pain.

Surgery

If the patella is in pieces, then surgery will be needed. There are 2 kinds of surgery that are commonly used to treat this injury:
  • Open reduction-internal fixation surgery —The doctor uses pins and screws to put the broken pieces back together.
  • Patellectomy—Rarely, the doctor removes part of the kneecap or the entire kneecap.
After surgery, physical therapy will be needed. This can involve range-of-motion exercises and stretching . In some cases, another surgery will be needed to remove the pins and screws.
Depending on the injury, recovery can take weeks to several months.

Prevention

To help reduce your chance of a patella fracture:
  • Do not put yourself at risk for trauma to the bone.
  • Do weight-bearing exercises to build strong bones.
  • Build strong muscles to support the knee, prevent falls, and to stay active and agile.
  • Wear proper padding and safety equipment when participating in sports or activities.

RESOURCES

American Physical Therapy Association
http://www.orthopt.org
Ortho Info—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References

Henry P, Panwitz B, et al. Rehabilitation of a post-surgical patella fracture. Physiotherapy. 2000;86:139-142.
Patellar (kneecap) fractures. Ortho Info—American Academy of Orthopaedics website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00523. Updated January 2017. Accessed August 30, 2017.
Stress fractures. The American College of Foot & Ankle Orthopedics & Medicine website. Available at: http://www.acfaom.org/information-for-patients/common-conditions/stress-fractures. Accessed August 30, 2017.
Tay G, Warrier S, et al. Indirect patella fractures following ACL reconstruction. Acta Orthopaedica. 2006;77:494-500.

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