The patella (kneecap) is one of 3 bones that make up the knee joint. It runs in a groove at the end of the femur (thigh bone) and is covered by very thick articular cartilage on its undersurface.
It has a very important function with the ability to straighten the knee.
A patella fracture is a break in the kneecap.
It occurs most often from a fall directly onto the kneecap.
X-ray of a broken kneecap (fractured patella)
Symptoms
These can include:
- Pain
- Swelling and tenderness
- Bruising
- Inability to extend the knee
- Inability to walk
- If the fracture is completely across the patella a gap may be felt in the knee-cap
Causes
The cause of a fractured patella are either direct injuries (eg falling on the knee) or indirect injuries (eg sudden contraction of the quadriceps muscle). This most commonly occurs in males between the ages of 20-50 years old.
Risk Factors
These can increase your chance of a patella fracture:
- Advanced age
- Postmenopause
- Decreased muscle mass
- Osteoporosis (decreased bone mass)
- Participation in contact sports (eg, football, soccer)
- Obesity, which places strain on muscles, bones, tendons, and ligaments
- Violence, such as car or car-pedestrian accidents
Investigations
X-rays can be performed to determine if you have a Fractured Patella.
Complications
These include:
- Stiffness of your knee
- Infection if there is an open wound
- Increased chance of osteoarthritis
Treatment
Treatment can be either non-surgical or surgical.
Non-surgical
If the patella is not badly injured, your doctor will place the knee in a cast . This cast may need to be worn for six weeks. After that, you will wear a knee brace and do physical therapy. You may need to use a cane or a crutch .
Your doctor may recommend pain medication to reduce pain and swelling.
Surgical
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—The doctor uses pins and screws to put the broken pieces back together.
- Patellectomy—The doctor removes part of the kneecap or the entire kneecap. They may
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.
Seeking Advice
Your Family Doctor (GP)
Your Family Doctor will be able to diagnose and help treat your problem. He or she will be able to
- tell you about your problem
- advise you of the best treatment methods
- prescribe you medications
- and if necessary, refer you to Specialists (Consultants) for further treatment
Prevention
As this is usually caused by trauma some form of protective padding over the knees can be helpful. This is especially true for those people who engage in activities and sports that might lead them to fall on their knees, such as skateboarders and handball players.
F.A.Q. | Frequently Asked Questions
How long does the fracture take to unite?
4-6 weeks
How can knee stiffness be prevented?
Stiffness is seen more in
- knees with arthritis (more age)
- fractures with multiple pieces
- fractures requiring removal of part or whole of patella
- immobilization in a plaster cast after surgery
The best way to prevent stiffness is to fix the fracture securely allowing early mobilization of the knee after surgery and start physiotherapy regularly.
How long does it take to reach the activity and strength level as before the fracture?
It can take 8 months to a year to reach the the pre-fracture level without physiotherapy.
If you want to return quickly to the pre-fracture level of activity following a patella fracture you need intensive physiotherapy at home or at a physiotherapy center.