Patellar Fracture

If you think you may have suffered a patellar fracture, immobilize your knee and see a doctor as soon as possible. Ice packs can be used in the meantime to prevent pain.

A patellar fracture is a crack or break in the patella (kneecap). The patella is a flat, triangular-shaped bone that sits on the front of the knee joint. It is buried in the tendon, a band of tissue connecting muscle to bone, of a large muscle named quadriceps femoris.

Causes
Patellar fractures can result from both direct and indirect trauma. Direct trauma, such as from a strong blow, results in the patella breaking into small fragments. The fragments usually stay contained in the quadriceps femoris tendon. Twisting at the knee or a violent contraction on the quadriceps muscles can cause indirect trauma. With these injuries, the bony fragments usually separate. Many patella fractures also involve sprains or ruptures (tears) of the surrounding ligaments and tendons.

Symptoms
Symptoms can include:

• pain
• tenderness
• swelling
• deformity
• locking of the knee
• numbness and coldness below the injury if blood supply is affected.

Immediate Treatment
Rest, ice packs to reduce swelling, compression and elevation of the injured leg are all helpful in caring for a patellar fracture. Be sure to immobilize the joint to prevent further injury and pain and see a doctor as soon as possible.

Medical Treatment

• Non-surgical
  Your doctor will need X-rays to diagnose this condition. It may be possible for your patellar fracture to heal on its own with casting. If your doctor takes this approach, he or she will manipulate your knee to set the bone back into place. You will be given medications to relax the muscles and control pain. An above-the-knee cast will be used to immobilize the joint for approximately four to six weeks. The cast will hold your knee straight and prevent bending.

  In approximately six weeks, physical therapy can begin with gentle range of motion exercises. Your therapist will also prescribe exercises for the muscles on the front of your thigh (quadriceps) to strengthen your leg.
   

• Surgical
  If your doctor recommends surgery, you will be referred to an orthopaedic surgeon. The bone will be set with hardware such as nails, pins, screws, rods or plates. One of several methods can be used to treat your knee, and each one varies in procedure and recovery time. Talk to your doctor about the treatment and your expected recovery. Your doctor will also advise you on a reconditioning and rehabilitation program, including any physical therapy.

  After surgery, your knee will be immobilized and elevated for two to three days. On approximately the fourth day after surgery, you may begin range of motion exercises as advised by your doctor. You can begin to put weight on your leg in about four to six weeks, depending on your progress.

Recovery Outlook
Your outcome depends largely on your health before the injury and how well you follow your rehabilitation program. In general, once the cast is removed, you can start ice massages. These can be completed three to four times a day for ten to fifteen minutes each time. Heat can also offer relief in the form of hot baths, heating pads or reactive ointments. Average healing time for a patellar fracture is six to eight weeks.