What is a patellar fracture: symptoms, principles of treatment

Among all limb fractures, one of the most common is a patellar fracture. Its frequency is approximately 2% of the total number of injuries of this kind. The cause of the injury is falling on the knee or receiving a blow to this part of the body.

Sometimes there are indirect fractures that occur due to a sudden spasm of the quadriceps femoris muscle (this is a fairly rare situation). In most cases, transverse and comminuted fractures occur. Regional and longitudinal ones are more rare. The degree of damage affects the direction of displacement of fragments. This factor also depends on the strength of the fibrous aponeurosis.

Anatomy of the knee joint

The patella is located in front of the knee joint.

The patella has two surfaces - the anterior one, which can be directly felt through the skin; posterior or articular, which slides along the femur.

The figure shows the patella - on the left is its anterior surface, which is palpated through the skin; on the right is the articular surface, which is involved in the formation of the knee joint.

The patella is located within the tendon of the quadriceps femoris muscle. The quadriceps femoris muscle is attached to its upper pole, covers the patella on all sides, and a powerful cord comes from the lower pole, which is attached to the tibial tuberosity. It is called the patellar ligament. You can read more about patellar tendon tears here.

Meniscal injuries

Meniscus injury

– one of the popular problems with the knee joint, which occurs with greater frequency in athletes (football players, basketball players, track and field athletes, skiers). This injury is no less common in people who dance, do heavy work, and are artists. Without preliminary mechanical action, damage to the menisci can also occur with arthrosis of the knee joint. The nature of the injuries ranges from small tears to complete ruptures. Often, damage to the meniscus is combined with injury to other structures of the knee.

The acute period is characterized by the following symptoms: pain, swelling, swelling, stiffness of movement. There may be exudate inside the joint. Within three weeks, the symptoms of the inflammatory process disappear, and the signs of meniscus injury become more pronounced. This is expressed in the appearance of a painful cushion at the level of the joint space. The following clinical picture is also recorded: pain when going down the stairs, making circular movements with a bent shin, or the “Turkish” position.

X-rays are not used for diagnosis (only to exclude other damage). Arthroscopy or MRI is usually prescribed. Ultrasound diagnostics of the knee joint is rarely performed. Treatment is prescribed based on the examination results. Small tears can be repaired with therapy. More serious damage can only be eliminated through surgery. Possible operations may include suturing, resection, or complete removal of the menisci. The latter is rarely performed due to the increased risk of arthrosis.

Symptoms of a kneecap fracture

When a kneecap is fractured, the following symptoms are observed:

• The pain is usually very severe and intensifies with movement in the knee joint.
• Swelling – the patella is involved in the formation of the knee joint, so any fractures are considered intra-articular injuries. With a fracture of the patella, as a rule, there is pronounced swelling of the soft tissues of the knee joint and hemarthrosis, that is, accumulation of blood in the knee joint.
• Impossibility of movement - since the patella is involved in the extension of the leg, any contraction of the thigh muscles increases the pain, the leg becomes unable to support.

With palpation, you can determine the retraction at the site of the kneecap fracture.

Conservative treatment of injuries

If we are talking about a minor injury, they resort to conservative treatment methods. First of all, this:

• Therapeutic gymnastics , performing various types of exercises under the guidance of a specialist for the allotted time (as a rule, this is a whole course of exercise therapy - there is no effect from one lesson);
• Physiotherapeutic measures - magnetic therapy, ultrasound, kinesio taping, exercises on special simulators;
• Taking medications.

The doctor will determine which medications will be prescribed and which physiotherapeutic procedures will be used – he will prescribe treatment depending on the severity of the injury and the characteristics of the individual patient’s body.

First aid for a fractured patella.

The first aid for a fracture of the patella is to ensure rest of the leg, cold, and painkillers. It is necessary to provide rest to the leg; this can be done with a plaster cast or any available means.

To confirm the diagnosis, it is necessary to take x-rays in two projections; sometimes an axial projection is required, especially with vertical fractures. Typically, a patellar fracture is clearly visible on x-rays.

The radiograph shows a fracture of the body of the patella without displacement.

The radiograph demonstrated a fracture of the inferior pole of the patella.

Fracture of the patella on the left with displacement of fragments. Surgery required.

Marginal fracture of the patella, clearly visible on an axial radiograph.

Prices for rehabilitation services

Cost of stay from 1500 rub. day.

How is the operation performed?

The operation can be performed using different techniques, depending on the clinical situation. If this is osteosynthesis using screws, it is performed both under general anesthesia and spinal anesthesia. With screw osteosynthesis, an arcuate tissue incision is made in the area of ​​the affected patella; the doctor separates the skin and underlying tissue from the bone area, turns them away, gaining access to the damaged patella. Open osteosynthesis is performed using compression screws with a partial threading area. The design of the screws is selected in such a way that the cutting area does not cross the fracture zone. The screws are inserted from the area of ​​the larger affected fragment.

Previously, channels are drilled in the area of ​​the fragments, which in diameter will correspond to the internal cross-section of the screw. In the area of ​​the canal of the opposite bone fragment, a thread is cut with a tap, and then the screw is screwed into both fragments at once, screwing firmly and forming an area of ​​compression of the fragments. After this, a control x-ray is taken to check the reliability of the bone fixation when bending the knee joint. The joint capsule and skin are sutured, drainage is placed, and a sterile bandage is applied to the wound.

If patellar fragments are fixed using the Weber osteosynthesis method, a drill of 2 mm in diameter is used. They drill two holes at a distance of about 25 mm, making parallel channels. After the first canal is created, before drilling the second, a needle is placed in it so that the doctor can simultaneously create the second canal. The bone fragments are then connected in the correct position, making sure that the articular surfaces on the kneecap are as even and smooth as possible. The fragments must be held in the correct position, then the drill must be inserted into the central fragment, drilling parallel holes in the peripheral one. Knitting needles with curved edges are placed inside these channels; the protruding sections of the knitting needles are wrapped with wire, forming loops and tightening them. The ends of the needles are cut off so that they are immersed in the tissue, then the joint capsule and skin are sutured, and the wound is treated.

Causes

Violation of the anatomical integrity of the cartilaginous and bone parts of the cup, as well as the ligamentous apparatus, occurs due to the influence of various causative factors. Of these, the most common are:

• Road traffic accidents.
• Domestic injuries.
• Industrial injuries.
• Sports injuries.

The mechanism of development of a violation of the anatomical integrity of the knee has certain similarities, regardless of the reason that led to its implementation.

Rehabilitation period

After surgery, you may need a temporary cast or splint for 5-6 weeks. Sometimes bandages are not applied, but walking is allowed only with crutches until the stitches are removed at 10-12 days. Then walking with a cane is acceptable until complete healing.

In our clinic you can get a preliminary consultation with a doctor with an estimate of the cost of knee osteosynthesis. In addition, it is important to take into account the cost of the examination and the preparatory stage, the features of the metal structures, the type of operation and the rehabilitation period. Our doctors perform all types of interventions, have extensive experience and can help restore the joy of movement.

Contraindications

Although the operation is performed quite often and quickly, there are a number of contraindications for its implementation that must be taken into account before the intervention. These include a large volume of affected tissue around the wound, torn, crushed and infected surfaces. In this situation, primary wound treatment (surgical) is first performed, and the osteosynthesis procedure is performed after healing. Surgical intervention is also contraindicated in case of acute infection or exacerbation of chronic pathologies, local inflammatory process with suppuration, severe combined injuries and shock, large blood loss, when the operation is associated with a high risk.

Diagnostics

Diagnostics

• X-ray of the knee in frontal and lateral projection is the most common diagnostic method, which is carried out in a trauma center.
• Ultrasound of the knee joint is a technique that allows you to determine the volume of synovial fluid or blood in the joint cavity.
• Computed tomography or magnetic resonance imaging are techniques that have high resolution and make it possible to visualize even small violations of the anatomical integrity of the knee structures.
• Arthroscopy is a therapeutic and diagnostic research method, the essence of which is to insert an arthroscope (a tube with a camera and lighting) into the cavity of the knee joint to visualize the condition of its internal walls. Arthroscopy is usually used for combined injuries.

Once patellar injuries have been identified, symptoms and treatment are determined individually by an orthopedic traumatologist.

Treatment of patellar luxation

There are several treatment methods.

Conservative treatment

Conservative treatment is used in the case of a single traumatic dislocation without significant damage:

• The doctor uses his hands to reduce and realign the patella using anesthesia.
• The hemorrhage is eliminated through puncture; if necessary, the procedure is repeated.
• To avoid an increase in swelling and for the purpose of pain relief, after reduction it is recommended to apply cold for some time, and, if necessary, take oral anti-inflammatory drugs.
• In the early period of recovery after injury, it is recommended to wear an orthosis or splint.
• Kinesiotherapy, mechanotherapy.
• Physiotherapeutic procedures.

Dynamic loads are prescribed and increased as swelling decreases.

Knee arthroscopy

The operation is performed according to indications. This may be repeated dislocation, damage to ligaments and cartilage, affecting the function of the joint. The operation is gentle, it does not involve a large incision, access is provided by small entrance holes for the arthroscope and surgical instruments. The image from the arthroscope camera is displayed on the screen, and the damaged areas are examined by a specialist. After which all necessary surgical procedures are performed. The patella is fixed, detached particles of cartilage are removed, the inner surface of the patella is leveled, the articular cavity is sanitized and hematomas are removed.

Features of patellar dislocation

Patella dislocation is a fairly common injury that occurs as a result of a fall on the knee or an impact, usually in the presence of corresponding anatomical features. Usually occurs in the outer (lateral) direction. In this case, a rupture of the patellar ligament and disruption of the cartilaginous structures may occur. Factors that contribute to the occurrence of pathology quite often go unnoticed until the incident itself, and do not manifest themselves in any way. Most often, injuries occur at a young age, mainly in females. This is due to the characteristics of the knee joint. People with existing valgus deformity of the lower extremities (x-shaped) or connective tissue dysplasia are more susceptible to dislocation.

Arthroscopic techniques

Arthroscopic techniques

• Injury to the patellar ligament, accompanied by its incomplete rupture, requires conservative therapy. For complete rupture, surgical treatment is used.
• A non-displaced fracture involves immobilizing the bone using a cast. In case of slight displacement, the fragments are first repositioned. For a comminuted fracture, surgery with osteosynthesis is performed.
• In case of dislocation, it is reduced using anesthesia and subsequent immobilization.

Arthroscopic surgical techniques are used for combined injuries.