Pediatric Orthopedic Surgeons treating a Humerus Fracture

KNEE FRACTURE

Breaking any one of three bones of the leg can damage the knee joint. These bones are the thighbone, shinbone, and kneecap.

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Knee Fracture

Fractures caused by an accident to the knee can damage three parts of the joint. The femur (thighbone), tibia (shinbone), and patella (kneecap) are these parts. Any fracture may result in excruciating pain and may require medical attention or surgery to restore the knee joint’s structural integrity. Knee fractures can affect the patella, the top of the tibia, or the lower end of the femur (kneecap). Therefore, an abrupt impact on the knee joint during a car accident, a fall, or a sports injury will indicate a typical cause of knee fractures.

Any form of trauma to the region increases the risk of knee fracture injuries in those with osteoporosis or bone loss. As previously stated, in most cases, knee fractures cause immediate, severe pain and edema. The severity of the damage determines the course of treatment. In order to fix the fractures or replace damaged parts and rebuild the knee joint’s structure, doctors will use both surgical and non-surgical methods.

One of the best things you can do for your child’s body and their joints is involve them in exercising. But accidents do happen, and knees frequently become involved. Meniscus tears, tendonitis, damaged ligaments, and a runner’s knee identify a few of the most typical issues. Also, an old knee injury that was not adequately addressed may occasionally flare up or cause pain.

A patella fracture, a significant injury, can affect your child’s ability to bend or straighten his or her knee. This injury also refers to a knee fracture. Even though this little bone can break into several fragments, some patella fractures are straightforward. Knee fractures, however, can also result in the following:

Patellar Fracture:

The patella, or kneecap, can break and suffer from a patellar fracture. A patella can fracture in a variety of ways, from a little chip to a total shattering of the bone. The following lists the primary forms of patellar fractures:

Displaced Fracture: The bone’s shattered ends appear apart and out of alignment.
Comminuted Fracture: Depending on the pattern of the fracture, the bone breaks into three or more fragments.
Open Fracture: Occurs when the shattered bone pierces the skin and harms the soft tissue in the vicinity.

Treatment Based on Fracture Type:

Treatment varies significantly depending on the type and severity of the fracture. If the bone pieces are touching, and the fracture isn’t severe, non-surgical methods may be recommended. This typically involves using a brace to stabilize the knee and restricting movement to prevent further injury. Limitations on bending and weight-bearing activities are often advised to aid recovery.

In cases where the bone pieces are pulled apart, surgical intervention is likely necessary. The main goal of surgery is to realign and secure the bones to restore proper function. Surgeons might employ wires, plates, sutures, or a combination of these techniques to reconnect the bone fragments effectively.

Each treatment path aims to restore knee stability and function, minimizing long-term complications and facilitating a swift recovery.

QUESTIONS AND ANSWERS

What are the symptoms of a fractured knee in children?

Pain: The child will likely experience significant pain in the knee area, especially when attempting to move or put weight on the affected leg.
Swelling and Bruising: It is normal for children to experience swelling around the knee joint, and the area should become bruised and discolored due to internal bleeding from the fracture.
Limited Range of Motion: The child may experience difficulty bending or straightening their knee, and the child should experience a loss of normal mobility.
Deformity: In severe cases, the child’s knee will be deformed, or misaligned.

How do doctors diagnose a fractured knee in children?

Clinical Examination: A healthcare provider will conduct a physical examination, evaluating the child’s ability to move the knee, assessing for tenderness and swelling, and looking for any visible deformities.
Imaging Studies: Doctors consider X-rays as the first-line imaging modality to confirm the presence of a fracture, determine its location and severity, and guide treatment decisions. In some cases, the doctor will order additional imaging such as MRI or CT scans for a more detailed assessment.
Medical History and Assessment: The child’s medical history, including any previous injuries or conditions, will be considered in the diagnosis and treatment plan.

How do doctors treat a fractured knee in children?

Casting or Splinting: For stable fractures, the doctor will use a cast or splint to immobilize the knee joint and allow the fracture to heal. This is often used for non-displaced or minimally displaced fractures.
Surgery: In some cases, particularly for more severe fractures or when there is a displacement of bone fragments, the doctor may recommend surgery. This can involve realignment of the fractured bones, internal fixation with pins, screws, or plates, or other surgical techniques to stabilize the knee joint.
Physical Therapy: Following immobilization or surgery, physical therapy is often recommended to help regain strength, flexibility, and mobility in the knee joint.
Pain Management: The doctor will prescribe pain medication to help manage discomfort during the healing process.

It’s important to note that the specific treatment approach will depend on factors such as the type and location of the fracture, the child’s age and overall health, and the presence of any associated injuries. A pediatric orthopedic specialist will make individualized recommendations based on a thorough evaluation of the child’s condition.

When children break bones, parents need to take them to the very best doctors. At the Medical City Children’s Orthopedics and Spine Specialists, we are the best. We specialize in children and their bones.

Potential Long-Term Effects of a Patella Fracture

Experiencing a fracture to the kneecap, or patella, can lead to various long-term consequences. While most individuals resume normal activities after recovery, this process might extend over several months due to the nature of the injury.

Cartilage Damage and Arthritis

A significant concern is the potential injury to the cartilage beneath the kneecap during the fracture. This damage can accelerate wear and tear in the knee joint, potentially leading to arthritis. Arthritis in the knee is known to cause long-lasting pain and stiffness, which can affect daily activities.

Joint and Movement Complications

Post-healing, stiffness in the knee joint can persist, making it difficult to bend or straighten the knee as before. In such cases, additional treatment could be necessary to restore full motion.

Surgical Considerations

Many fractures require surgical intervention using hardware like wires or screws. Occasionally, this hardware can become uncomfortable or loosen, necessitating its removal through another surgical procedure. If the initial fracture does not heal correctly, further surgery might be required to realign the bone fragments.

Additional Risks

Though uncommon, complications can arise, such as problematic wound healing or the formation of blood clots. Adhering to medical advice during your recovery can mitigate these risks.
In summary, while full recovery from a patella fracture is often achievable, being aware of these potential long-term effects is crucial for managing expectations and ensuring informed decisions about your health.

What Other Things Might Cause Knee Pain?

Bursitis

A bursa refers to a sac under the skin above the joint that contains a small quantity of fluid. As the joint moves, it lessens friction. The bursa on top of the kneecap might get irritated by overuse, accidents, or frequent bending and kneeling. This causes discomfort and edema.

Dislocated kneecap

The kneecap falls out of place as a result, resulting in knee discomfort and swelling. Doctors will refer to this as “Patellar dislocation”.

Iliotibial band syndrome

From your child’s hip to the outside of the knee, there is a thick band of tissue called the iliotibial (IT) band. It might eventually get inflamed when your child overdoes an activity. The knee’s outside side feels tender as a result. Running downhill often causes it for runners.

Meniscal tear

Occasionally, a knee injury might result in cartilage tearing. These jagged edges may become lodged in the joint, resulting in inflammation and discomfort. When they become active, people frequently experience a “catching” in the joint.

Osgood-Schlatter disease

Young people who still have developing bones and other knee components have this problem. A painful lump might develop where a tendon from the kneecap connects to the shin below the knee. Overdoing activities and inflammation in the tibial tubercle, a spot on the bottom of your knee, usually affects this area. The discomfort could reappear over time. Osgood-Schlatter disease occurs mostly in teenage boys and girls.

Osteoarthritis

Arthritis refers to the “wear and tear” variety. After age 50, doctors see osteoarthritis as the main cause of knee discomfort. When your child is active, this ailment causes the knees to have pain or a bulge. Early in the day, osteoarthritis-affected joints may also feel stiff.

Femoral Shaft Fracture:

Anywhere along the femoral shaft, the long, straight portion of the femur, a break can result in a femoral shaft fracture.

Distal Femur Fracture:

Clinically speaking, the distal femur refers to the portion of the thigh that extends from the metaphyseal-diaphyseal junction to the knee’s articular surface. The elderly, whose bones are weaker, or as a consequence of direct damage after impact, are the groups that suffer distal femur fractures most frequently. Distal Femur fractures occur just above the knee joint.

Proximal Tibial Fractures:

The shin bone’s uppermost portion, the proximal tibia, is where it expands and joins the knee joint. Depending on the location of the fracture, there are many forms of proximal tibia fractures.

A proximal tibial fracture refers to a break or fracture of the tibia, the shin bone. Proximal tibial fractures, which take place nearer to the knee joint (proximal), can lead to arthritis and instability by altering the alignment of the legs and creating uneven joint surfaces and defects.
Tibial shaft fractures frequently cause damage to the soft tissues in the immediate area, including blood vessels, nerves, muscles, and torn skin. Tibial Shaft Fractures occur in the region between the knee and ankle joints.

Patellar tendinitis

Tendons, which refer to hard bands of tissue, attach the muscles to bones. They may swell up and hurt if your child uses them excessively. Because doctors tell us that repetitive jumping appears as the most prevalent cause, you may also hear it referred to as “jumper’s knee.”

Symptoms of Knee Fracture

An injured kneecap frequently hurts right away. However, further signs may include the following:

Immediate knee bruising and swelling.
Knee pain in the back.
Difficulty bending the knee or putting weight on the injured leg.
A sensation of scraping or grinding while moving.
Spasms of the muscles.

The shattered bone may, however, occasionally show through the skin. In other situations, the knee has the same appearance as always, but performs abnormally.

What Kind of Knee Damage Generates Discomfort Behind the Knee?

Pain behind the knee, generally more on the inside or outside, might result from meniscus or cartilage tears in the knee. These tears are mostly generative. The ‘root’ of the meniscus, where it joins to the center of the knee, does, on occasion, rupture. A doctor may advise rest and ice application if your child has sudden or severe discomfort behind his or her knee. In some circumstances, your doctor could also advise you to elevate your child’s leg while seated to enhance the blood flow in the leg.

Knee Fracture Diagnosis:

How do doctors diagnose a fractured knee in children?

A fractured kneecap, or patella fracture, presents with specific symptoms that can guide the diagnostic process. Recognizing these symptoms early is crucial for effective treatment.

Immediate Symptoms: If a child suffers a patella fracture, the knee will likely swell, and the child may struggle to straighten the leg or walk due to pain.
Initial Medical Response: When these symptoms are present, prompt medical evaluation is necessary. Doctors at the emergency room or urgent care will conduct an assessment, prioritizing the immediate use of imaging studies.
Clinical Examination: A healthcare provider will conduct a physical examination, evaluating the child’s ability to move the knee, assessing for tenderness and swelling, and looking for any visible deformities.
Imaging Studies: X-rays serve as the first-line imaging modality to confirm the presence of a fracture, determine its location and severity, and guide treatment decisions. In some cases, the doctor will order additional imaging, such as an MRI or CT scans, for a more detailed assessment.
Medical History and Assessment: The child’s medical history, including any previous injuries or conditions, will be considered in the diagnosis and treatment plan.

This thorough approach ensures that the diagnosis of a patella fracture is accurate, allowing for a tailored treatment plan that addresses the child’s specific needs.

Solutions for Treating Broken Bones and Knee Fractures

Depending on the severity of the fracture and your child’s medical history, treating a knee fracture today is no longer a challenging situation for the doctors at Medical City Children’s Orthopedics and Spine Specialists. For the treatment of knee fractures, both surgical and non-surgical options consist of the following:

Non-Operative

Surgeons will not recommend surgery if a knee fracture appears straightforward and the bones do not move. Instead, to keep your child’s bone in place, your doctor may recommend medications and a cast or splint. Your child will need to refrain from activities or carrying heavy objects during this period.
Depending on the severity of the fracture and your child’s medical history, treating a knee fracture today is no longer a challenging situation for orthopedic specialists. For the treatment of knee fractures, both surgical and non-surgical options consist of the following:

Patella Fracture Surgical Methods

When it comes to treating a broken kneecap, the primary goal is to reconnect the bones effectively. This is often achieved through common surgical techniques such as:

Wires and Sutures: These are used to hold the fracture fragments together, particularly in transverse fractures, using a “figure-of-eight” tension band configuration.
Plates and Screws: Metal plates and specialized screws are employed to realign and stabilize the broken pieces.

Operative

The kind of surgery will depend on the kind and severity of your child’s fracture. Your initial meeting with our surgeon will include a thorough discussion of the possible choices. Also, if it appears that broken bone fragments exist or if a large space exists between the fractured pieces to negatively affecting healing, surgery will be suggested. If a doctor sees a broken bone exiting the skin because of an open fracture, he will advise immediate surgery.

Finally, the kind of procedure that doctors will conduct depends on the kind of fracture that has occurred. While the tiny bone pieces from a comminuted fracture are removed from the knee joint, a transverse fracture is mended with the use of wires, pins, and a tension band in a “figure-of-eight” arrangement.

Internal Fixation

Both femoral and tibial fractures require internal fixation. The surgeon will use intramedullary rods and screws to hold the bones together after being initially moved into their natural positions.

Intramedullary Nailing

If your child has a fractured femur, or if only the upper quarter of the tibia is damaged and the joint is intact, the surgeon inserts a specially designed rod into the medullary canal of the damaged bone. The surgeon will attach the rod with screws at each end.

Plates and Screws

Your surgeon will realign the damaged pieces into their proper positions instead of inserting a rod, and then secure them in place using metal plates and specialized screws.

External Fixation

In rare circumstances, the fracture may seriously harm the nearby soft tissues. Thus, in this situation, inserting a rod might endanger the tissue even more. So, the surgeon will stabilize the midpoint of the tibia and femur by inserting pins and metal screws. Then to hold your child’s bones in place, screws will attach to an outside bar. In an emergency or when the limb appears severely damaged, doctors will use external fixation.

This enables your bone to recover before having an internal fixation or knee replacement. By integrating these techniques, specialists can address a variety of knee fractures, ensuring that each treatment plan is tailored to the specific needs of the fracture type and the patient’s condition.

Why Might Additional Surgery Be Required After Initial Patella Fracture Treatment?

After the initial treatment of a patella fracture, there are several reasons why further surgical intervention might become necessary:

Hardware Complications: The implants used, such as wires or screws, may shift or loosen over time. This movement can cause discomfort or compromise the stability of the knee joint, prompting the need for their removal or adjustment.
Bone Healing Issues: In some cases, the fractured pieces of the kneecap might not heal as intended. If the bone fragments begin to separate, it can disrupt proper healing. This situation typically requires another surgical procedure to realign and stabilize the bones to encourage natural healing.

Conclusion

Understanding these potential complications can help anticipate and address any issues promptly. Regular follow-ups with your healthcare provider are crucial to monitor progress and decide on further surgical measures if needed.

Complications from a Patella Fracture and Its Treatment

A patella fracture, while concerning primarily during the initial injury, can bring about several long-term complications, both inherent from the fracture and as side effects of treatment.

1. Arthritis Development:

One common issue arising is the potential onset of arthritis in the knee joint. The cartilage on the kneecap, crucial for smooth movement, can be damaged during the fracture. This damage may eventually manifest as arthritis, leading to persistent pain and stiffness.

2. Limited Knee Mobility:

Post-recovery, some individuals may notice reduced flexibility in their knees. It might not bend or straighten as freely as before. In certain cases, additional therapeutic interventions are necessary to restore mobility.

3. Surgical Hardware Concerns:

During repair, hardware such as wires or screws are often used to stabilize the fracture. Occasionally, these components can cause discomfort or become loose. Removal might be necessary post-healing, requiring an additional surgical procedure.

4. Non-Healing Fractures:

In some cases, the fracture itself may not heal as expected. If the bone fragments do not fuse properly, further surgery might be essential to connect the bones adequately.

5. Wound Healing Issues and Blood Clots:

Complications like issues with wound healing or blood clots are less common but possible. These underscore the importance of following medical advice to minimize risks.

Being mindful of these potential complications and closely adhering to your doctor’s recommendations can significantly influence the quality of your recovery and long-term knee health.

What Does Recovery from Patella Fracture Surgery Involve?

Recovering from patella fracture surgery requires careful attention to your body’s healing process. Here’s what you can expect:

Initial Steps

Brace Use: A brace is often used post-surgery to stabilize your knee and control its movements. This helps avoid undue stress on the healing fracture.
Weight-Bearing Instructions: Depending on the severity of the fracture, your doctor will provide guidelines on how much weight you can safely put on your leg. In some cases, walking with the leg kept straight by the brace is advised.

Mobility and Physical Therapy

Movement Restrictions: While some limited movement might be permitted, bending your knee will likely be restricted for a period. Adhering to these guidelines is crucial to ensure proper healing.
Physical Therapy: Engaging in physical therapy is a significant part of the recovery process. A physical therapist will guide you through exercises designed to restore strength and flexibility in your knee.

Ongoing Care

Follow-Up Appointments: Regular follow-ups with your doctor will help monitor your recovery progress. Adjustments to your treatment plan may be made based on how well you’re healing.
Patience and Compliance: Speeding up the process can lead to complications. It’s important to follow all medical advice, including adjustments to your activity levels and any recommended exercises.

The journey to full recovery can vary from person to person, so staying connected with your healthcare team and consistently following their advice is key to regaining optimal knee function.

Why choose the Doctors at Medical City Children’s Orthopedics and Spine Specialists

Every year, hundreds of children, teens, and young adults with fractures of all sorts and levels of complexity are treated by the orthopedic and fracture experts at Medical City Children’s Orthopedics and Spine Specialists. We have offices in Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX. Our expertise in children permits precise diagnosis of illnesses affecting the growing musculoskeletal system and the development of efficient treatment plans. Orthopedic injuries that require immediate medical attention but are not severe enough to warrant emergency room care are treated by our orthopedic specialists.

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Footnote:

American Academy of Orthopaedic Surgeons: Patella Fracture

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