KNEECAP (PATELLA) FRACTURE |
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General Information
DEFINITION--A complete or incomplete break in the upper or lower portion of the patella (kneecap). Most fractures of the patella are accompanied by sprain or rupture of ligaments or tendons attached to the patella.
BODY PARTS INVOLVED
Patella.
Knee joint.
Soft tissue surrounding the fracture site, including nerves, tendons, ligaments and blood vessels.
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SIGNS & SYMPTOMS
Severe pain at the fracture site.
Pain when moving the knee forward or backward.
Swelling around the fracture.
Visible deformity if the fracture is complete and bone fragments separate enough to distort normal knee contours.
"Catching" or locking of the knee.
Tenderness when pressing the kneecap against underlying bones.
Numbness and coldness beyond the fracture site if the blood supply is impaired.
CAUSESDirect blow or indirect stress to the kneecap. Indirect stress may be caused by twisting or violent muscle contraction.
RISK INCREASES WITH
Contact sports, especially football.
History of bone or joint disease, especially osteoporosis.
Obesity.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia is needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENT
Build adequate muscle strength and achieve good conditioning prior to exercise, athletic practice or competition. Increased muscle mass helps protect bones and underlying tissue.
Use appropriate protective equipment, such as knee pads, when participating in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment to manipulate and set the broken bones.
Hospitalization (sometimes) for anesthesia and surgery to remove the fractured piece of bone and repair the damage to soft tissue.
Whirlpool, ultrasound or massage after healing (to displace fluid from the injured joint space).
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the knee joint.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels or connective tissues. AFTER TREATMENT OR SURGERY:
Delayed union or non-union of the fracture.
Impaired blood supply to the fracture site.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Arrest of normal bone growth in children.
Infection in open fractures (skin broken over fracture site), or at the incision if surgical setting was necessary.
Proneness to repeated knee problems. After healing, the fracture often leaves a roughened contact surface in the kneecap.
Unstable or arthritic knee following repeated injury.
Prolonged healing time if activity is resumed too soon.
Problems caused by casts. See Appendix 2 (Care of Casts).
PROBABLE OUTCOMEThe average healing time for this fracture is 6 to 8 weeks. Healing is considered complete when there is no motion at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing, if possible. Don't move the injured knee to remove clothing.
Use a padded splint to immobilize the hip joint and the ankle joint before transporting the injured person to the doctor's office or emergency facility.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will realign and set the broken bones with surgery or, if possible, without. Manipulation should be done as soon as possible after injury. Six or more hours after the fracture, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CARE
Immobilization will be necessary. A rigid cast will be used from the upper leg to the ankle.
After the cast is removed, use frequent ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments or ointments.
Take whirlpool treatments, if available.
MEDICATIONYour doctor may prescribe:
General anesthesia or local anesthesia for surgery to remove fractured patella fragments.
Narcotic or synthetic narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to inactivity.
Acetaminophen (available without prescription) for mild pain after initial treatment.
ACTIVITY
Actively exercise all muscle groups not immobilized. The resulting muscle contractions promote fracture alignment and hasten healing.
Resume normal activities gradually after treatment. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATIONBegin reconditioning the injured knee after clearance from your doctor. See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have signs or symptoms of a kneecap fracture.
Any of the following occur after surgery or other treatment:
Increased pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
Nausea or vomiting.
Swelling above or below the cast.
Blue or gray skin color beyond the cast, particularly under the toenails.
Numbness or complete loss of feeling below the fracture site.
Constipation.
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