Fracture of patella: symptoms and treatment

Fracture of the knee cap is of different types. Usually, the process is accompanied by swelling of the leg and painful sensations, which are strengthened by flexion and extension of the shin. With this type of joint damage, the patient can not move.

Anatomy of the patella

The patella is a flat, round bone that is located on the surface of the knee joint in front. To the upper part of the knee cap are attached the tendon of the quadriceps muscle located in the thigh. Also, the attachment is made to the lower patellar patella. Outside and inside, the bone adheres to the lateral ligaments.

The smooth surface of the patella, located inside, adjoins the surface above the knee. The outer surface is rough. It is covered with tendon fibers. The patella protects the knee during bumps and injuries.

The main types of fractures

It is accepted to distinguish the following varieties of fractures:

• Fracture of patella without displacement. It is characterized by the fact that parts of the damaged bone, not moving, are adjacent to each other. In case of damage of this type, the bone remains in place throughout the therapy.
• Fracture with the presence of displacement. It is characterized by the displacement of parts of the broken patella in relation to each other. In most cases, surgical intervention is required to re-assemble the fragments.
• Fracture with the presence of many fragments. It is characterized by the fact that the knee cap is fragmented into more than three fragments. This fracture is considered to be the heaviest and requires prolonged therapy.

Open and closed fracture forms

Fracture of the knee cap is divided into an open and a closed type.

When the fracture is closed, the skin at the fracture site is not damaged. It remains intact.

When the type is open, there is a strong disruption in the structure of the skin, from which the fragmented bone is seen. In addition, the open type causes serious disruption of the structure of the adjacent ligaments, tendons and muscles.

How does the fracture occur?

Usually, a fracture of the kneecap is the result of direct injury when it falls to the knee in a bent state, or if it hits a sharp or hard object. An indirect type of injury is possible with a sudden contraction of the quadriceps muscle of the thigh.

A mechanism of a mixed type 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 flexor located on the side (tendon fibers of the quadriceps muscle located in the thigh).

When the tendon ruptures, a discrepancy of bone fragments in the patella appears.

Symptomatic of damage

How does the fracture of the patella develop?

Symptoms are as follows:

• When the knee is damaged, there is a marked puffiness in the knee joint area.
• When palpation revealed sharp pain, noted the presence of a gap between debris, there is hemarthrosis (poured out blood in the knee joint).
• Often, the pathological mobility and the presence of crepitation (crunching) of bone fragments are revealed.
• Pain when trying to bend the knee is sharp. Active extension is impossible or becomes sharply limited.
• With a trauma without displacement, the patient does not lose the ability to walk, however, movements are accompanied by sharp combat sensations.
• Fracture of the patella with the presence of displacement makes walking impossible. Also, the patient can not raise the limb in the straightened state and produce active joint motion.

Diagnosis of trauma

Diagnosis of the fracture is carried out by a trauma doctor on the basis of the clinical picture, which is characteristic for this type of lesion. The data obtained by X-ray diffraction are also actively used.

Additional methods of diagnosing trauma are magnetic resonance imaging of the affected joint. Hemarthrosis is confirmed by diagnostic puncture of the joint.

Differential diagnosis

Fracture of the calyx of the knee joint is differentiated from rupture of the ligament of the patella, rupture in the quadriceps tendon, as well as the presence of arthritis of traumatic nature or prepatellar bursitis. In all of the above cases, there is no evidence of a gap between bone fragments.

Fracture of the kneecap should be distinguished from the abnormal development of the joint (divided patella). Unlike the fracture, with this pathology there is no trauma and sharp pain sensations. The gap between the fragments of the bone differs smoothness and smoothness. As a rule, such an ailment is revealed 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 are stable and unstable. With a stable form, there is a tendency to shift. Unstable shape suggests fractures, in which the bones have already shifted or can move after a while.

Principles of conservative therapy

Many people are interested in how the fracture of the kneecap is treated? Treatment in the presence of bias more than 0.5 cm is carried out conservatively. To conduct such therapy, local anesthesia of the fracture is first performed by the introduction of anesthetics.

The fixation of the affected limb by means of a gypsum bus is carried out. The patient is thus allowed to move on crutches. After removing the tire, it is recommended to perform massage procedures, exercise therapy. Physiotherapeutic procedures (electrophoresis, magnetolaser, etc.) are also conducted.

In the absence of displacement, the damaged limb is fixed in the straightened state. The tire is applied from the gypsum to the upper part of the thigh to the ankle. As a rule, the duration of such fixation is 4-6 weeks. It is shown the conduct of 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 kneecap with displacement of the patella fragments more than 2 mm requires an operation in which the fragments are compared, the joint surface is restored and the patella is fixed. Elimination of this condition without a surgical method is impossible.

In the surgical intervention, various methods can be used with the application of a soft tissue seam, bone seam and the plasticity of the tendon muscles.

The method, which was especially popular, was the Berger-Schultze operation, during which the fragments are brought closer together with the subsequent insertion of the nearby patella tissues. 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 multiple fragments and the impossibility of restoring the patella, surgical interventions are applied that involve the removal of fragments of the bone or patella.

If there is a possibility of preserving the joint, then carrying out such operations is not recommended.

How fast is the fracture of the knee cap treated? The timing of treatment depends on the degree of fragmentation of the joint. As a rule, the restoration of work capacity is 2 months. If blood is collected in the joint, then it is to be removed by means of a puncture of the knee cap. With simple forms of fractures, a complete recovery, as a rule, occurs in 3 months.

Rehabilitation and therapeutic gymnastics

After removing the tire from gypsum, it is necessary to undergo restoration measures, which include a set of special physical exercises, exercise therapy, and massage. It is important that all rehabilitation activities, their frequency are set by the attending physician.

An important role is played by the systematic implementation of exercises, as they serve as an excellent way to develop a damaged joint.

The set of exercises used can look something like this:

• A healthy leg is wound under the injured leg, active movements are made around the knee joint.
• The patient is standing near the wall. Behind him is a big ball with which squats are performed.
• Walking on the treadmill in the opposite direction is carried out. The speed should be no more than 2 km per hour.
• A set of exercises on a stationary bike with pedals of no more than 10 cm in length is performed. The seat must be positioned so that the injured leg can fully straighten.
• Jumps are performed on the injured leg. An important condition is the absence of pain.

Possible complications

What can cause a fracture of the kneecap? It should be noted that with a conservative method of treatment, the risk of improper fusion of bones 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 kneecap.

Conclusion

Fracture of the kneecap is a serious injury. It should be noted that such a state appears rarely. As a rule, fragmentation occurs when severe impacts or accidents occur. 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.