Patellar Fracture

What is a patellar fracture?

A patellar fracture is a break in your kneecap.

What are the types of patellar fractures?

• Nondisplaced: The broken pieces stay in line.
  
  
• Displaced: The broken pieces move out of line.
  
  
• Open fracture: There is a break in the skin that covers the kneecap.
  
  
• Closed fracture: There is no break in the skin.

What causes a patellar fracture?

• Direct trauma: A car accident or a sports injury are examples of direct trauma. A direct blow to your knee or a hard fall on your knee are also examples of direct trauma.
  
  
• Indirect trauma: A strong contraction (tightening) of the thigh muscles when the knee is bent is an example of indirect trauma. This contraction pulls the tendon connected to the kneecap, which breaks the kneecap.

What increases my risk of a patellar fracture?

If you had total knee replacement surgery, you are more likely to have a patellar fracture. This is because your knee is less stable after knee replacement surgery. Osteoporosis (brittle bones) or arthritis also increases your risk.

What are the signs and symptoms of a patellar fracture?

• You have pain when your knee is touched or when you move your leg.
  
  
• You have swelling and bruising around your knee.
  
  
• You are able to straighten your leg but you cannot bend it.
  
  
• You cannot stand up or put weight on your injured leg.

How is a patellar fracture diagnosed?

Your caregiver will ask you about the injury and examine you. He may check if the bone pieces are in their correct places by feeling your knee. You may need any of the following tests:

• X-ray: This is a picture of your knee to see what kind of fracture you have. More than one picture may be taken. Caregivers may also x-ray your other leg.
  
  
• CT scan: This is also called a CAT scan. An x-ray machine uses a computer to take pictures of your knee. You may be given dye in your IV to help your caregivers see the images better. Tell the caregiver if you are allergic to dye, iodine, or seafood.
  
  
• MRI: This scan uses powerful magnets and a computer to take pictures of your knee. You may be given dye in your IV to help your caregivers see the images better. Tell the caregiver if you are allergic to dye, iodine, or seafood. Do not enter the MRI room with anything metal. Metal can cause serious injury. Tell caregivers if you have any metal in or on your body.
  
  
• Bone scan: This is a test to look at your patellar fracture and check for infection. You will get a radioactive liquid, called a tracer, through a vein in your arm. The tracer collects in your bones and pictures are taken.

How is a patellar fracture treated?

• Brace, cast, or splint: These are supportive devices that stop the kneecap from moving and help it heal. They often extend from the groin to the ankle. You may also need to use crutches to help you move around while your knee heals.
  
  
• Medicines:
  
  
  • Pain medicine: You may be given medicine to take away or decrease pain. Do not wait until the pain is severe before you take your medicine.
    
    
  • Antibiotics: These medicines help fight or prevent an infection. They are usually given if you have an open fracture.
    
    
  • Td vaccine: This vaccine is a booster shot used to help prevent diphtheria and tetanus. You may need the Td vaccine if you have an open patellar fracture.
  
  
• Surgery:
  
  
  • Irrigation and debridement: This procedure is done to clean and remove objects, dirt, or dead tissue from the fracture area.
    
    
  • Open reduction and internal fixation: During this surgery, caregivers make a large incision over your kneecap. The broken pieces of bone and ligaments are moved back to their correct places. Bone pieces and ligaments may be secured using wires, pins, screws, or bands.
    
    
  • Closed reduction: During this surgery, caregivers move the broken pieces of bone and ligaments back to their correct places without a large incision. External fixation may be used to hold your kneecap in place, and then later removed.
    
    
  • Patellectomy: During a partial or complete patellectomy, part or all of your kneecap is removed.
  
  
• Physical therapy: You may need to see a physical therapist to teach you special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your risk for loss of function.

What can I do to help my patellar fracture heal?

• Elevate: Raise your knee above the level of your heart as often as you can. This will help decrease swelling and pain. Lie down and rest your leg on pillows.
  
  
• Ice: Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack or put crushed ice in a plastic bag. Cover the ice pack with a towel and place it on your knee or supportive device for 15 to 20 minutes every hour for 2 days.

What are the risks of a patellar fracture?

• Your leg may get stiff if you wear a supportive device. You may still have knee pain, even after treatment. You knee may not look like it did before the injury. You may need to have surgery again. Even after surgery, the broken pieces of bone or the hardware may move out of place. You can get an infection. You are at higher risk of osteoarthrosis (cartilage loss) in your knee after surgery.
  
  
• You may get a blood clot in your leg. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. A blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening.
  
  
• Without treatment, your kneecap may not heal correctly. You may have pain or weakness, or you may get an infection. You may not be able to move your leg as well as you did before your injury.

When should I contact my caregiver?

Contact your caregiver if:

• You have a fever.
  
  
• Your wound is red, swollen, and feels warm.
  
  
• You have pus coming from your wound.
  
  
• Your knee pain is getting worse, even after treatment.
  
  
• You have questions or concerns about your condition or care.

When should I seek immediate care?

Seek care immediately or call 911 if:

• Your cast or splint breaks or gets damaged.
  
  
• Your foot or toes are swollen, cold, numb, or they turn white or blue.
  
  
• Blood soaks through your bandage.
  
  
• Your leg feels warm, tender, and painful. It may look swollen and red.
  
  
• You suddenly feel lightheaded and have shortness of breath.
  
  
• You have chest pain. You may have more pain when you take a deep breath or cough. You may cough up blood.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Learn more about Patellar Fracture