The predominant symptom manifesting after a patella fracture is knee pain [7]; the patient's medical history will illustrate the way in which the traumatization was sustained: direct force, indirect force or a combination of those.

Displaced fractures usually present with abnormal appearance of the knee and the dislocated pieces may as well be palpable. Medial and lateral retinacula disruption may also be present, accompanied by hemarthrosis.

• Pain

  Chronic Pain Long-term pain in the front of the knee is common with patellar fractures. While the cause of this pain is not completely understood, it is likely that it is related to posttraumatic arthritis, stiffness, and muscle weakness. [orthoinfo.aaos.org]

  The patient presented peripatellar pain in full knee flexion and kneeling position. We resected the ossification, and the patient was immediately relieved from pain and was mobilised under full weight bearing with no limitation of knee flexion. [ncbi.nlm.nih.gov]

  Patients present with marked swelling and pain over the patella with point tenderness and marked reduction in extension strength. Usually, there is a large joint effusion or hemarthrosis. [radiopaedia.org]

• Falling

  They happen during falls, eg. falls from the bicycle or motorcycle, falls after slipping on ice, but they are also common after car accidents. [videoreha.com]

  These three types of patella fractures are commonly caused by the following: A Fall. Falling directly on the knee can cause a patella fracture. Falls may occur will walking, running, or participating in exercise programs or sports. [totalorthosportsmed.com]

  Cause of fracture: Direct trauma: Due to its position under the skin in front of the knee, it is vulnerable to fracture with direct trauma e.g. falling directly on the knee or being hit by a car. [hip-knee.com]

  One fall or continued lack of compliance with bracing can pull the bone ends apart and result in the need for surgery. Knees treated in long term braces often become quite stiff. [renoortho.com]

  Complications stiffness weak extensor mechanism degenerative disease of the patellofemoral joint Etiology There are different causes of patella fracture: direct blow to patella, e.g. dashboard injury (high energy) or fall onto the patella (low energy) [radiopaedia.org]

• Swelling

  Patients present with marked swelling and pain over the patella with point tenderness and marked reduction in extension strength. Usually, there is a large joint effusion or hemarthrosis. [radiopaedia.org]

  Raise your knee above the level of your hips to reduce swelling. [fracturecare.co.uk]

  Swelling: Swelling and bruising around the front of the knee is typical of a patella fracture. Often, as days go by, the swelling extends down the leg and even into the foot. [orthopedics.about.com]

  Medicine will be needed to ease swelling and pain. Other options are: Without Surgery A mild fracture may be treated with a cast to keep the knee from moving as it heals. A brace, cane, or crutches may be needed after the cast comes off. [winchesterhospital.org]

• Surgical Procedure

  Internal fixation devices made of stainless steel or titanium are commonly used in ORIF surgical procedures. With any ORIF procedure, there is the high risk of infection. [ebtrialattorneys.com]

  Surgical Procedures The type of procedure performed often depends on the type of fracture you have. Before the surgery, your doctor will discuss your procedure with you, as well as any potential complications. Transverse fracture. [orthoinfo.aaos.org]

• Difficulty Walking

  Signs of a Patella Fracture Patella fractures can cause severe pain and difficulty walking. Some of the more common symptoms of this injury include: Pain: Patella fractures are generally quite uncomfortable. [orthopedics.about.com]

  Signs Patella fractures can cause severe pain and difficulty walking. Some of the more common symptoms of this injury include: Pain: Patella fractures are generally quite uncomfortable. [verywellhealth.com]

  Contact one of our experienced orthopedic surgeons if you suffer from the following patella fracture symptoms: A snapping or popping sound at the time of the injury Pain, swelling, bruising, or tenderness immediately after the injury Difficulty walking [orthosportandspine.com]

• Fracture

  fracture of mid patella (most common) comminuted fracture vertical fracture (rare) osteochondral defect usually from medial facet patellar sleeve fracture in children Some fractures are more subtle and need to be differentiated from normal variants. [radiopaedia.org]

  Using a novel Arthrex ® technique, the Patella Fracture System is utilized in repairing a patella fracture. [arthrex.com]

  Discussion Patients who sustain inferior pole patella fractures have limited options for fracture fixation. [ncbi.nlm.nih.gov]

  This involves drilling the wires through the fracture site prior to reduction. Once the wires are passed through the fracture, the wire end nearest the fracture surface is made flush with the fracture. [emedicine.medscape.com]

• Arthritis

  Posttraumatic Arthritis Posttraumatic arthritis is a type of arthritis that develops after an injury. Even when your bones heal normally, the articular cartilage covering the bones can be damaged, leading to pain and stiffness over time. [orthoinfo.aaos.org]

  Patella Fracture Treatment Treatment of patellar fracture, should be to maximize the restoration of the smooth articular surface, to give a more solid fixation and early knee joint activity to prevent the occurrence of traumatic arthritis. 1. [clorelaw.com]

  Patellar fractures can lead to stiffness, extension weakness, and patellofemoral arthritis. Nonsurgical management is indicated for nondisplaced fractures with an intact extensor mechanism. [ncbi.nlm.nih.gov]

• Knee Pain

  In this confusing presentation, a high index of suspicion for patella fracture should be maintained for patients with knee pain and osteoporosis on x-ray with a dysplastic syndrome. [ncbi.nlm.nih.gov]

  Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee Anterior knee pain is pain that occurs at the front and center of the knee. [mountsinai.org]

  A 9-year-old girl presented with knee pain and inability to extend her leg after landing on her flexed right knee while jumping on a trampoline. [nejm.org]

  Knee pain following a Patella fracture is quite common, even after the fracture has healed. Many people find that a Knee Brace or Support helps to provide warmth and alleviates their knee pain symptoms. [physioroom.com]

• Long Legs

  Gypsum-based care or possession of a fixed This law applies to a non-displaced patellar fracture, without manual reduction, intra-articular blood out, bandage, care, or with long legs plaster cast limb fixed in extension position 3 ~ 4 weeks. [clorelaw.com]

  A long-leg immobilizer is applied for 6 to 8 weeks. Following removal of the brace, gradual exercise may be started and weight placed on the leg for a few weeks, after which the patient may walk. [medical-dictionary.thefreedictionary.com]

  Knee > Fractured Kneecap > Treatments Restrict Activities, Brace Home Recovery If your fractured kneecap does not require surgery, your physician will likely immobilize your leg in a cylindrical long leg cast or, in rare cases, a knee immobilizer for [iskinstitute.com]

  – Knee should be immobilized for 3 to 6 weeks in a long leg cast at 10degrees flexion for both partial and complete patellectomy. 17. Patella Knee Support • Fig 18. Cont.. • Open reduction and internal fixation for transverse fracture 19. [slideshare.net]

  Recommend immobilization in extension either with a long-leg cast or knee immobilizer. (Berry DJ. Patellar fracture following total knee arthroplasty. [eorif.com]

• Anterior Knee Pain

  Patellofemoral syndrome; Chondromalacia patella; Runner's knee; Patellar tendinitis; Jumper's knee Anterior knee pain is pain that occurs at the front and center of the knee. [mountsinai.org]

  Pain, swelling and knee deformity. [radiopaedia.org]

  From the time of the original fixation she had experienced mild persistent anterior knee pain, with a reduced range of motion and grinding. She had been discharged from further follow up. [bjmp.org]

• Suggestibility

  Your physical therapist may also suggest you include manageable stretching and strengthening moves in your home routine in among sessions. [hydroactive.ca]

  CONCLUSIONS: These data suggest that high-energy trauma often results in a comminuted patellar fracture, which is often combined with cruciate ligament injury. Traffic accidents are the main risk factor for this combined injury. [ncbi.nlm.nih.gov]

  Pale cool foot or pins and needles in the foot suggest neurovascular compromise. The tibial plateau is made of cancellous bone, which has a honeycombed appearance and is relatively soft. [patient.info]

  The initial radiographs demonstrated that she had broken hardware and an incongruency of the patella suggesting malunion on the articular surface with a residual step (figure 1). [bjmp.org]

• Irritability

  Suture fixation for pole patella fractures provides reliable fixation and reduces the risk of postoperative complications secondary to hardware irritation. This case highlights the success of this technique. [ncbi.nlm.nih.gov]

  Complications Soft tissue irritation from harware - Subcutaneus location of hardware and large joint range of motion lends itself to soft tissue irritation. This may necessitate hardware removal post fracture healing. [orthopaedicsone.com]

• Unable to Walk

  Diagnosis: The patient is usually unable to extend the knee fully against resistance and is unable to walk. Bruising and swelling occurs on the front of the knee. [hip-knee.com]

  […] to walk.[1] Complications may include injury to the tibia, femur, or knee ligaments.[2] It typically results from a hard blow to the front of the knee or falling on the knee.[1] Occasionally it may occur from a strong contraction of the thigh muscles [en.wikipedia.org]

  The patient will be unable to walk with a broken knee cap or put weight on or lift the knee area, although the ankle and toes can normally be moved as usual, except if there is injury to the neuro-vascular system in addition to the knee cap. [ctikneebraces.co.uk]

A patella fracture usually manifests with intense knee pain and a medical history involving a direct blow to the kneecap, an indirect strain, such as the one sustained by a fall, or a combination of these forces. Dislodged bone may be observable with a bare eye, especially in the cases of open fractures.

The first step towards evaluating a potential patella fracture is radiographic imaging. X-rays obtained from a lateral, anteroposterior and axial perspective are widely used to provide critical information about the skeletal structures underneath tissue. Radiographic depiction assesses the direction of the fracture, its type, possible comminution and other important features. Magnetic Resonance Imaging helps to evaluate osteochondral fractures, sleeve fractures [8] and generally fractures that prove difficult to characterize with other than MRI examinations.

A patient also needs to be evaluated for the presence of hemarthrosis and damage to the extensor mechanism, namely the medial and lateral retinacula. A potentially impaired joint can be aspirated, which will help diagnose hemarthrosis or a joint effusion; the latter leads to the aspiration of fluid containing fat globules. Lidocaine can be administered intra-articularly, in order to reduce the pain and allow for a more extensive examination of the patient's ability to extend the knee against gravity.

Fractures that do not involve displacement respond to conservative treatment at a rate of nearly 90%. The patient does not benefit from any surgical intervention and is treated with a cylinder cast that is kept for 4 to six weeks, depending on the specific characteristics of the fracture. An assessment is carried out after the initial period has passed and is sign of healing are evident, the cast is removed and the patient is required to use a removable brace. the decision of cast discontinuation is based on the results of the clinical examination (painless knee, even when palpated) and radiologic findings which are compatible with union.

Gradual strengthening of the arthrosis should be attempted alongside physiotherapy to restore the range of movement. A patient can stop using a removable brace when they are able to flex their knee joint over 90 degrees and raise their leg freely against gravity.  

Fractures that involve displacement do not benefit from conservative treatment and require surgical intervention instead. The precise technique is decided depending on the particular characteristics of each fracture and greatly depends on whether it is an open fracture, if arthrotomy has been sustained and if ligaments will have to be repaired as well. At any case, a thorough examination and detection of the damage is mandatory before deciding upon the best surgical treatment. A widely used surgical technique generally involves the conversion of tensile force into a compressive one, with the use of a tension band, thereby helping the patella to regain continuity faster [9] [10]. Open fractures are operated as an emergency condition.

Antimicrobial treatment is also administered prophylactically before a patella reconstructive surgery. In a case of open wound, further antibiotics are introduced into the therapeutic scheme. Tetanus shots are also mandatory if a wound is open. An orthopedic surgeon should always consider the possibility of infection before proceeding to surgery and treat it appropriately.

Surgical intervention is expected to result in a successful repair of patella continuity and functionality. The more extensive the damage sustained by the structure, the more time it will require to reach a stage of complete recovery; even less severe traumatizations can result in significant complications, such as patellofemoral arthrosis [5]. 10-20% of the patients who undergo open reduction internal fixation also experience displacement of the patella segments following surgery, which is believed to be the case when the separated parts are not fixed together properly by a surgeon [6]. Hardware prominence is also possible in some cases.

In general, the patella is an anatomical structure that is susceptible to injuries, due to the fact that it is located subcutaneously and is therefore not as protected from extreme forces as other structures are. There are three possible causes of a patella fracture:

• Direct force
• Abrupt tensile force
• A combination of the above

Direct force exerted on the patella usually produces a comminuted fracture, as the regional anatomical structures are obliged to absorb the force. This may result in the traumatization not only of the patella, but of the cartilage and femoral condyles as well.

Should the patella sustain tensile-type force, such as the type sustained when the quadriceps contact violently in hyperflexion, the most common fracture acquired is a nondisplaced fracture. Lastly, if the traumatization is a result of the two forces combined, fractures of various types can occur, i.e. tansverse, displaced fractures that become comminuted at a later stage.

Patella fractures represent 1% of all traumatizations sustained by the skeleton.

The patella is a small triangular bone which covers the joint between the femoral bone and tibia. The conjoined tendons of the four quadriceps muscles, known as the quadriceps tendon encases the structure and assumes the function of the patella tendon. The forces sustained by the patella when the quadriceps muscles contact are able to strain the former at such an extent that an indirect fracture can occur.

The vastus medialis is one of the four quadriceps muscles of the thigh, which function in unison. Its tendon is extended to form the medial patellar retinaculum, which is itself linked to the upper-and-towards-the-midline part of the patella. Respectively, the lateral patellar retinaculum is formed by the last part of the vastus lateralis and is also attached to the patella. The lateral and medial retinacula are responsible for a person's ability to flex the knee, an ability that is preserved if both structures are unharmed after an injury.

Patella fractures are a result of direct forces exerted on the patella or indirect forces induced by the surrounding tendons. Typically, indirect fractures are a result of abnormal or excessive knee flexion. If a major fall occurs for example, the joint is forced to absorb great pressure, which will result either in the rupture of the tendons or in a transverse patella fracture [2]. Displacement is a frequent finding is these types of fractures, whereas direct traumatization induces a comminuted fracture, articular traumatization and, most likely, open fractures [3]. Both types of forces may be exerted, which cause bone displacement alongside tissue traumas.

Regarding the regional perfusion, the three largest branches of the geniculate artery are responsible for providing the knee with the required volume of blood. Since the superior and inferior medial geniculate arteries penetrate the knee joint, a patella fracture may severely compromise the knee blood supply, leading to an avascular necrosis [4].

In order to prevent a patella fracture, one should regularly exercise, giving emphasis to the strengthening of the knees: surrounding muscles are able to protect the patella if a person maintains good physical status. Suitable protection like kneepads are required, if one participated in a sport likely to cause knee injuries.

The patella bone is otherwise known as the "kneecap" bone. It is a structure located in the front part of the joint of the knee, at the point where the femoral bone and the tibia are joined together. The joint itself alongside the part of the patella that lies above it are enclosed by the articular cartilage, which lubricates the structures in order to allow for smoother motion, minimal friction and damage to the bones.

The patella can sustain various types of fractures. Depending on their morphology, primary patella fractures are divided in transverse, vertical, osteochondral, sleeve and marginal [1], with the fracture located at the top, lower part or center of the patella.

Depending on the severity of the fracture, it can be stable, displaced, comminuted or open. Stable fractures are those whereby the two separated parts remain in place and correct alignment. In a displaced fracture, alignment is impaired and surgical intervention is necessary before the bone starts to heal. On the other hand, comminuted fractures involve shattering of the patella into 3 pieces or more. Finally, open fractures are the severer type: the bone has torn out of the skin and adjacent structures have also sustained massive damage.

A patella fracture is an injury to the patella, commonly known as the kneecap. A fracture can have various degrees of severity and may also be accompanied by damage to the surrounding ligaments, muscles and tendons.

Patellar fractures are sustained in three different ways. the first one involves a direct blow to the patella, usually forceful. the second one is an indirect mechanism, whereby the patella is injured when the thigh muscles contract very violently; the quadriceps (thigh muscles) are connected to the kneecap, so their abrupt and violent contraction strains the patella to such an extent, that a fracture can occur. This can happen when falling from a considerable height. The third mechanism involves a combination of the two aforementioned ways.

Typical symptoms include knee pain, regional tenderness and swelling, knee bruises, inability to extend ones knee, defects visible with a bare eye (bone protruding, dislodged patellar pieces) and numbness. A patella fracture is diagnosed with the help of an x-ray obtained at different angles, possibly an MRI and a thorough physical examination.

Patella fractures may be treated both surgically and non-surgically, depending on the case. Generally, fractures where the patella has broken but all the damage is minimal and the segments still remain in their original place does not need surgery. The patient initially wears a cast for 1-1.5 month and then, if recovery is proceeding, discontinues the cast use and starts to wear a removable brace. Gradually, a person regains their ability to flex the knee and perform a fully-ranged knee motion. Fractures where the bone segments are out of place need to be operated on, in order to reconstruct the patella or remove some of the pieces that cannot be placed in their right position.

Antibiotic treatment is administered before and shortly after surgery, in cases of bone exposed through the skin, or, generally, when infection is clinically evident.

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