A fracture of the kneecap is considered a patella fracture. This usually results in a fragmentary or transverse fracture.
What is a patella fracture?
A patella fracture is a fracture of the kneecap (patella). A typical feature of this injury is the occurrence of comminuted or transverse fractures. Mixed fractures are also within the realm of possibility. In most cases, these are caused by falls on the knee.
The proportion of patella fractures in the total number of all broken bones is about one percent. The human kneecap is part of the extensor apparatus. It prevents the thigh extensor tendon from rubbing directly on the knee joint. The patella moves on a femoral groove. See foodanddrinkjournal for DNA Dictionary Definitions.
Causes
Most kneecap fractures result from falls onto the flexed knee joint. The intense force causes the patella to break into two pieces or multiple fragments. In a car accident, the kneecap, which is bent when sitting in the vehicle, can also hit an object such as the dashboard, sometimes resulting in fracture. In such cases, doctors speak of a so-called dashboard injury.
In addition, there are certain sports in which falls often result in a patella fracture. These include primarily inline skating and skateboarding. Occasionally, abrupt bending of the fully extended knee also leads to a fracture of the patella. Sometimes a patellar dislocation (dislocation of the kneecap) is also the cause of a kneecap fracture.
The human kneecap is located just under the skin. For this reason, patella fractures are often open fractures. Bone parts protrude through the skin.
Symptoms, Ailments & Signs
A fracture of the kneecap becomes noticeable through a severe pain above the patella with movement and pressure. Because the pain is very severe, the affected person is usually unable to walk. Furthermore, stretching movements can no longer be carried out in the knee joint. Another typical symptom of a patella fracture is the bruise (hematoma). This appears as swelling and as a bruise. Bleeding occurs in the knee joint, which is called knee joint effusion.
Sometimes a crunching sound can also be heard after the fracture of the kneecap. This sound is medically called crepitation and is heard when the kneecap moves. It is not uncommon for the fracture of the patella to be accompanied by side effects such as cartilage injuries in the joint head region and damage to the bursa. If the fracture of the kneecap was caused by the transmission of force, fractures of the shaft of the femur or a dislocation of the hip joint sometimes also occur.
Diagnosis & course of disease
In order to be able to make the diagnosis of a patella fracture with certainty, the treating physician carries out an X-ray examination. He takes pictures of the knee in two or three planes. In some cases, a scintigraphy, computed tomography (CT) or magnetic resonance imaging (MRI) can also take place. The differential diagnosis also plays an important role.
A rupture of the quadriceps tendon with a low position of the kneecap or a rupture of the patella tendon with an elevated position of the kneecap can also be responsible for the symptoms. The course of a kneecap fracture depends on its extent. The lower the kneecap damage, the more favorable the long-term prognosis. Around one third of patients continue to experience stress-related pain, even with optimal fracture care. There is also an increased risk of kneecap arthrosis and arthrofibrosis (joint scarring).
Complications
First and foremost, those affected by a patella fracture suffer from very severe pain. The pain is stabbing and can be so severe that the affected person loses consciousness completely. Furthermore, the pain often spreads to other regions of the body and can lead to pain in the entire leg. The patient’s quality of life is significantly restricted and reduced due to the patella fracture.
In addition, there is usually severe swelling and bruising in the knee joint. The affected person’s movement is significantly restricted by the patella fracture, which can lead to limitations in everyday life. Hip dislocation is also possible if the patella fracture is not properly treated.
Persistent pain often has a negative effect on the psyche and can lead to depression and other mental upsets. Surgery is usually required for a patella fracture. However, there are no particular complications and the course of the disease is usually positive. However, the affected person may still be restricted in their movement after the operation.
When should you go to the doctor?
A doctor must be consulted if the body of the person affected develops severe physical symptoms after a fall, accident or the effects of violence. If there is swelling in the knee or limitations in the usual range of motion, a doctor is needed. Pain, visual changes in the bone structure or circulatory disorders must be presented to a doctor immediately. Due to the numerous side effects and possible complications, taking painkillers should be avoided. Medicines to alleviate existing symptoms should only be taken after consulting a doctor.
If the knee joint can no longer be moved without symptoms, a doctor’s consultation is indicated. If a bruise develops in the knee, this is a characteristic feature of a patella fracture. Since the disease, if left untreated, can lead to a significant deterioration in the state of health and further damage to the cartilage, nerves, muscle fibers and tendons, the affected person requires adequate medical care immediately. If there are noticeable changes in behavior, sudden strong tearfulness or an intense inner restlessness, a doctor’s visit is recommended.
A doctor is required for heart palpitations, high blood pressure, reddening of the skin and hypersensitivity to touch. Feelings of numbness and sensory disturbances should be presented to a doctor. If consciousness is impaired due to the pain, the emergency services should be alerted.
Treatment & Therapy
Treatment for a fractured kneecap depends on the shape of the fracture. Both conservative and surgical therapy are possible. However, conservative treatment can only be carried out if the fracture has not shifted. Such types of fractures only exist if the reserve stretch apparatus (retinaculum patellae) is still intact.
Longitudinal fractures, which in most cases diverge only slightly, are also suitable for conservative therapy. If the periosteum is still intact, there is even no need to immobilize the injured knee. This involves an early functional treatment including pain-adapted full weight bearing.
In conservative therapy, the knee is immobilized with a sleeve made of plastic or plaster. As a result, the fracture fragments cannot drift apart. The patient must not put weight on the affected leg for a certain period of time. With the help of repeated X-ray examinations, the doctor can determine whether the treatment is progressing successfully. To avoid the formation of thrombosis (blood clots), the patient is given injections of heparin.
If the bone fragments break apart after the fracture of the kneecap, a surgical intervention must take place. The patient receives a spiral anesthetic or a general anesthetic. During the operation, the surgeon removes the extensor fibers from the fracture site and reassembles the individual fragments. In addition, the joint surface is restored. Osteosynthesis is required to fix the patellar fragments. This bone union allows for a functional follow-up treatment.
If there is an open fracture of the kneecap, the operation must be performed within six hours. Otherwise there is a risk of infection from colonized bacteria, which can spread to the entire knee. To prevent infection, the patient is given antibiotics.
Outlook & Forecast
In most patients, the prognosis of a patella fracture is positive. In about 70 percent of all affected people, the fracture of the kneecap heals within six to eight weeks. The respective leg can then be fully used again. Nevertheless, the patella fracture is a serious injury that requires patience during the healing process.
In addition, in the course of the rupture, some problems are possible that negatively affect the prognosis. If there is a comminuted or transverse fracture, cartilage irregularities may also be present on the back of the kneecap after surgery. The wear and tear of the joint in turn threatens the early occurrence of arthrosis, which shows up in the plain bearing of the patella. However, there are ways to counteract osteoarthritis. In this way, the kneecap can be completely removed as part of a patellectomy.
Another conceivable consequence is the loss of strength in the thigh. In some cases, the knee is threatened with instability. It is not uncommon for the joint to be unable to move as well after a patella fracture as before the injury. Sometimes the knee joint is stiff and painful after the surgical procedure. However, in most cases these symptoms go away after some time.
Orthopedic rehabilitation is recommended to improve the chances of recovery. It helps the patient to be able to actively organize their normal everyday life again.
Prevention
To avoid a patella fracture, it is advisable to always wear protective clothing with knee pads for high-risk sports such as inline skating. When driving a car, rounding off the dashboard and scanning it are sensible preventive measures.
Aftercare
In most cases, those affected with a patella fracture have very few and sometimes very limited follow-up measures available. The affected person should therefore contact a doctor at an early stage so that no further complications or symptoms can occur. As a rule, a patella fracture cannot heal on its own. Without expert treatment, the affected area sometimes grows together incorrectly.
Most patients require surgery to relieve discomfort and relieve pain. After such a procedure, the person concerned should definitely rest and take care of his body. Efforts or stressful and physical activities should be avoided in order not to unnecessarily burden the body.
In many cases, excess weight should be reduced as much as possible. Infection and inflammation can be prevented with the help of antibiotics. The person concerned should pay attention to regular intake and also to the prescribed dosage. The consumption of alcohol together with antibiotics should be avoided if possible, as it weakens the effect of the drug. The patella fracture usually does not reduce the life expectancy of the patient.
You can do that yourself
A patella fracture requires medical attention. The self-help measures are limited to protecting the injured kneecap and otherwise complying with the doctor’s instructions. Since a kneecap fracture is associated with severe pain and restricted movement, painkillers must be taken. In consultation with the doctor, homeopathic remedies can be used to support the effects of the drugs or to taper them off at the end of the treatment.
Since those affected are occasionally bedridden as a result of the injury, the diet may also have to be changed. Regular massages and physiotherapy prevent pressure points and circulatory disorders. In addition, the wound should be disinfected several times a day to avoid inflammation. If there is an open fracture, surgical measures are necessary. Rest and bed rest apply again after the procedure. In addition, the affected area must be carefully cared for, as there is an increased risk of infection.
The patient must recover from the injury for at least four to six weeks. After that, physical activity can slowly be resumed. In less severe cases, recovery can be supported by physiotherapeutic measures or physiotherapy. Nevertheless, check-ups by a specialist are always necessary.
