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Patella Fracture

(Broken Kneecap; Fracture, Patella; Kneecap Fracture; Patellar Fracture)

Definition

A patella fracture occurs when there is a break in the patella, better known as the kneecap. The patella is a large, movable bone at the front of the knee.
The Kneecap
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Causes

Some common causes of this injury include:
  • Sharp blow to the knee
  • Excessive stress on the knee

Risk Factors

Factors that may increase your risk of a patella fracture include:
  • Increased age
  • Postmenopause
  • Decreased muscle mass
  • Decreased bone mass— osteoporosis
  • Participation in contact sports such as football and soccer
  • Obesity , which places strain on muscles, bones, tendons, and ligaments
  • Violence, such as car or car-pedestrian accidents

Symptoms

Patella fracture may cause:
  • Sudden, excruciating pain in the kneecap
  • Swelling, bruising, and tenderness
  • Inability to extend the knee
  • Difficulty walking

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. The doctor will look closely at the knee to see if there are signs of fracture . A straight leg test may be done.
Images can evaluate your knee and surrounding structures. These may include:

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Nonsurgical Approach

After the tests, your doctor will determine whether you need surgery. If the patella is not badly injured, your doctor will place the knee in a cast . This cast may need to be worn for 6 weeks. After that, you will wear a knee brace and do physical therapy. You may need to use a cane or crutches.
Your doctor may recommend medication to reduce swelling and pain.

Surgery

If the patella is in pieces, then you will need surgery. There are two kinds of surgery that are commonly used to treat this injury:
  • Open reduction-internal fixation surgery —The doctor uses pins and screws to put the broken pieces back together.
  • Patellectomy—Rarely, the doctor removes part of the kneecap or the entire kneecap.
After surgery, you will need to do physical therapy. This can involve range-of-motion exercises and stretching . You will slowly build strength in the injured leg. In some cases, another surgery will be needed to remove the pins and screws.
Depending on the injury, recovery can take weeks to several months.

Prevention

To help reduce your chance of a patella fracture:
  • Do not put yourself at risk for trauma to the bone.
  • Do weight-bearing exercises to build strong bones.
  • Build strong muscles to support the knee, prevent falls, and to stay active and agile.
  • Wear proper padding and safety equipment when participating in sports or activities.

RESOURCES

American Physical Therapy Association http://www.orthopt.org

Ortho Info—American Academy of Orthopaedic Surgeons http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association http://www.coa-aco.org

Canadian Orthopaedic Foundation http://www.canorth.org

References

Henry P, Panwitz B, et al. Rehabilitation of a post-surgical patella fracture. Physiotherapy. 2000;86:139-142.

Patellar (kneecap) fractures. American Academy of Orthopaedics website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00523. Updated March 2010. Accessed August 25, 2014.

Stress fractures. The American College of Foot & Ankle Orthopedics & Medicine website. Available at: http://www.acfaom.org/information-for-patients/common-conditions/stress-fractures. Accessed August 25, 2014.

Tay G, Warrier S, et al. Indirect patella fractures following ACL reconstruction. Acta Orthopaedica. 2006;77:494-500.

Revision Information

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