Patella fracture

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Patella fracture
Other namesBroken kneecap
Fracpetella.PNG
A fracture of the patella seen on a lateral view
SpecialtyOrthopedics
SymptomsPain, swelling, bruising to front of the knee[1]
ComplicationsInjury to the tibia, femur, or knee ligaments[2]
TypesStable, displaced, comminuted, open[1]
CausesTrauma to the front of the knee[1]
Diagnostic methodBased on symptom, confirmed with X-rays.[3]
Differential diagnosisBipartite patella[3]
TreatmentCasting, splinting, surgery[2]
PrognosisGenerally good with treatment[2]
Frequency~ 1% of fractures[3]

A patella fracture is a break of the kneecap.[1] Symptoms include pain, swelling, and bruising to the front of the knee.[1] A person may also be unable 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.[1] Diagnosis is based on symptoms and confirmed with X-rays.[3] In children an MRI may be required.[3]

Treatment may be with or without surgery, depending on the type of fracture.[2] Undisplaced fracture can usually be treated by casting.[2] Even some displaced fractures can be treated with casting as long as a person can straighten their leg without help.[2] Typically the leg is immobilized in a straight position for the first three weeks and then increasing degrees of bending are allowed.[2] Other types of fractures generally require surgery.[2][4]

Patella fractures make up about 1% of all broken bones.[3] Males are affected more often than females.[3] Those of middle age are most often affected.[3] Outcomes with treatment are generally good.[2]

Sign and symptoms

The presentation for patella fracture is as follows:[5]

Cause

The cause of a patellar fracture is as follows:[6]

Diagnosis

A vertical patella fracture with the fracture line marked by a black arrow

Diagnosis is based on symptoms and confirmed with X-rays.[3] In children an MRI may be required.[3]

Treatment

Treatment may be with or without surgery, depending on the type of fracture.[2]

Conservative

Undisplaced fracture can usually be treated by casting.[2] Even some displaced fractures can be treated with casting as long as a person can straighten their leg without help.[2] Typically the leg is immobilized in a straight position for the first three weeks and then increasing degrees of bending are allowed.[2]

Surgery

Patellectomy (in cases of comminuted fracture) is removal of the entire patella[7], whereas a partial patellectomy is removal of only a portion of the patella[8][9]. The fracture may require tension band wiring (in case of two part fracture) to unite the fractured bones. [9]:1765

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 "Patellar (Kneecap) Fractures". OrthoInfo - AAOS. January 2017. Archived from the original on 16 October 2017. Retrieved 16 October 2017.
  2. 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 Kakazu, R; Archdeacon, MT (January 2016). "Surgical Management of Patellar Fractures". The Orthopedic Clinics of North America. 47 (1): 77–83. doi:10.1016/j.ocl.2015.08.010. PMID 26614923.
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Abbasi, David. "Patella Fracture - Trauma". Orthobullets.com. Archived from the original on 17 October 2017. Retrieved 16 October 2017.
  4. Melvin, JS; Mehta, S (April 2011). "Patellar fractures in adults". The Journal of the American Academy of Orthopaedic Surgeons. 19 (4): 198–207. doi:10.5435/00124635-201104000-00004. PMID 21464213.
  5. Sueki, Derrick; Brechter, Jacklyn (2009). Orthopedic Rehabilitation Clinical Advisor - E-Book. Elsevier Health Sciences. p. 592. ISBN 978-0-323-07252-6. Retrieved 14 January 2021.
  6. Scuderi, Giles R. Techniques in Revision Hip and Knee Arthroplasty E-Book: Expert Consult. Elsevier Health Sciences. p. 240. ISBN 978-1-4557-3732-1. Retrieved 14 January 2021.
  7. Gunal, I; Karatosun, Vasfi (August 2001). "Patellectomy: An Overview With Reconstructive Procedures". Clinical Orthopaedics and Related Research. 389: 74–78. doi:10.1097/00003086-200108000-00012. PMID 11501826. Retrieved 14 January 2021.
  8. Foy, Michael A.; Fagg, Phillip S. (2011). Medicolegal Reporting in Orthopaedic Trauma E-Book. Elsevier Health Sciences. p. 280. ISBN 978-0-7020-4886-9.
  9. 9.0 9.1 Rockwood, Charles A.; Bucholz, Robert W.; Court-Brown, Charles M.; Heckman, James D.; Tornetta, Paul (2010). Rockwood and Green's Fractures in Adults. Lippincott Williams & Wilkins. p. 1767. ISBN 978-1-60547-677-3. Retrieved 15 January 2021.

External links

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External resources