Patellar Fracture

Patellar Fracture

Article
Bone, Muscle, & Joint
Diseases & Conditions
Contributed byMaulik P. Purohit MD MPHAug 07, 2020

What are the other Names for this Condition? (Also known as/Synonyms)

  • Broken Kneecap
  • Fracture of the Kneecap
  • Fracture of the Patella

What is Patellar Fracture? (Definition/Background Information)

  • The patella is the flat triangular piece of bone situated in front of the knee joint, also called the kneecap
  • A Patellar Fracture is a break or crack in the kneecap, usually caused by a high-energy impact that results from an athletic sport, motor vehicle accident, or a fall from a substantial height

There are four different types of Patellar Fractures:

  • Stable fracture: In this type of fracture, the bone pieces are only slightly displaced. The broken bone ends remain in place and stay aligned, as the injury heals
  • Displaced fracture: In this type of fracture, the bone may fragment around the point of breakage and get misaligned; hence, surgery is usually required
  • Comminuted fracture: In a comminuted fracture, the bone is broken into three or more pieces. It is considered one of the most unstable type of fracture
  • Open fracture: In this type of fracture, the bone breaks and pierces the skin, requiring immediate medical treatment. Apart from this, ligament, muscle, and tendon damage, may also occur

Who gets Patellar Fracture? (Age and Sex Distribution)

  • Patella Fractures are non-specific and can occur in individuals of all age, race, ethnic group, and gender
  • Adolescent males, who participate in high-impact sports, have the highest incidence rate
  • A Patella Fracture may also occur in middle-aged or elderly adults, who develop osteoarthritis of the knee

What are the Risk Factors for Patellar Fracture? (Predisposing Factors)

Risk factors associated with a Patellar Fracture include:

  • Participation in high-risk contact sports, such as football
  • Advanced age (elderly adults are higher prone)
  • Reduced bone mass (osteoporosis)
  • Reduced muscle mass
  • Excess body weight associated with obesity, which can cause increased pressure on the joints
  • Post-menopausal women

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Patellar Fracture? (Etiology)

Some common causes of a Patellar Fracture include:

  • Abnormal stress on the knee, associated with weight-lifting or climbing stairs
  • Direct trauma to the kneecap, due to automobile accidents
  • Indirect trauma, which is the abnormal tightening of the thigh muscles, when the knees are bent
  • Taking part in any rough or high-impact sport
  • Falling from a significant height (or the fracture occurring since the individual is overweight)
  • Osteoporosis, a degenerative condition that is caused by decreased bone mass

What are the Signs and Symptoms of Patellar Fracture?

Signs and symptoms of a Patellar Fracture include

  • Sharp and sudden pain in the knee, immediately after the injury occurs
  • Swelling, tenderness, and possible bruising around the injury site
  • Inability to bend or extend the knee; unable to walk
  • Inability to put weight or pressure on the injured leg
  • Excessive pain

How is Patellar Fracture Diagnosed?

Diagnostic methods that a physician may use to help diagnose a Patellar Fracture include:

  • Physical examination: A thorough physical examination is important in identifying any noticeable deformities, swelling, and contusions in the injured knee. Individuals are also expected to provide an explanation of the circumstances that caused the injury. In addition to this, a complete medical history may be evaluated
  • X-ray: X-rays are the most common imaging methods used in assessing a fracture. This diagnostic test can help provide a clear image of the bone, identify exact location of the injury, and determine the extent of the fracture
  • Magnetic resonance imaging (MRI):  An MRI is a more detailed scan that uses radio waves and a magnetic field that generates thorough images of interior bones and soft tissues. However, an MRI is usually only performed in situations, where the physician suspects additional injury to the soft tissues surrounding the knee
  • Bone scan: During a bone scan, the physician checks for signs of an infection by administering a small, safe dose of radioactive material (called tracer). It is inserted into the arm intravenously.  The tracer accumulates within the bones and allows the physician to identify any fractured bones, signs of infections, or even cancer within the bones
  • Computerized tomography (CT) scan: A CT scan takes a series of x-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues of the leg, which then allows a physician to examine the knee and surrounding structures. This diagnostic test also helps a physician evaluate the severity of the injury

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Patellar Fracture?

Complications associated with a Patellar Fracture include:

  • Infection of the bone (osteomyelitis)
  • Prolonged or delayed healing process
  • Damage to the nerves or blood vessels of the knee
  • Abnormal pressure build-up within the muscles of the knee that reduces blood flow, preventing oxygen and nourishment from reaching the nerve and muscle cells (termed as compartment syndrome)
  • Formation of blood clots (deep vein thrombosis); inflammation of veins due to blood clots (thrombophlebitis)

How is Patellar Fracture Treated?

A Fracture of the Knee cap (Patella) may be treated non-surgically or surgically. Both methods of treatment include certain risks and benefits.

Non-surgical methods of treatment may include:

  • Applying ice to the knee, to help reduce pain and swelling
  • Complete immobilization of the leg with a splint or cast may be required. Specialized assistive devices, such as a cane, walker, or walking boot, are also recommended to avoid placing any significant weight/pressure on the bone until it has healed. This may help the individual perform some of their regular/daily activities too
  • Oral medications, such as acetaminophen, or ibuprofen can help decrease the knee pain
  • Stronger prescription medications, such as codeine or a combination of hydrocodone-acetaminophen may be prescribed, if over-the-counter medications are unsuccessful in relieving pain
  • Individuals are likely to need physical therapy exercises after the cast is removed. The goals of these exercises are to strengthen the knee, improve flexibility, and decrease stiffness. It may take several months for an individual to complete the physical therapy program and regain full strength and functionality

Surgical treatment methods include:

  • Closed reduction: Closed reduction is a surgical procedure that involves manipulating the upper part of the tibial bone back to its original anatomic position. This procedure is usually performed under a local anesthesia
  • Open reduction and internal fixation (ORIF): Open reduction is a surgical procedure to realign the fractured bone, to its original position. Surgical hardware (such as plates, screws, or rods) is then used to stabilize the fractured bone under the skin
  • Partial Patellectomy: Partial Patellectomy is a surgical procedure that involves a partial removal of the patella
  • Patellectomy: Patellectomy is a surgical procedure that involves the complete removal of the patella

How can Patellar Fracture be Prevented?

To prevent a Patellar Fracture, individuals should be careful and consciously aware, while performing any physical activities, such as sports, or even some normal daily activities that could lead to situations involving accidents. Children must be provided a safe environment to work, study, or play. Any possible dangers should also be anticipated and appropriate safety measures adopted.

A few ways to further help prevent unwanted injuries or Patellar Fractures include:

  • Individuals who participate in any high-risk sports, should wear appropriate safety equipment to help prevent the possibility of such fractures
  • Wearing appropriate footwear (such as the proper shoe size), may help prevent accidents
  • Consuming foods rich in calcium, such as milk, yogurt, and cheese, help build bone strength. Regular diet with appropriate calcium-intake is recommended, even after a Fracture of the Kneecap. For women, the recommended amount of calcium, increases with age and menopause
  • Perform weight-bearing exercises to strengthen bones

What is the Prognosis of Patellar Fracture? (Outcomes/Resolutions)

  • A majority of Patellar Fractures heal without any serious complications
  • A full recovery and a return to sports or normal daily activities usually require 6-16 weeks, depending on the severity of the injury
  • When properly treated and rehabilitated, usually under the guidance of a physiotherapist/specialist, a high percentage of individuals regain their full strength and range of motion in the injured knee/leg

Additional and Relevant Useful Information for Patellar Fracture:

  • A fracture of the distal femur is a break or crack that occurs anywhere within the lower region of the femur (near the knee)
  • A fracture of the proximal tibia is a break or crack that occurs within the upper region of the tibia, just below the knee
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Maulik P. Purohit MD MPH

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