Pediatric Orthopedic Surgeons treating a Patella Fracture

PATELLA FRACTURE

 

A Patella Fracture is a broken kneecap.  Children get broken kneecaps from sports and playing.

If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Patella Fracture

A patellar fracture means a break in your child’s kneecap, the bone on the front of the knee. Broken pieces may be displaced or can even break through the skin. Factors that can cause a patella fracture are a blow to the knee, a fall directly onto the knee, forced stress on the muscle that extends the knee, etc. Treatment will depend on how the kneecap breaks.

Signs of a Patellar Fracture

  • Pain when your child’s knee touches something or he moves the leg
  • Bruising and swelling around the knee
  • Unable to put weight on the leg
  • Unable to raise the leg while lying down

Patellar Fracture Diagnosis

The doctor will ask about the injury and then examine your child. Our specialists will look for the fractured bone through the skin. By touching your child’s knee, they might be able to tell whether or not the bone pieces are in their places. They might also recommend any of the following tests:

  • An x-ray – It may help show the sort of fracture your child has. Healthcare providers often x-ray the other leg as well to compare both kneecaps.
  • A bone scan – This procedure helps to look into your child’s fracture while checking for infection. Experts will put a radioactive liquid, called a tracer, through a vein. The tracer gathers in your child’s bones. And then they take pictures.
  • A CT scan or an MRI – This demonstrates a fracture or other injury. Experts might give your child a contrast liquid to help them check the kneecap better. Do not forget to tell the doctor if your child is prone to having an allergic reaction to contrast liquid. Also, remember that your child should not enter the MRI room wearing anything metal because metal can cause serious injury.

Patella Fracture Treatment

  • A cast, brace, or splint is often necessary. These supportive devices prevent the kneecap from moving and help it heal better. Your child may also need crutches to move around while the kneecap heals.
  • Medicines can relieve pain or prevent bacterial infection. Your child may also need a Td vaccine, a booster shot that prevents tetanus. The child may require the Td vaccine if the bone breaks through the skin.
  • Doctors often use closed reduction procedures to set the broken pieces back into their places without surgery. Also, sometimes they use external fixation to hold your child’s kneecap in place. Then, once the problem is solved, they will remove it.
  • Surgery may be necessary to relocate the broken pieces into their correct positions. Surgeons often require wires, screws, pins, or bands to hold the pieces. Also, surgery might be essential to remove a part or the entire kneecap.
  • Doctors may also recommend physical therapy. A physical therapist will teach your child proper exercises to help improve movement and boost strength while decreasing pain.

Surgical Procedures for a Patella Fracture

The type of relevant surgical procedures often depends on the type of fracture your child has. Prior to the surgery, our doctor will discuss the process and any associated complications with you.

Transverse Fracture – This is a two-part fracture. These are set with screws, pins, wires, and a figure-of-eight configuration tension band. The figure-of-eight band helps press the two displaced pieces together. This process is the most suitable for treating fractures near the center of the patella. Fractured pieces at the outer area of the kneecap are too small for this process. The tension band can over-compress the breaks in pieces. Also, there is another approach to a transverse fracture. And that is to secure the bones by using small screws or small screws along with small plates.

Comminuted fracture – In some cases, the top or bottom of the patella breaks into multiple small pieces. This kind of fracture occurs when the kneecap is pulled apart and then crushed when the individual falls on it. In this case, since the broken bone fragments are too small to be fixed back into place, your doctor will remove them. Then they will attach the loose patellar tendon to the patellar bone.

If the kneecap is broken into multiple pieces and separated at the center, the doctor may use a combination of wires and screws to fix it. Eliminating the tiny portions of the kneecap that experts cannot reconstruct may also bring better results. In treating a comminuted fracture, removing the kneecap completely is the last strategy.

What Will Help Patellar Fracture Heal Faster

Rest The Knee

When your child will be walking, crutches will help rest and support your child’s knee. The doctor will tell you when your child can start using crutches. Ensure you follow all the instructions regarding how much weight your child can put on that leg.

Use An Ice Pack 

Applying ice will be highly effective in relieving swelling and pain. You can use an ice pack or put crushed ice in a plastic bag. Then cover it with a towel and place it on your child’s knee or that supportive device. It is advisable to apply ice for 15 to 20 minutes every hour for two days. Or, simply follow your doctor’s instructions.

Elevate The Knee 

It is also advisable to elevate the knee above the level of the patient’s heart as often as possible. It will help reduce swelling and pain. Set your child’s leg on pillows or blankets so he can keep it like that comfortably. Avoid putting a pillow directly under the affected knee.

Recovery from a Patella Fracture

Recovery from such fractures is about pain management, rehabilitation, and weight bearing. Most fractures might be moderately painful for several days or for a couple of weeks. Using ice, elevating the affected leg, and taking simple, non-prescription medications for pain relief help relieve pain. Also, rehabilitation will play a crucial role in getting you back to your daily activities, no matter the treatment – surgical or nonsurgical. Treatment for a patellar fracture often requires keeping that leg immobilized in a cast for a long time. That is why your child’s knee may feel stiff, and the thigh muscles may also weaken.

However, during rehabilitation, specific exercises will help the leg get back in form. These will improve the range of motion in your knee, and decrease stiffness while strengthening your leg muscles. Then it comes to weight bearing. Your doctor will tell you when your child can start to bear weight on the healing leg.

When to Seek Immediate Medical Attention

You might seek immediate medical attention if:

  • Your child feels lightheaded and short of breath all of a sudden.
  • Your child has chest pain when he takes a deep breath or coughs.
  • Your child is coughing up blood.
  • The cast or splint breaks or gets damaged.
  • Feet or toes feel numb.
  • Feet or toes turn white or blue or are swollen or cold.
  • Your child has a fever.
  • Knee pain gets worse, even after treatment, etc.

Conclusion

It is true that fractures of the patella in children are not so common. Still, we need to consider it one of the crucial diagnoses in severe knee injuries. It needs special care, especially when the reason for the injury is an excessive force like jumping or sports injuries.

Believe it or not, even the diagnosis can often miss a small bony fragment in fractures. Hence, our doctors suggest MRI scans in doubtful cases for early and accurate diagnosis. Early surgical corrections and internal fixation accompanied by mobilization can help achieve better results for displaced fractures of the patella.

 

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at four convenient locations: Arlington, Dallas, Frisco and McKinney.