Knee

The knee is one of the largest and most complex joints in the body. The knee is made up of bones, cartilage, ligaments, and tendons. The knee joins the thigh bone (femur), the shin bone (tibia), the smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) altogether to make up the knee joint. The knee is a synovial joint, meaning it contains a fluid-filled capsule.

Tendons connect the knee bones to the leg muscles that move the knee joint, and ligaments join the knee bones and provide stability to the knee.

Patella Fracture

WHAT IS A PATELLA FRACTURE?

A patella fracture is a break in the kneecap, which is the small bone that sits at the front of your knee. This usually occurs due to a direct impact to your kneecap.

The patella can fracture in many ways: the bone can break into two pieces or break into many pieces. A break can occur at either the top, middle, lower part of the bone, or sometimes in more than one area of the kneecap.

WHAT ARE THE SYMPTOMS OF A PATELLA FRACTURE?

Pain and swelling at the front of the knee are the most obvious symptoms of a patella fracture. Other symptoms include:

  • Inability to lift the leg
  • Inability to straighten the leg
  • Inability to walk
  • Bruising around the front of the knee

WHAT ARE THE CAUSES AND RISK FACTORS OF A PATELLA FRACTURE?

Patella fractures are most commonly due to:

  • A direct blow to the knee, such as during a motor vehicle collision and your kneecap directly hits into the dashboard
  • Falling directly onto the knee while it is bent

WHAT IS THE DIAGNOSIS OF A PATELLA FRACTURE?

A history of the injury and a physical examination of the knee will be conducted by the Doctor. During the examination, your doctor checks for a condition called hemarthrosis. Hemarthrosis occurs when there is painful swelling due to the blood from the fractured bone ends collecting inside the joint space. Sometimes, there may be large amounts of blood in your knee, which your doctor may drain out to ease the pain.

Your doctor will also check if you can perform the straight leg raise test. This is done by having the patient’s leg outstretched on a bed. With the leg straight, the patient should then raise his or her foot off the bed and hold it in the air.

Imaging tests such as an x-ray may be ordered to examine your fracture in further detail.

WHAT ARE THE TREATMENT OPTIONS FOR A PATELLA FRACTURE?

The first line of treatment is always nonsurgical treatment. For patients who are able to do a straight leg raise, their bones are not displaced or minimally displaced and hence can be treated nonsurgically. Your doctor will get you to wear a cast or splint to keep your knee immobilized and straight, to allow for broken bone healing.

For patients whose patella bones are displaced, surgery will be required. An incision is made over the front of the knee joint, and the fractured pieces are realigned and held in place using screws, pins or wires. This method is best suited for fractures located near the middle of the patella. For a patella that has been broken into many small fragments, your doctor will remove a portion of the patella and attach the loose patella tendon to the remaining patella bone.

WHAT IS THE RECOVERY PROCESS AFTER A PATELLA FRACTURE SURGERY?

After a patella fracture surgery, your doctor may recommend:

  • Icing and elevating the affected leg
  • Pain relief medications
  • Physiotherapy to restore muscle strength, decrease stiffness and restore mobility in your leg

 

As you slowly recover from your injury and regain muscle strength, you will be able to put on more weight on your leg.

WHAT ARE THE RISKS AND COMPLICATIONS OF A PATELLA FRACTURE?

Even after recovery, some patients may experience complications. These include:

  • Posttraumatic arthritis- pain and stiffness overtime due to damage to your articular cartilage which covers the bones, even after your bones have healed
  • Muscle weakness in front of the thigh, and may experience some loss of motion
  • Long-term chronic pain in the knee
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