Fracture of the patella is of various types. Usually, the process is accompanied by swelling of the leg and pain, which intensifies with flexion and extension of the lower leg. With this type of joint damage, the patient cannot move.
Patella anatomy
The patella is a flat, rounded bone that sits on the front of the knee joint . The tendons of the quadriceps muscle located in the thigh are attached to the upper part of the patella. Also, attachment is carried out to the lower own ligament of the patella. Outside and inside, the bone adheres to the lateral ligaments.
The smooth surface of the patella located inside adjoins the surface located above the knee. The outer surface is rough. It is covered with tendon fibers. The patella serves as a knee protector for bumps and injuries.
The main types of fractures
It is customary to distinguish the following types of fractures:
- Fracture of the patella without displacement. It is characterized by the fact that parts of the damaged bone, not shifting, are adjacent to one another. With injuries of this type, the bone remains in place throughout the course of therapy.
- Fracture with the presence of displacement. It is characterized by the displacement of the parts of the broken patella relative to each other. In the vast majority of cases, surgical intervention is required to reunite the fragments.
- Fracture with the presence of many fragments. It is characterized by the fact that the patella is fragmented into more than three fragments. This fracture is considered the most severe and requires long-term therapy.
Open and closed fracture forms
Fracture of the patella is divided into open and closed type.
With a closed fracture, the skin at the fracture site is not damaged. She stays whole.
With the open type, there is a strong violation of the structure of the skin, from which the fragmented bone is visible. In addition, the open type causes serious disturbances in the structure of nearby ligaments, tendons and muscles.
How does a fracture occur?
Usually a fracture of the patella is the result of a direct injury when falling on the knee in a bent state or when it is struck by a sharp or hard object. An indirect type of injury is possible with a sudden contraction of the quadriceps femoris.
A mixed-type mechanism is distinguished, in which a fracture occurs when a combination of elements of direct and indirect damage occurs.
Fracture of the patella is often combined with damage to the bending apparatus located on the side (tendon fibers of the quadriceps muscle located in the thigh).
When the tendons rupture, a discrepancy of bone fragments in the patella is noted.
Symptoms of Damage
How does a fracture of the patella manifest itself?
Symptoms are as follows:
- If the knee is damaged , severe swelling in the knee joint area is manifested.
- On palpation, sharp pain is detected, the presence of a gap between the fragments is noted, hemarthrosis occurs (spilled blood in the knee joint).
- Often revealed pathological mobility and the presence of crepitus (crunching) of bone fragments.
- Pain when trying to bend the knee is sharp. Active extension is impossible or becomes sharply limited.
- With an injury without displacement, the patient does not lose the ability to walk, however, movements are accompanied by sharp pain.
- Fracture of the patella with the presence of displacement makes walking impossible. Also, the patient cannot raise the limb in a straightened state and produce active joint movements.
Trauma diagnosis
Diagnosis of a fracture is carried out by a trauma doctor based on the clinical picture that is characteristic of this type of lesion. Also actively used are the data obtained by x-ray examination.
Additional methods for diagnosing injury are magnetic resonance imaging of the affected joint. Hemarthrosis is confirmed by diagnostic puncture of the joint.
Differential diagnosis
A fracture of the patella of the knee joint is differentiated from a rupture of the ligament of the patella, a rupture in the quadriceps tendon, as well as the presence of arthritis of a traumatic nature or prepatellar bursitis. In all of the above cases, there is no trace of a gap between bone fragments.
A fracture of the patella has to be distinguished from the abnormal development of the joint (divided patella). Unlike a fracture, with this pathology there is no trauma and sharp pain. The gap between bone fragments is even and smooth. As a rule, such an ailment is detected on both sides.
Treatment
The choice of a specific method of therapy depends on two main indicators: the nature of the fracture and the type of displacement of the fragments.
Fractures are stable and unstable. With a stable form, a tendency to shift is observed. An unstable form suggests fractures in which the bones have already displaced or may displace after some time.
Principles of Conservative Therapy
Many are interested in how a kneecap fracture is treated. Treatment in the presence of an offset of more than 0.5 cm is carried out by a conservative method. To carry out such therapy, local anesthesia of the fracture is first performed by administering anesthetics.
The affected limb is fixed by means of a gypsum tire. The patient is allowed to move on crutches. After removing the tire, it is recommended to carry out massage procedures, physical therapy exercises. Physiotherapeutic procedures are also carried out (electrophoresis, magnetic laser, etc.).
In the absence of displacement, the damaged limb is fixed in a straightened state. A splint of gypsum is applied to the upper thigh to the ankle. As a rule, the duration of such fixation is 4-6 weeks. Conducted control radiographs.
Conservative treatment involves prolonged immobilization of the joint, the development of which is a long and painstaking process.
Surgical intervention
According to traumatologists, a fracture of the patella with a shift of the patellar fragments by more than 2 mm requires an operation, during which the fragments are compared, the joint surface is restored and the patella is fixed. Elimination of such a condition without a surgical method is impossible.
With surgical intervention, different methods can be used using a suture of soft tissues, a bone suture and a tendon muscle plasty.
The Berger-Schultze operation, during which the fragments are brought together, followed by the flashing of nearby patella tissue, became a method that has become especially popular. The duration of immobilization after surgery is 1 month. After removing the tire from gypsum, massage, physiotherapy and therapeutic exercises are prescribed.
In fractures with the presence of many fragments and the inability to restore the patella, excision surgical procedures are used, which involve the removal of fragments of the bone or patella.
If it is possible to preserve the joint, then such operations are not recommended.
How quickly is a patella fracture treated? The timing of treatment depends on the degree of fragmentation of the joint. As a rule, disability recovery occurs in 2 months. If blood has collected in the joint, then it must be removed by puncture of the patella. With simple forms of fractures, complete recovery, as a rule, occurs in 3 months.
Rehabilitation and physiotherapy
After removing the tire from gypsum, it is necessary to undergo restoration measures, which include a set of special physical exercises, exercise therapy, as well as massage. It is important that all rehabilitation measures, their frequency are determined by the attending physician.
An important role is played by the systematic execution of exercises, since they serve as an excellent way to develop a damaged joint.
The set of exercises used may look something like this:
- A healthy leg is wound under a damaged leg, active movements are carried out in a circle in the knee joint.
- The patient is standing near the wall. Behind him is a large ball with which squats are performed.
- Walking along the treadmill in the opposite direction. Speed should be no more than 2 km per hour.
- A set of exercises is performed on an exercise bike with pedals no more than 10 cm long. The seat must be positioned so that the injured leg can be fully extended.
- Jumps on the injured leg. In this case, the absence of pain is an important condition.
Possible complications
What are the consequences of a fracture of the patella? It should be noted that with a conservative method of treatment, the risk of abnormal bone fusion in the knee joint is very high, which, in turn, can impair its functionality and lead to the development of such severe pathological conditions as gonarthrosis or osteoarthritis of the patella.
Conclusion
Fracture of the patella is a serious injury. It should be noted that such a condition appears quite rarely. As a rule, fragmentation occurs during strong impacts or accidents. If such a pathology occurs, you should seek help from a traumatologist as soon as possible. With proper diagnostic procedures, the doctor will be able to determine the degree of joint damage and select the appropriate treatment tactics.