Fracture of the patella can be of different types. Usually, the process is accompanied by leg swelling and pain, which increase with flexion and extension of the lower leg. With this type of joint damage, the patient cannot move.
Anatomy of the patella
The patella is a flat rounded bone that is located on the surface of the knee joint in front. The tendons of the quadriceps muscle located in the thigh are attached to the upper part of the patella. Also, fastening is carried out to the lower own ligament of the patella. Outside and inside the bone is held by 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 protects the knee from impacts and injuries.
Main types of fractures
It is customary to distinguish between the following types of fractures:
- Fracture of the patella without displacement. It is characterized by the fact that parts of the damaged bone, without shifting, are adjacent to one another. With damage of this type, the bone remains intact throughout the therapy.location.
- Fracture with displacement. It is characterized by the displacement of parts of a broken patella in relation to each other. In the vast majority of cases, surgery is required to reunite the fragments.
- Fracture with 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 fractures
Fracture of the patella is divided into open and closed type.
When the fracture is closed, 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 a crushed bone is visible. In addition, the open type causes serious damage to the structure of nearby ligaments, tendons and muscles.
How does a fracture occur?
Typically, a fracture of the patella is the result of a direct injury from a fall on the knee in a bent position or from a blow to a sharp or hard object. An indirect view of the injury is possible with a sudden contraction of the quadriceps femoris.
A mixed type mechanism is distinguished, in which a fracture occurs when elements of direct and indirect damage are combined.
Fracture of the patella is often combined with damage to the flexor apparatus located on the side (tendon fibers of the quadriceps muscle located in the thigh).
When a tendon ruptures, there is a divergence of bone fragments in the patella.
Symptomatic damage
How does a broken patella feel?
Symptoms are as follows:
- When the knee is damaged, severe swelling appears in the area of the knee joint.
- On palpation, sharp pains are detected, there is a gap between the fragments, hemarthrosis occurs (bleeding in the knee joint).
- Pathological mobility and the presence of crepitus (crunching) of bone fragments are often detected.
- Pain when trying to bend the knee is sharp. Active extension is impossible or becomes severely limited.
- With an injury without displacement, the patient does not lose the ability to walk, however, movements are accompanied by sharp pain sensations.
- A broken patella with displacement makes walking impossible. Also, the patient cannot raise the limb in a straightened state and make active movements of the joint.
Injury diagnosis
Diagnosis of a fracture is carried out by a traumatologist based on the clinical picture, which is typical for this type of lesion. X-ray data are also actively used.
Additional methods for diagnosing injury is magnetic resonance imaging of the affected joint. Hemarthrosis is confirmed by diagnostic puncture of the joint.
Performing differential diagnosis
Fracture of the calyx of the knee joint is differentiated from rupture of the ligament of the patella, rupture in the tendon of the quadriceps muscle,as well as the presence of traumatic arthritis or prepatellar bursitis. In all of the above cases, the presence of a gap between bone fragments is not traced.
Fracture of the patella has to be distinguished from the abnormal development of the joint (split patella). Unlike a fracture, with this pathology there is no trauma and sharp pain. The gap between the 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 debris.
Fractures can be stable or unstable. With a stable form, there is a tendency to shift. The unstable form suggests the presence of fractures in which the bones have already moved or may move after some time.
Principles of conservative therapy
Many are interested in how a fracture of the patella is treated? Treatment in the presence of a displacement of more than 0.5 cm is carried out by a conservative method. For such therapy, first of all, local anesthesia of the fracture is performed by introducing anesthetics.
The affected limb is fixed with a plaster splint. The patient is allowed to walk on crutches. After removing the tire, massage procedures and physiotherapy exercises are recommended. Physiotherapeutic procedures are also carried out (electrophoresis, magneto laser, etc.).
In the absencedisplacement, the damaged limb is fixed in a straightened state. A cast splint is placed on the upper part of the thigh up to the ankle. As a rule, the duration of such fixation is 4-6 weeks. Control radiographs are shown.
Conservative treatment involves long-term immobilization of the joint, the development of which is a long and painstaking process.
Surgery
According to traumatologists, a fracture of the patella with displacement of fragments of the patella by more than 2 mm requires an operation, during which the fragments are compared, the articular surface is restored and the patella is fixed. Elimination of such a condition without a surgical method is impossible.
During surgery, various methods can be used using soft tissue suture, bone suture and tendon muscle plasty.
The Berger-Schultze operation has become a method that has become especially popular, during which fragments are brought together with subsequent stitching of nearby tissues of the patella. The duration of immobilization after surgery is 1 month. After removing the plaster splint, massage, physiotherapy and therapeutic exercises are prescribed.
In case of fractures with many fragments and the impossibility of restoring the patella, excising surgical interventions are used, which involve the removal of bone fragments or the patella.
If it is possible to save the joint, then such operations are notrecommended.
How fast is a patella fracture treated? The duration of treatment depends on the degree of fragmentation of the joint. As a rule, recovery of working capacity occurs in 2 months. If blood has collected in the joint, then it must be removed by puncture of the patella. For minor fractures, full recovery usually occurs within 3 months.
Rehabilitation and therapeutic exercises
After removing the plaster splint, it is necessary to undergo recovery measures, which include a set of special physical exercises, exercise therapy, and massage. It is important that all rehabilitation measures and their frequency are set by the attending physician.
The systematic exercise is important, as it is a great way to develop a damaged joint.
The set of exercises used might look something like this:
- A he althy leg is wound under the injured 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 on the treadmill in the opposite direction. The speed must be no more than 2 km per hour.
- A set of exercises is performed on an exercise bike with pedals no longer than 10 cm. The seat should be positioned so that the injured leg can fully straighten.
- Jumping on the injured leg. In this case, an important condition is the absence of pain.
Possible Complications
What can cause a fracture of the patella consequences? It should be noted that with a conservative method of treatment, the risk of improper bone fusion in the knee joint is very high, which, in turn, can disrupt its functionality and lead to the development of such severe pathological conditions as gonarthrosis or osteoarthritis of the patella.
Conclusion
A broken patella is a serious injury. It should be noted that this 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 choose the appropriate treatment tactics.
