PATELLAR FRACTURE

PREPARED BY : ZURRIYATAN SOLIHAH

GROUP : 88

What is a patellar fracture?

A patellar fracture is a condition characterized by a break in the knee cap bone (patella)
The knee comprises of the union of 3 bones the long bone of the thigh (femur), the shin bone (tibia)

and the knee cap (patella) The patella (knee cap) is situated at the front of the knee and lies within the
tendon of the quadriceps muscle (the muscle at the front of the thigh). The quadriceps tendon
envelops the patella and attaches to the top end of the tibia (figure 1). Due to this relationship, the
knee cap sits in front of the femur forming a joint in which the bones are almost in contact with each
other.
During certain activities, such as a fall onto the knee cap or following a direct blow to the front of the
knee, stress is placed on the patella bone. When this stress is traumatic, and beyond what the bone can
withstand, a break in the patella may occur. This condition is known as a patellar fracture.
Because of the large forces required to break the patella bone, a patellar fracture often occurs in
combination with other injuries such as patella or femoral joint damage or a quadriceps tear.
Patellar fractures can vary in location, severity and type including stress fracture, displaced fracture,
un-displaced fracture, compound fracture, greenstick, comminuted etc.

CAUSES OF PATELLAR FRACTURE

A patellar fracture most commonly occurs due to

direct trauma to the knee cap such as a fall onto the

knee cap or a direct blow to the patella (e.g. from a
hockey stick). Occasionally it may also occur due to a
forceful quadriceps contraction such as landing from
a height. A stress fracture to the patella, although
rare, may occur as a result of overuse, often
associated with a recent increase or high volume of
jumping. An acute patellar dislocation can also
sometimes result in a fracture to the patella.

SIGNS AND SYMPTOMS

Patients with this condition typically experience a sudden onset of sharp, intense

pain at the front of the knee at the time of injury. This often causes the patient to
limp so as to protect the patella. In severe cases, particularly involving a displaced
fracture of the patella, weight bearing may be impossible. Pain is usually felt on
the front or sides of the patella and can occasionally settle quickly with rest leaving
patients with an ache at the site of injury that may be particularly prominent at
night or first thing in the morning. Occasionally patients may experience
symptoms in the back of the knee, the thigh or lower leg regions.
Patients with a patellar fracture may also experience swelling, bruising and pain
on firmly touching the affected region of bone. Pain may also increase during
certain movements of the knee when standing or walking (particularly up or down
hills or on uneven surfaces) or when attempting to stand or walk. Squatting or
kneeling is also usually painful with many patients being unable to perform these
activities. In severe cases (with bony displacement), an obvious deformity may be
noticeable. Occasionally patients may also experience pins and needles or
numbness in the knee, lower leg, foot or ankle.

PHYSIOTHERAPY FOR PATELLAR FRACTURE

Physiotherapy treatment is vital in all patients with this condition to hasten healing and ensure an optimal

outcome. Treatment may comprise:

soft tissue massage

joint mobilization

electrotherapy (e.g. ultrasound)

dry needling

Patella taping or bracing

the use of a protective splint

Ice or heat treatment

the use of crutches

progressive exercises to improve strength (especially the quadriceps VMO muscle), flexibility, core stability
and balance

hydrotherapy

education

activity modification

a graduated return to activity plan

biomechanical correction

footwear advice

PROGNOSIS
Patients with this condition usually make a full recovery with appropriate

management (whether surgical or conservative). Return to activity or

sport can usually take place in a number of weeks to many months and
should be guided by the treating physiotherapist and specialist. In
patients with severe injuries such as those that involve damage to other
bones, soft tissue, nerves or blood vessels, recovery time may be
significantly prolonged and there may be some ongoing disability.
Sometimes a poorly rehabilitated patellar fracture may develop into
other conditions such as patellar femoral pain syndrome even though full
bony healing may have taken place. In these instances further
physiotherapy treatment and rehabilitation may be required before the
patient is able to return to full activity, pain free.

EXERCISE FOR PATELLAR FRACTURE

The following exercises are commonly prescribed to patients

with a patellar fracture following confirmation that the fracture

has healed or that pain free mobilization can commence as
directed by the surgeon. You should discuss the suitability of
these exercises with your physiotherapist prior to beginning
them. Generally, they should be performed 3 times daily and
only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin
the initial exercises and eventually progress to the
intermediate, advanced and other exercises. As a general rule,
addition of exercises should take place provided there is no
increase in symptoms.

INITIAL EXERCISE
Static Quadriceps Contraction
Tighten the muscle at the front of your thigh (quadriceps) by pushing

your knee down into a towel (figure 2). Put your fingers on your inner
quadriceps to feel the muscle tighten during contraction. Hold for 5
seconds and repeat 10 times as hard as possible without increasing your
symptoms.

 Knee Bend to Straighten

Bend and straighten your knee as far as you can go without pain and

provided you feel no more than a mild to moderate stretch (figure 3).
Gradually increase movement as tolerated over a number of sessions
provided the exercise is pain free. Repeat 10 - 20 times provided there
is no increase in symptoms.

 Hip Extension in Standing

Begin this exercise standing at a table or bench for balance. Keeping

your back and knee straight, slowly take your leg backwards, tightening
your bottom muscles (gluteals) (figure 4). Hold for 2 seconds then
slowly return to the starting position. Repeat 10 times provided the
exercise is pain free.

OTHER INTERVENTION:
Despite appropriate physiotherapy management, some patients

with this condition do not improve adequately and may require

other intervention. The treating physiotherapist or doctor can advise
on the best course of management when this is the case. This may
include further investigations such as X-rays, CT scan, MRI or bone
scan, periods of splinting or plaster cast immobilization or referral
to appropriate medical authorities who can advise on any
intervention that may be appropriate to improve the fractured
patella. Occasionally, patients with fractures that are initially
managed without surgical intervention may require surgery to
stabilize the fracture and a bone graft to aid fracture healing.

THANK YOU !