A patella fracture is a fracture of the kneecap. In most cases, a comminuted or transverse fracture occurs.
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 bone fractures is about one percent. The human patella is a component of the extensor apparatus. It prevents the thigh extensor tendon from rubbing directly against the knee joint. In this process, the patella moves on a femoral groove.
Causes
Most fractures to the patella occur from falls that occur on the flexed knee joint. The intense force causes the patella to break into two pieces or multiple fragments. In the context of a car accident, the kneecap, which is bent while sitting in a vehicle, can also hit an object such as the dashboard, sometimes resulting in its fracture. Medical professionals refer to such cases as a so-called dashboard injury. In addition, there are certain sports in which it is not uncommon for falls to result in a patella fracture. These primarily include inline skating and skateboarding. Occasionally, abrupt bending of the maximally extended knee also leads to a fracture of the patella. Occasionally, a patellar luxation (dislocation of the kneecap) is also the cause of a patellar fracture. The human kneecap is located directly under the skin. For this reason, patella fractures are often open fractures. This causes parts of the bone to protrude through the skin.
Symptoms, complaints, and signs
A fracture of the patella is noticeable by a sharp pain above the patella during movement and pressure. Because the pain is severe, the affected person usually cannot walk. Furthermore, it is no longer possible to make an extension movement in the knee joint. Another typical symptom of the patella fracture is the bruise (hematoma). This appears as a swelling and a bruise. Bleeding into the knee joint occurs, which is called knee joint effusion. Sometimes a crunching sound can also be heard after the fracture of the kneecap. This sound is called crepitation in medicine and can be heard when the kneecap moves. It is not uncommon for concomitant symptoms to appear along with the fracture of the patella, such as cartilage injuries in the joint head region and damage to the bursa. If the patellar fracture was caused by the transfer of force, fractures of the femoral shaft or dislocation of the hip joint sometimes also occur.
Diagnosis and course of the disease
To be able to establish the diagnosis of patella fracture with certainty, the attending physician performs an X-ray examination. In doing so, he takes images of the knee in two or three planes. In some cases, a scintigraphy, computed tomography (CT) or magnetic resonance imaging (MRI) may also take place. Differential diagnosis also plays an important role. For example, a rupture of the quadriceps tendon with a low patella or a patellar tendon rupture with a high patella may be responsible for the symptoms. The course of a patellar fracture depends on its extent. The smaller the patellar damage, the more favorable the long-term prognosis. In about one third of patients, load-dependent pain continues to occur even with optimal treatment of the fracture. In addition, there is an increased risk of patellar osteoarthritis as well as 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 completely loses consciousness. Furthermore, the pain often spreads to other regions of the body and can cause pain throughout the entire leg. The patient’s quality of life is significantly restricted and reduced due to the patella fracture. Furthermore, there is usually also severe swelling and bruising of the knee joint.The movement of the affected person is significantly restricted by the patella fracture, so that there may be limitations in everyday life. Dislocation of the hip joint is also possible if the patella fracture is not treated properly. Permanent pain not infrequently has a negative effect on the psyche and can lead to depression and other psychological upsets. As a rule, a patella fracture requires surgical intervention. However, there are no particular complications and the disease usually progresses positively. However, the affected person may still be restricted in his or her movement after the operation.
When should one go to the doctor?
If severe physical discomfort sets in after a fall, accident or violence to the body of the affected person, a doctor must be consulted. If there is swelling at the knee or restrictions on the usual range of motion, a doctor is needed. Pain, visual changes in the bone structure or circulatory disturbances must be presented to a doctor immediately. Due to the numerous side effects and possible complications, the use of a painkilling medication should be avoided. Only after consultation with a physician should medications be taken to alleviate existing symptoms. If the knee joint can no longer be moved without pain, consultation with a physician is indicated. If a bruise develops on the knee, this is a characteristic sign of a patella fracture. Since the condition can lead to a significant deterioration in health and further damage to cartilage, nerves, muscle fibers as well as tendons if left untreated, the affected person requires adequate medical care without delay. If there are noticeable changes in behavior, sudden severe weepiness or intense inner restlessness, a visit to the doctor is recommended. In case of palpitations, increased blood pressure, redness of the skin as well as hypersensitivity to touch, a doctor is needed. Numbness as well as disorders of sensitivity should be presented to a doctor. If a disturbance of consciousness due to pain sets in, emergency medical services should be alerted.
Treatment and therapy
Treatment of a fractured patella depends on the form of the fracture. Thus, both conservative and surgical therapy are possible. However, conservative treatment can only be performed if the fracture has not shifted. Such fracture forms exist only if the reserve extensor apparatus (retinaculum patellae) is still intact. Also suitable for conservative therapy are longitudinal fractures, which in most cases are only slightly displaced. If the periosteum is still intact, it is even possible to avoid immobilizing the injured knee. In this case, early functional treatment including pain-adapted full weight-bearing is carried out. In conservative therapy, the knee is immobilized with a sleeve made of plastic or plaster. This prevents the fracture fragments from drifting apart. For a certain period of time, the patient is not allowed to put any weight on the affected leg. With the help of repeated X-ray examinations, the doctor can determine whether the treatment is progressing successfully. To prevent the formation of a thrombosis (blood clot), the patient receives injections of heparin. If the bone fragments break apart after the fracture of the kneecap, a surgical intervention must take place. During this procedure, the patient receives spiral anesthesia or general anesthesia. During the operation, the surgeon removes the fibers of the extensor apparatus from the fracture site and puts the individual fragments together. In addition, reconstruction of the joint surface is performed. Osteosynthesis is required to fix the patellar fragments. This bone union allows functional aftercare. If there is an open fracture of the patella, the operation must be performed within six hours. Otherwise, there is a risk of infection by settled bacteria, which can spread to the entire knee. To prevent infection, the patient is given antibiotics.
Outlook and prognosis
In most patients, the prognosis for a patella fracture is positive. For example, the fracture of the kneecap heals within six to eight weeks in about 70 percent of all affected individuals. The respective leg can then be fully used again.Nevertheless, the patella fracture is a serious injury that requires corresponding patience in the healing process. In addition, some problems are possible in the course of the fracture, which have a negative impact on the prognosis. If a comminuted or transverse fracture is present, cartilage irregularities may be present on the back of the patella even after surgery. Joint wear and tear, in turn, threatens the early onset of osteoarthritis, which is evident in the sliding bearing of the patella. However, there are certainly ways to counteract arthrosis. For example, the patella can be completely removed in the course of a patelectomy. Another conceivable consequence is the loss of strength in the thigh. In some cases, the knee is at risk of instability. It is not uncommon for the joint to not move as well after a patella fracture as it did before the injury. Sometimes the knee joint appears stiff and painful after the surgical procedure. However, in most cases, these complaints subside after some time. To improve the chances of recovery, orthopedic rehabilitation is recommended. It helps the patient to be able to actively organize his normal everyday life again.
Prevention
To prevent a patella fracture, it is recommended that protective clothing with knee pads always be worn during high-risk sports such as in-line skating. When driving a car, rounding the dashboard and strapping on are considered sensible preventive measures.
Aftercare
In most cases, the person affected by a patella fracture has only very few and sometimes very limited aftercare measures available to him or her. The affected person should therefore contact a physician early on to prevent further complications or discomfort. As a rule, patella fractures do not heal on their own. Without expert treatment, the affected area will sometimes fuse incorrectly. Most patients depend on surgical intervention, which relieves the discomfort and alleviates the pain. After such an operation, the affected person should in any case rest and take care of his body. Efforts or stressful and physical activities should be refrained from in order not to put unnecessary strain on the body. In many cases, excess weight should also be reduced as much as possible. Infections and inflammations can be prevented with the help of antibiotics. The person concerned should ensure that they take them regularly and also that they are taken in the prescribed dosage. The consumption of alcohol together with antibiotics should be avoided if possible, as it weakens the effect of the drug. In this context, the patella fracture does not usually reduce the patient’s life expectancy.
What you can do yourself
A patella fracture must be treated by a doctor. Self-help measures are limited to taking it easy on the injured kneecap and otherwise following the doctor’s instructions. Since a patellar fracture is associated with severe pain and restricted movement, painkillers must be taken. In consultation with the physician, homeopathic remedies can be used to support the drugs in their effect or to balance them out at the end of the treatment. Since the affected person is occasionally bedridden as a result of the injury, the diet may also have to be changed. Regular massages and physiotherapy prevent pressure sores and circulatory problems. Accompanying this, the wound should be disinfected several times a day to prevent inflammation. If an open fracture is present, surgical measures are necessary. After the operation, rest and bed rest are again required. In addition, the affected area must be carefully cared for, as there is an increased risk of infection. The patient must cure the injury for at least four to six weeks. After that, physical activity can be slowly resumed. In less severe cases, recovery can be supported by physiotherapeutic measures or physiotherapy. Nevertheless, control examinations by the specialist are always necessary.
