1. Patella Fracture
Ms. T and Ms. Raj

2. What has occurred anatomically?
A patella fracture, or broken knee cap, is usually caused by a forceful direct blow to the knee, such direct trauma from an opponent during sport.
IS THIS AN ACUTE OR CHRONIC INJURY?
IS THE PATELLA PART OF THE AXIAL OR APPENDICULAR SKELETON?

3. What has occurred anatomically?
The patella fracture may consist of a single crack across the kneecap or the kneecap may be broken into several pieces

4. What has occurred anatomically?
In some instances a forceful contraction of the quadriceps muscles can be enough to cause a fracture of the patella. This causes a horizontal crack across the knee cap, which makes it impossible for the patient to straighten their knee.

6. IS THE PATELLA ON THE ANTERIOR OR POSTERIOR SIDE OF THE BODY?

8. Signs and Symptoms of Injury
There is immediate intense knee Pain.
Almost immediately the knee will become Swollen and the patient is unlikely to be able to bend the affected knee.
WHAT OTHER SIGNS/SYMPTOMS MIGHT BE OCCURING FOLLOWING THE ONSET OF THIS ACUTE INJURY?
WHAT PROCESS IS OCCURRING IN THE BODY IF S.H.A.R.P. IS SETTING IN?
WHAT STAGE OF INFLAMMATION IS THIS?
If the patella fracture is right across the knee cap it may be possible to feel a gap.

9. WHAT IS ACTUALLY CAUSING THE SWELLING TO OCCUR?

11. Treatment of the Injury
If a fracture is confirmed, subsequent treatment will depend upon the appearance of the fracture fragments.
The orthopaedic consultant will aim to restore the knee cap to its original state.

12. Treatment of the injury
If the fracture is in the form of a small crack, and the knee cap retains its original position, the consultant usually decides to immobilize the knee joint in a plaster cast for 6 weeks.

13. Treatment of the injury
If the fracture is caused by more force and the fragments of the knee cap are severely disrupted, it is usually necessary to operate and restore the knee cap to its original position using tensioned wire.

14. Treatment of the injury
Where the damage to the kneecap is so great that normal alignment is impossible, it may be necessary to remove the knee cap completely.
This is to prevent the development of osteoarthritis in the joint. Where the kneecap is removed the leg is usually put in a plaster cast for 6 weeks.

15. Treatment of the injury
Patella replacement surgery might be necessary depending on the severity of the fracture (partial or full replacement).

16. Rehabilitation of the injury
The rehabilitation protocols vary according to the choice of technique used by the orthopaedic consultant.
Some consultants allow the patient to come out of the plaster/cast after 2 to 3 weeks and use a knee brace instead.
This allows the physiotherapist to
begin work on restoring range of
movement and strength.
What stage of healing/inflammation is
this?

17. Rehabilitation of the injury
At around six weeks, as long as there is no pain, the patient can usually begin using the static cycle.

18. Rehabilitation of the injury
At between 6 and 12 weeks, once the range of movement and strength have been restored, the level of activity can be progressed under the supervision of a physiotherapist.
Pool running and exercises in
water using a buoyancy belt can help to restore full movement.

19. Rehabilitation of the injury
Long term maintenance of quadriceps strength is thought to be particularly important to prevent the onset of patello-femoral osteoarthritis.
Knee pain following a patella fracture is quite common, even after the fracture has healed. Many people find that a knee brace or support helps to provide warmth and alleviates their knee pain symptoms.

21. Injury prevention
Some form of protective padding over the knees may be helpful, particularly in those people who are engaged in activities that might lead them to fall on their knees, such as skateboarders and handball players.