knee cap (patella) fractures

KNEE CAPFRACTURES(PATELLA)

Dr. A.MOHAN KRISHNA M.S.ORTHO, MCh ORTH(U.K)Consultant Orthopaedic surgeon ,Trauma, Arthroscopy, Arthroplasty Surgeon Apollo hospitals, Hyderabad

Consultant Orthopedic Surgeon at

www.drmohankrishna.comwww.healthyjointclub.comwww.bonesandjointsclinic.com

KNEE CAP - PATELLA

Knee cap (patella) is a small bone in front of the knee joint. It protects knee joint and connects the muscles in front of thigh to shin bone.

Knee cap acts as fulcrum for the knee joint movement.The back side of knee cap and lower end of thigh bone is covered with cartilage which helps in smooth movement of knee

KNEE CAP – PATELLA Fractures

Knee cap can fracture in variety of ways1. UNDISPLACED FRACTURES2. DISPLACED FRACTURESa. Transverseb. Lower end c. Upper endd. Comminuted (Multiple bits)e. Undersurface of patella

(cartilage)3. OPEN FRACTURES:There is break in skin with fracture is exposed to outside environment.

CAUSES: INJURY MECHANISM

1. Direct blow on knee: - Fall on knee cap- Dashboard injuries2. Indirect injuries- Sudden pull of thigh muscles can fracture the knee cap

SYMPTOMS

Pain/swelling in front of knee

bruising

Inability to straighten the knee and walk

DOCTOR EXAMINATION

deformity swelling contusion

INVESTIGATIONS

X-RAYS

TREATMENT: Non-operative treatment

-

- If the broken knee cap is not displaced- Even multiple pieces if they are not displaced.- Knee is put in cast or splint for 6 to 8 weeks- Not to put weight on the leg until fracture heals.- Walk with help of crutches or walker.

CYLINDER CAST

OPERATIVE TREATMENT

- Displaced and comminuted (multiple bits) fracture of knee cap need surgery.

- Fractured knee cap bones are usually separated because of pull of strong thigh muscles that are attached on the top.

Timing of surgery:- If skin is intact and healthy surgery can

be done immediately.- If the skin is bruised contused and

swollen wait for skin to heal.- If the fracture is open to outside

environment it needs emergency surgery.

SURGERYTYPE OF PROCEDURE DEPENDS ON TYPE OF FRACTURE.

TRANSVERSE FRACTURE:- Two part fracture with horizontal break in knee cap.- Figure of eight tension band wiring with wires and pins.- Screws also can be used in place of pins.

SURGERYCOMMUNITED FRACTURE:- If the knee cap is broken into several pieces and are in place it can be

fixed with multiple pins and wires- Some times wire is circled along the knee cap to hold pieces- In this case the knee is kept in immobilizer for 4 to 6 weeks and

started on exercises

SURGERYPATELLECTOMY : REMOVAL OF KNEE CAP1. PARTIAL PATELLECTOMY: When the lower portion of knee cap is broken into multiple bits, these bits can be removed and tendon can be sutured to the major bit of knee cap

SURGERY2. COMPLETE PATELLECTOMY:Total removal of knee cap. In case the bone bits cannot be put together these bits can be removed and soft tissue of thigh and shin bone can be sutured back.There may be weakness of knee function in case of complete removal of knee cap.

POSTOPERATIVE MANAGEMENT: After patella fixation

Day 1• Static quadriceps• Ankle pumps• Protected weight bearing with walker or crutchs

Day 2• Discharge• Gentle knee movements• If the fracture is multiple bits knee movements are

restricted for 3 to 4 weeks

End of 2 weeks• Stitches removal• Exercises as advised• Full weight bearing after 3 to 4 weeks

POSTOPERATIVE MANAGEMENT: After partial and complete knee cap removal

Day 1 • Patient on Brace or cast for 4 weeks• Ankle pumps, walking with the help of walker/crutches

Day 2• Discharge • Review after 2 weeks

2 weeks• Stitches removal• Review after 4 weeks from date of surgery

COMPLICATIONS

Delayed unionNonunion

Infection Knee stiffness

arthritis

IMPLANT REMOVALIn some cases or thin individuals the implants can be felt underneath the skin, and can cause some discomfort. In such instances implant can removed after one or one and half year after the surgery.

CONTACTDr.A.MOHAN KRISHNAM.S.Ortho., MCh Ortho(U.K).,Consultant Orthopaedic Surgeon,Apollo Hospitals,Hyderabad.Appointments: Secretary : 09247258989 09441184590 08332936085 www.drmohankrishna.comwww.healthyjointclub.comwww.bonesandjointsclinic.comEmail: bonesandjointsclinic@gmail.com