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Patellar Fracture In Children


What is a patellar fracture in children?

A patellar fracture is a break in your child's 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 in children?

  • Direct trauma: A car accident or a sports injury are examples of direct trauma. A direct blow to your child's knee or a hard fall on his 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 are the signs and symptoms of a patellar fracture in children?

  • Your child has pain when his knee is touched or when he moves his leg.
  • Your child has swelling and bruising around his knee.
  • Your child cannot stand up or put weight on his injured leg.
  • Your child cannot raise his leg when he is lying down.

How is a patellar fracture in children diagnosed?

Your child's healthcare provider will ask about the injury and examine your child. He may check if the bone pieces are lined up by feeling your child's knee. Your child may need any of the following tests:

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

How is a patellar fracture in children treated?

  • Brace, cast, or splint: These are supportive devices that stop your child's kneecap from moving and help it heal. They often extend from the groin to the ankle. He may also need to use crutches to help him move around while his knee heals.
  • Medicines:
    • Pain medicine: Your child may be given medicine to take away or decrease pain. Do not wait until the pain is severe before you give your child his medicine.
    • Antibiotics: These medicines help fight or prevent an infection. They are usually given if your child has an open fracture.
    • Td vaccine: This vaccine is a booster shot used to help prevent diphtheria and tetanus. Your child may need the Td vaccine if he has 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, healthcare providers make a large incision over your child's 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, healthcare providers 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 child's kneecap in place, and then later removed.
    • Patellectomy: During a partial or complete patellectomy, part or all of your child's kneecap is removed.
  • Physical therapy: Your child may need to see a physical therapist to teach him special exercises. These exercises help improve movement and decrease pain. Physical therapy can also help improve strength and decrease your child's risk for loss of function.

What can I do to help my child's patellar fracture heal?

  • Elevate: Help your child raise his knee above the level of his heart as often as he can. This will help decrease swelling and pain. Have him lie down and rest his 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 child's knee or supportive device for 15 to 20 minutes every hour for 2 days.
    Ice and Elevation

What are the risks of a patellar fracture?

  • Your child's leg may get stiff if he wears a supportive device. He may still have knee pain, even after treatment. His knee may not look like it did before the injury. He may need to have surgery again. Even after surgery, the broken pieces of bone or the hardware may move out of place. He can get an infection.
  • Without treatment, your child's kneecap may not heal correctly. It may be permanently displaced. This can affect how your child walks. His leg muscles may weaken, which can limit your child's activities.

When should I contact my child's healthcare provider?

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

When should I seek immediate care?

  • Your child's cast or splint breaks or gets damaged.
  • Your child says that his foot or toes feel numb.
  • Your child's foot or toes are swollen, cold, or turn white or blue.
  • Blood soaks through your child's bandage.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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Further information

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