A fracture to the patella is simply a bone injury to the kneecap. The kneecap is the bone that is at the center joint of the leg. Three bones are attached to it and these are the femur, the tibia, and the fibula. The function of the patella is to serve as the fulcrum and provide support and strength for the whole leg. Patella fractures usually occur from hard falls when the person landed on his or her knees first. With such impact, the fracture can also create lacerations and abrasions to the skin that is on top of the patella.
Aside from the sudden impact or blow that directly engaged the patella, another reason for breakage is during the sudden contraction of the quadriceps muscle that forces the knee to straighten up which can injure the knee. When the muscle is forcefully pulled out this can really fracture the patella.
Patella Fracture Types
There are several primary types of fractures of the patella and each of them has individual diagnostic, characteristic, and management considerations. These are the following:
• Transverse patellar fracture. This fracture occurs in medial-lateral direction hence the name transverse. The locations of the fractures are usually found on the central or distal third of the patella
• Vertical patellar fractures. These are in the superior-inferior direction so these are rare types of fractures.
• Marginal patellar fractures. These fractures involve the edge of the patella and the fracture does not surpass its boundaries but only limited to the patella.
• Osteochondral patellar fractures. When direct or indirect blows occur on the patella, this type of fracture occurs. Children are prone to this type of fracture because they always use their knees to support their falls.
Most doctors prefer the use of radiographs (X-rays) as their imaging tool when examining patella fractures. If this procedure is not enough, computerized tomography (CT) scans will be used. For complete and detailed diagnosis, the doctor can also subject the patient’s injury to bone scan or even magnetic resonance imaging (MRI). CT scan can be useful if the fracture is not clearly visible on the X-ray plate. It can help identify the position of the fragments of the fracture. Bone scans are used when the result of the X-ray is normal but there seems to be internal fracture on the bone. However, it can only be effective if the injury is older than 24 hours. MRI can detect even small fractures that cannot be exposed by X-rays and unlike bone scans, it can produce result without delay. Rehabilitation or patella rehab is crucial.
Patella Fracture Causes
Because the patella is located on the subcutaneous region of the front leg, it is prone to fracture or other injuries. The usual causes are direct blow to the knee, sudden tensile force during the sudden hyperflexion of the knee, or the combination of these two. The condition of the injury depends on the mechanism on how the injury occurs. The usual injuries are the transverse injuries and the less common are the marginal, vertical, and the osteochondrial types. Osteochondrial types are the result of small bony avulsion while a direct blow to the kneecap can result in transverse (stellate) fracture. Marginal and vertical fractures are caused by the hyperflexion of the knee with the contraction of the quadriceps muscles.
Patella Fracture Symptoms:
Once the patient suffers from a Patella bone fracture or fractured knee, some of these following symptoms will occur:
• Severe pain in the knee
• Swelling on and around the knee area
• Deformity of the knee joint
• Tenderness of the skin of the injured part
• The knee cannot be moved
• The person cannot be able to stand
• Weakness of the leg specifically on the lower limb
• Foot weakness
• Numbness in the leg that is specific below the knee
Patella Fracture Treatment
A patellar fracture is always associated with severe pain because there can be ligaments and tendons involved. This is why the patient should be rushed to the emergency room during patella rupture and X-rays must be obtained to determine what type of patella fracture is sustained. A straight leg raise will also enable the doctor to test the function of the quadriceps muscles and to know if the muscles are still attached to the shinbone. If the straight leg raise prove there is no disruption on the patella or to the patellar tendon, non-operative treatment will proceed to set the patella fracture straight. The leg will be put in a cast or put a knee immobilizer until the kneecap gets back to its normal condition.
Patella xray should always be taken in case of damage or torn patellar bone. Severe swelling can occur.
However, when there is the displacement of the fractured patella or if there is a severed tendon, surgery or reconstruction will be necessary. An incision will be made over the front of the knee and the fractured ends of the kneecap will be realigned and will be reconnected with the use of some combination of screws, pins, and wires. Unfortunately, if the patella is already fragmented in many pieces, only some of the usable bones will be reconnected and part of it will be removed. Metal plates will be in place of the missing parts and then the patient must use braces or keep his knee in straight position for sometime until his wound and bones heal. When healing is almost complete, the person can now move his knees slowly. Physical therapy is also important. Emedicine may help too.
Patella Fracture Recovery Time or Healing Time: You need more than 8 weeks.
Prevention of Patella Bone Injury
You must always take precautions to reduce your chance of getting patella fracture or bone injuries because the knees are most important for our mobility. The best thing that you can do is not to put yourself in situations where you can have a trauma to the knee. Weight-bearing exercises can build you strong bones and support this with eating foods rich in calcium and vitamin D. When engaging in active sports, always wear proper padding especially kneepads and other safety gears.
When to Call A Doctor
Patellar fractures can be easily distinguishable by the symptoms of kneecap dislocation. There is usually the swelling of the knee or a deformity. Open fractures are already obvious but if any symptom appears, call medical help at once. If someone landed hard on his knees and you see a broken knee do not force the person to straighten his knee because some tendons can be damaged further.