PATELLA FRACTURE

QUESTIONS AND ANSWERS

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, the doctor can tell whether or not the bone pieces are in their places. To see the actual break, the doctor will order one or two 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. After surgery or in more serious fractures, your child may need to wear a knee brace that limits how much they can bend their knee. In many cases, your child will be able to walk, sometimes with the leg held straight by the brace, but only if advised by your doctor. The healthcare team will let you know whether your child can put weight on the injured leg and how much movement is safe. It’s important to closely follow the guidance from your doctor or surgeon during this time to help ensure the best possible healing.
• 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 Tdap 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 often necessitates the relocation of the broken pieces into their correct positions. Surgeons often require wires, screws, pins, or bands to hold the pieces. Also, surgery might need 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.

Initial Care for a Patella Fracture in the ER or Urgent Care

When you arrive at the emergency room or Urgent Care with a suspected kneecap fracture, the first step is a thorough evaluation. The healthcare team will typically order X-rays to confirm the break and assess its severity. If the skin around your child’s kneecap is intact and there are no signs of an open wound, initial treatment may include immobilizing the knee with a brace or splint. This helps to keep the kneecap stable and minimize movement, reducing pain and the risk of further injury.

In most cases, the doctor will tell your child to keep weight off the affected leg, using crutches if necessary until the child sees a pediatric orthopedic doctor. Pain management and further monitoring are also part of the immediate care provided, ensuring your child is as comfortable as possible.

Surgical Procedures for a Patella Fracture

Patella (kneecap) fractures are fairly common, especially in children and adolescents who are active in sports or may take a tumble during play. These injuries most often occur after a direct blow to the kneecap, such as a fall onto the knee, or, less frequently, from a sudden and forceful contraction of the thigh muscles. When the quadriceps (the large muscles at the front of the thigh) contract strongly, they can pull the broken pieces of the patella away from each other, making the fracture more complex.

The type of relevant surgical procedure often depends on the specific pattern and severity of the fracture your child has. Before any surgery, our doctor will thoroughly review the process and discuss any potential risks or complications with you.

Transverse Fracture

A transverse fracture is a two-part break, where the patella is split into two large pieces, usually near its center. These are typically set using screws, pins, wires, and a figure-of-eight tension band. The figure-of-eight band is specially designed to press the two displaced pieces together, counteracting the pull of the quadriceps muscles and helping the kneecap heal in proper alignment. This approach is most effective for fractures near the central part of the patella.

However, if the fractured pieces are at the outer edge of the kneecap, they may be too small for this method, as the tension band can over-compress the small fragments. In such cases, surgeons may instead use small screws or a combination of screws and plates to secure the bones.

Comminuted Fracture

Sometimes, the patella can break into several small pieces, a comminuted fracture, which often happens when the kneecap is not only pulled apart by the thigh muscles but also crushed from a direct impact, like a hard fall. In these cases, when the bone fragments are too tiny to be fixed back into place, your doctor may remove the small pieces and then reattach the loose patellar tendon directly to the remaining patellar bone.

If the kneecap is broken into multiple pieces and separated at the center, a combination of wires and screws may be needed to stabilize the area. Removing tiny, non-reconstructable fragments can sometimes offer a better outcome. Complete removal of the kneecap is considered only as a last resort when other options are not viable.

Understanding the type of fracture, whether the patella has simply split into two (transverse) or shattered into several pieces (comminuted), is essential for planning the right treatment. Your child’s orthopedic team will use X-rays to determine the fracture pattern and choose the surgical method most likely to restore movement, stability, and strength to the knee.

What happens if a patella fracture does not heal properly?

If a patella fracture does not heal as expected, a few complications can occur. Sometimes, the broken pieces of the kneecap may not join back together, which can cause the bones to stay separated. In these cases, additional treatment—possibly even another surgery—may be needed to restore proper alignment and function. Other potential issues include delayed wound healing or, in rare cases, the development of blood clots. While complications are not common, following your child’s orthopedic specialist’s guidance carefully can help reduce the risk of these problems and support the best possible recovery.

Why Following Your Surgeon’s Instructions Matters

After a patella fracture,  especially if surgery is required, closely following your surgeon’s advice is crucial to ensure proper healing and avoid setbacks. Your surgeon will likely recommend using a knee brace to keep your leg stable and outline when, and how much, you can bend your knee or put weight on the injured leg. These guidelines are designed to protect the healing kneecap and prevent the fragile bone pieces from shifting out of position.

Ignoring these recommendations could put your child at risk for complications such as delayed healing, the bone pieces not joining properly, or even wound issues like infection. In rare cases, if the patella doesn’t heal as expected, additional surgeries might be needed to correct the problem. Adhering to your surgeon’s advice also lowers the chances of other complications, including blood clots, and helps ensure the knee regains its full strength and mobility with physical therapy.

The key takeaway: every step and precaution your care team suggests—from restricted movement and medications to rehabilitation exercises—is carefully chosen to help your child heal safely and get back to their regular activities as soon as possible. If you have any concerns about the recovery plan or your child’s progress, stay in close communication with your surgeon and medical team for ongoing guidance.

Possible Complications After Kneecap Surgery

While kneecap surgery is generally safe and effective, there are a few potential complications parents should know.

• Wound Healing Problems: Sometimes, the incision site may have trouble healing. This can lead to redness, swelling, or even infection. Keeping the wound clean and following the surgeon’s instructions can help reduce these risks.
• Blood Clots: There is a small risk of developing blood clots in the legs after surgery. Signs include swelling, pain, or warmth in the calf or thigh. Your child’s doctor may recommend gentle movement, specific exercises, or, in some cases, medications to lower this risk.
• Other Considerations: Additional rare complications could include hardware irritation (from the pins, screws, or wires used in the repair), stiffness in the knee, or ongoing pain. Regular follow-up visits will help the care team monitor for these issues and guide you through any necessary steps if they arise.

Staying in close contact with your surgeon and carefully following all post-operative instructions can go a long way in preventing or catching these problems early.

Can Surgical Hardware Cause Problems or Be Removed?

In some cases, the hardware—such as wires, screws, or pins—used to stabilize your child’s kneecap during surgery may cause discomfort after the bone has healed. If your child experiences irritation, pain, or limited movement due to the hardware, let your doctor know. Occasionally, these devices can become loose or bothersome. If this happens, your child’s surgeon may recommend a second procedure to remove the hardware once the fracture is fully healed. This is a relatively common occurrence and generally leads to improved comfort and mobility for your child.

What Will Help Patellar Fracture Heal Faster

Rest The Knee

When your child is 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 relieve 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 can help relieve pain. Also, rehabilitation will play a crucial role in getting your child back to his or her 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.

If your child has had surgery, the recovery process often involves wearing a brace.  The brace limits how much the knee can bend. Your child might be able to walk with the leg held straight by the brace.  It’s important to follow the surgeon’s instructions about movement and weight bearing. The doctor will let you know exactly when your child can start putting weight on the healing leg and how much movement is safe. In some cases, physical therapy may be recommended after surgery to help restore knee function, improve range of motion, and rebuild strength.

Rehabilitation

However, during rehabilitation, specific exercises will help the leg get back in shape. These will improve the range of motion in the knee and decrease stiffness while strengthening leg muscles. It’s important to know that your child’s knee might still feel stiff for some time even after the bone has healed. Bending or straightening the knee fully may be difficult at first. In some cases, your child may need additional treatment or therapy to help regain normal movement in the knee. Staying consistent with the recommended exercises and following your doctor’s advice will go a long way toward a smoother recovery.

Then it comes to weight bearing. Your doctor will tell you when your child can start to bear weight on the healing leg. After surgery, your child may need to wear a brace that keeps the knee from bending too much. Sometimes, walking is possible with the leg held straight by the brace, but only if the doctor approves. The doctor will give you detailed instructions on whether your child can put any weight on that leg and how much the knee can move during recovery. It’s important to carefully follow all recommendations from your child’s surgeon to ensure the best healing and prevent any setbacks.

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.

How Medical City Children’s Orthopedic and Spine Specialists Care For Broken Knee Caps

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.

The board-certified pediatric orthopedic surgeons and fellowship-trained physicians at Medical City Children’s Orthopedic and Spine Specialists treat children, adolescents, and young adults who have fractures of all complexities. Our expertise gives room for the accurate diagnosis of problems that relate to the growing musculoskeletal system. We will develop optimal care plans that will ensure that your child’s specific condition is catered for.

Finally, we offer personalized treatment and urgent pediatric care services at all of our five locations — Dallas, Arlington, Flower Mound, Frisco, and McKinney, TX.  If you notice any symptoms of a broken leg in your child, don’t hesitate to contact us to avoid complications.

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Footnote:

American Academy of Orthopaedic Surgeons: Broken Patella