The knee joint consists of three bones: the femur, tibia and patella. The latter, because of its location, is the one that runs a greater risk of fracture in case of trauma. This fracture is a serious injury that can limit or even prevent movement.
What are the characteristics of the fracture of the patella and how do you intervene in its presence? We talk about it with Dr. Andrea Bruno, orthopedist and traumatologist at Humanitas.
The kneecap may fracture in the event of a fall on the front of the knee, perhaps bent, as can happen while climbing stairs, another example is the so-called trauma from the dashboard, when during a road accident the driver slams the bent knee against the internal structure of the car, thus fracturing the kneecap.
How is the diagnosis made?
An X-ray is an examination that allows the patella fracture to be diagnosed and its characteristics to be identified.
The fracture can be transversal, with a line that runs horizontally on the front of the bone; comminute, or plurifragmentary, as if it were a star, with a central point of impact and the rhymes of fracture that radiate on the surface; longitudinal, which occurs more rarely.
The fracture can then be composed, when the bone fragments remain in contact or are spaced one to two millimeters apart, or decomposed, when the contact between the bone fragments is lost.
The fracture can also occur with a skin lesion, swelling and significant blood spillage inside.
In the light of the results of the X-ray, it is decided how to proceed in terms of treatment.
“In general, surgery is performed, particularly when the patella fracture is complete and therefore affects the entire thickness of the bone. It should be noted that the patellar and quadricepital tendons, which make up the extensor apparatus of the knee, join the patella. This brings up the proximal bone fragment while the distal one remains fixed to the tibia thanks to the patellar ligament. Hence the inability of the subject to maintain an upright position”, emphasizes Dr. Bruno.
Surgery is indicated for broken fractures, which are the most frequent, while if the fracture is composed you can resort to a conservative operation with plaster: this will help to maintain contact of bone fragments during healing.
“Traumas from a car accident, in particular, can also cause injury to the ligaments, especially the cruciate ligaments. However, these injuries will be treated later because healing the patellar fracture is the priority,” the specialist points out.
The rehabilitation process
Once the fracture has healed, it will be necessary to define a rehabilitation pathway in order to allow the patient to recover joint mobility, muscle reinforcement (which may have been affected by forced immobility) and reduction of joint stiffness.
After surgery or treatment with plaster, the doctor will ensure that the patient can gradually rest his body weight on the leg affected by the fracture. “It will take at least two to three months to be able to return to daily activities, for example, to restart physical activity,” says Dr. Bruno.
The fracture of the patella can also be associated with some complications: “A form of post-traumatic arthrosis may develop due to the involvement of the patellofemoral cartilage, especially if the fracture is multifragmentary. In addition, the patient may experience a form of chronic pain and inflammation, stiffness, and joint scabs,” concludes Dr. Bruno.