What is a patella/knee fracture?

A patella fracture is a break in your kneecap — that small, flat bone that covers the knee joint like a shield, usually due to direct injury from a fall on your knee, a blow to the knee, or even a collision with the dashboard in a car accident. A fractured patella is a severe injury that may limit your ability to bend or straighten your knee. Most fractures are uncomplicated, but this small bone can break into many small fragments.

What are the symptoms and signs of a fractured patella?

Pain.
Swelling.
Bruising.
The patellar defect is palpable (a change in your kneecap that you can feel through your skin).
I cannot straighten my leg.
Cannot lift the extended leg.
I cannot walk.

What is the cause of a patella fracture?

A break in the patella - a patella fracture - usually results from a direct blow to your kneecap, for example, in a fall from a height, from a sports injury, or following a car accident. Sometimes, it may be due to a sudden contraction of one of your knee muscles.

How is the diagnosis of a patella fracture made?

Your doctor will want to know about your symptoms and what happened at the time of the injury. They will then examine your knee. You might be asked to try extending your leg. If you are unable to, surgery will probably be necessary. They can probably feel through your skin to the edges of the broken pieces of bone.

They will be checking for open wounds and hemarthrosis, a significant swelling resulting from blood clotting from fractured bone fragments collecting in the joint. They can even use a CT scan aside from X-rays to pinpoint the fracture.

What is the treatment for a patella fracture?

Examination: The treatment for a patella fracture will depend on the nature of your break. The initial step that your healthcare provider will take is the physical examination of your knee and checking for signs of hemarthrosis. They might have to treat the hemarthrosis first by draining some of it. After that, they will take X-rays to know what kind of fracture you must advise if it is stable. If you have a stable fracture, they will tell you that your bone can heal within the expected time frame without surgery.
Surgery: Your bone pieces would then need to be reunited again in surgery. Since the powerful muscles surrounding your knee tend to pull the pieces of bones apart, the bone fragments are separated too widely to be reduced by themselves. Orthopedic surgeons may use wires, plates, screws, or pins to stabilize your broken bone. Because the bone pieces of your bones might be so small that they cannot be implanted, your surgeon will have to retrieve them. It may need to reattach your tendon to the bone.
Rest: The patient will be discharged home with a cast, splint, or brace that will allow their knee to be put in the best position and used less for healing. They will be taught how much weight can be placed on the knee and how far it can bend. Pain medication over the counter and periodic ice and elevation will be ordered to reduce swelling.
Rehabilitation: Your knee will need physical therapy to regain mobility. Injury often causes stiffness and muscle weakness, implying the need to retrain your knee into almost the same movement before your injury was sustained. The doctor can order physical therapy that includes exercises aimed at strengthening and stretching and range-of-motion exercises.

How long does it take to recover from a patella fracture?

The treatment of a patella fracture varies from person to person. The healing process is a bit longer in the case of a severe break and those who need surgery. People generally feel well about six weeks after the injury and can resume all activities within three to six months. Long-term symptoms are confined to pain and stiffness; some prefer using a knee brace for continued support.

What happens when the patella fractures or breaks?

A patellar fracture is usually because of a direct hit to the knee. Depending on how much power is applied, it may break into two parts, be a hairline crack, or into several tiny fragments. Your knee's extensor mechanism becomes dysfunctional when you have a patella fracture. You usually can flex and extend your knee because of the quadriceps and patellar tendon attached to your patella. Cartilage covers the patella, making it a cushion for your knee joint. This kind of fracture may damage the cartilage, which may cause post-traumatic arthritis.

What are the types of patella fractures?

Stable patella fracture: In a stable fracture, sometimes known as a "nondisplaced" fracture, the bone pieces on both sides stay roughly in the right place. They might still be glued together or separated by only a millimeter. Such fractures tend to heal well without surgery. If your doctor feels that surgery is not necessary, they will stabilize your knee in extension by applying a knee immobilizer, a hinged knee brace, or a cast. You may support as much weight as you feel comfortable supporting.
Displaced patella fracture: In a displaced fracture, your fractured pieces of bone are out of place and do not line up as they should. This sometimes requires surgical intervention to hold the pieces in place so the bone can heal and your knee can work properly.
Transverse patella fracture: This type of break where your patella breaks into two pieces. The breaks are usually fixed with surgery. Various techniques stabilize such injuries; thus, the decision will depend on your surgeon and the best for you.
Comminuted patella fracture: A comminuted fracture means that your bone has broken into three or more pieces. A comminuted fracture may be stable or unstable. An unstable comminuted fracture implies that some of your bone pieces are too small to reattach and must be taken out during surgery.
Open patella fracture: The skin over your bone is open in an open fracture. Either your fragments themselves have breached your skin, or something has come in from the outside to breach your knee. An open fracture is usually treated with urgent antibiotics and surgery to clean the wound thoroughly. Open fractures are more prone to infection, so always seek medical attention soon after an injury. Your surgeon will decide which surgical treatment will be used to fix your fracture.

What is the long-term outcome for a fractured patella?

Even though most fractures are deemed healed within three to six months, it's common for patients to indicate more significant difficulties for years later. These include:

Permanent loss of movement in your knee, specifically in its ability to bend and extend.
Chronic knee pain: Doctors don't really know why, but apparently, it has something to do with stiffness and muscle weakness.
Post-traumatic arthritis: This develops when the cartilage that lines the joint and cushions your kneecap has been damaged. Up to 50% of patients report some arthritis after about eight years.

Living With

How do I take care of my knee following a patella fracture?

Be sure to continue physical therapy after your fracture has healed so that you can regain your muscle strength and range of motion.
Your doctor may recommend you abstain, as far as possible, from stairs, squatting, and bending due to the pressure these acts would exert on your knee and later develop the condition further.
If you still have stiffness or weakness in the joint, you may want to continue wearing knee support.
NSAIDs, aspirin, or ibuprofen should aid you with regards to your sprees of pain and inflammation.