Have you been diagnosed with a patellar fracture?
This means your kneecap is broken. Regardless of the treatment you receive it will take a few weeks for your patella to fully recover.
Here are the answers to the questions you are probably asking yourself about the treatment, rehabilitation, recovery time, walking, and potential complications of a patellar fracture.
To answer these questions, I rely on:
My experience as a diagnostic radiographer and extensive research of medical literature on the management of patellar fractures.
Happy reading!😀
Have any questions, remarks, or experience to share? Feel free to use the comments section at the end of the article!🙏
Last updated: March 2024. Written by Juliet Semakula, diagnostic radiographer.
Disclaimer: no affiliate links.
Before I delve into your questions, I will briefly give you some bit of anatomy of the patella.
A bit of anatomy
A kneecap (patella) fracture is a break of the bone located on the front of the knee joint. The patella is a sesamoid bone or a round bone rooted in a tendon that shields and protects a joint.
In the case of the patella, ligaments attach it to both the thigh muscles (quadriceps) and the shinbone (tibia).
These images show an AP and lateral image of transverse patellar fracture
▶️Types of patellar fractures.
There are different types of patellar fractures, According to studies they account for approximately 1% and they are most prevalent in 20- to 50-year-olds.
Kneecap fractures usually occur as a result of trauma to the patella; it could be a fall, sports or car accident.
Common patellar fractures include:
#️⃣Closed Fracture or hairline breaks: Most types of patella fractures I see are closed fractures, in which the patella does not break through the skin.
#️⃣Open Fracture. An open fracture occurs when the broken bone breaks through the skin, exposing the injured patella.
#️⃣Nondisplaced Fracture, the pieces of bone remain either in contact with each other or just a millimetre or two away. Stable fractures usually heal easily. They occur when there is no break in any of the bones, but there is a crack or chip in one or more of them.
#️⃣A Displaced Fracture occurs when a break in one or more of the bones causes the bones to shift out of place. They do not align properly, and this type of fracture often requires surgery to realign and stabilise the broken bone.
#️⃣Comminute fracture or multi-fragmented displacement, here the bone shatters into three or more pieces in this type of fracture.
To diagnose a comminute fracture, a doctor will examine the bone. If the pattern of the fracture is stable, it is best to treat the injury with immobilisation. If the fracture pattern is unstable, surgery may be necessary to repair or remove one or more pieces of bone.
Images from Larangeira, 2015
Management and treatment will be based on the fracture classification and findings on physical examination. what ever fracture your have got rehabilitation and recovery are the same.
▶️How painful is a patella fracture?
⏸️When you have had a kneecap fracture you will experience severe pain around the kneecap or in the knee.
⏸️You will also have some bruising and swelling, which can be severe, even with relatively minor kneecap fractures.
⏸️You will find it difficult to bend or straighten the knee or to hold the leg out straight.
I have seen patients come for x-ray, in pain and sometimes they are given painkillers to help with the pain. But with proper treatment your pain will be history.
▶️Can a fractured patella heal on its own?
I have seen a few people ask this question and my answer is NO!🙅
When you think you have fractured your patella, please seek medical treatment as soon as possible.
When you go to the doctor, they will examine your kneecap to see if it’s tender, stiff, swollen and test the range of movement.
Then x-rays will be requested to confirm diagnosis. If it is found that you have fractured your kneecap then treatment will commence.
So, to answer your question a fractured kneecap will need treatment or some kind of therapy to help with complete healing.
▶️How do you treat a fractured patella bone?
Treatment of your fracture will depend on the severity and location of your fracture.
If your fracture is nondisplaced then it will be treated non-surgical. But if your fracture is displaced surgical treatment may be used.
What is the treatment for a non-displaced and minimally displaced patella fracture (non-surgical)
When you are told that your fracture is fractured but not displaced it means the pieces of the bone are not out of place. In this case you may not need surgery.
A cast or splint, knee braces, or hinge braces will be applied to your kneecap to keep the knee straight to help prevent motion in your leg.
This type of knee brace is more likely what you will have after a kneecap fracture whether operated or not.
This kind of immobilisation helps to keep the broken ends of the bone in proper position while they heal.
What is the treatment for a displaced patella fracture (surgical)
When you are told that the pieces of your bone are out of place (displaced), you will most likely need surgery.
One of the reasons why fractured patella bones that are not close together often have difficulty healing or may not heal is:
♦️The thigh muscles that attach to the top of the patella are very strong and can pull the broken pieces out of place during healing.
♦️Timing of surgery. If the skin around your fracture has not been broken, your doctor may recommend waiting until any cuts have healed before having surgery.
♦️If your bone comes through the skin, surgery will typically be performed as soon as possible to reduce the risk of infection.
When your patella fracture is transverse as in the image below most often it will be fixed using screws or pins, wires or a configuration tension band to help keep the bone together.
This aims to convert the tensile force applied to the patella via the extensor mechanism into a compression force to assist with fracture reduction and healing.
Note! This procedure is best for treating fractures that are located near the centre of the patella. Fracture pieces at the ends of the kneecap are too small for this procedure.
Breaks that are in many pieces can be over-compressed making it difficult to press together by the tension band.
Another approach to a transverse fracture is to secure the bones using small screws or small screws and small plates.
Based on scientific studies, the described methods lead to better functional outcomes, decreasing hardware-related complications, and can be used in simple as well as comminute fractures.
Also, the fracture healing and functional outcomes and rate of complications were satisfactory after surgery. (kachare, 2023).
▶️Possible complication of both non-surgical and surgical treatment
⚫There is a possibility of possible loss of range of motion in the knee. Some people experience ongoing loss of knee movement, they find it difficult to bend and straighten the knee.
⚫Some patients are also at risk of secondary osteoarthritis at the patellofemoral joint following a fracture.
⚫ The position of the patella makes it prone to open injuries and infection.
⚫Prolonged postoperative immobilisation and improper rehabilitation.
⚫Delayed or non-union of the patella fracture
All these possible complications are uncommon if you get the best care and therapy.
Things like osteoarthritis primarily depends on the amount of cartilage damage that occurs during the initial injury.(Nathan, 2011)
The treatment of patella non-union and delayed union is a challenging problem with limited evidence in the literature regarding the management protocol. (Nathan,2011)
There is a need for more studies to add to the limited available evidence regarding the management of non-union and delayed union of patella fractures.
▶️Rehabilitation and physical therapy for a non-surgical kneecap fracture
Whether your treatment is surgical or nonsurgical, rehabilitation will play a vital role in getting you back to your daily activities.
After your treatment, your leg will be immobilised in a cast or a brace for 2 to 6 weeks whilst the injury heals. Because of this your knee will became stiff and your thigh muscles may become weak
Tips to help you at home.
♦️Elevate the injured leg when resting to help reduce swelling.
♦️In the first couple of weeks after injury, minimise the amount you move around to allow the pain and swelling to settle.
♦️Use ice over the injured area to help with pain and swelling.an ice pack or a bag of frozen peas wrapped in a tea towel can be used for 10 minutes at a time.
♦️You should not drive whilst in a brace or cast.
♦️You can return to work or school as soon as you are able to do your normal duties.
▶️How long does it take to recover from a fractured patella?
Most kneecap injuries I have seen heal without any problems in around six weeks. Patients are able to walk on the leg.
Your recovery will depend on several factors:
♦️The severity of your injury
♦️Whether your treatment was surgical or nonsurgical
♦️The time needed for rehabilitation.
However, some patients do complain of pain or discomfort, stiffness, swelling, and decreased strength in their kneecap even after 6 weeks.
⚠️Caution⚠️! If you suffer from diabetes or if you smoke, these factors can hinder bone healing and certain symptoms may take longer to settle down.
So, if possible you can stop smoking during the recovery period.
Simple exercises you can try at home from NHS guidelines
 | Point your foot up and down within a comfortable range of movement. You can try these three to four times a day |
 | With the leg straight and supported, gently tense your thigh muscle and try to straighten your knee further. Hold for 10 seconds and repeat 7-10 times. |
▶️Immobilisation of the knee after surgical treatment of a broken kneecap.
🚶Weight-bearing on the affected leg
Your doctor will tell you when you can begin to bear weight on your leg.
Usually, some people start after a few weeks after surgery. This depends on the fracture severity.
However Initial weight-bearing exercise is usually limited to gently touching your toe to the floor. Most doctors encourage people to wear a leg brace when putting weight on the knee.
As your injury heals and your muscles strengthen, you will gradually be able to put more weight on your leg.
I have seen Some people put weight on their leg as soon as the pain is bearable while wearing a brace, especially for minimally displaced fractures but some fractures cannot bear weight for at least 6 to 8 weeks of treatment.
🪜Climbing stairs and walking after a kneecap fracture surgery
Some people do ask about climbing the stairs and walking after surgery, studies show that climbing stairs after kneecap surgery is ok but you must listen to your body and not push yourself too hard. If you are experiencing any pain or discomfort. Stop and ask for help!
Here are some tips to help you climb stairs after a kneecap surgery.
🟢Start slowly and take your time. Don’t try to rush up or down the stairs.
🟢Use a handrail for support.
🟢Lead with your good leg as you go up the stairs, and lead with your operated leg as you go down the stairs. This will help to take some of the weight off your knee.
🟢Keep your knee straight as much as possible. Don’t bend your knee too much, as this can put a strain on your new joint.
🟢Take breaks as needed. Don’t be afraid to stop and rest if you start to feel pain.
🚶Walking after knee surgery
🟢It is better to begin with short walks and gradually increase the duration as your strength improves.
🟢You may use crutches or walkers recommended by your doctor to help you put some weight on your affected leg.
This is what I wanted to tell you about kneecap fractures. I hope I have given you some reassurance, I wish you a quick recovery.🙋
Below are some of the articles I have relied on for this article.
📚Source:
Henrichsen JL,Wilhem SK, Siljander MP, Kalma JJ, Karadsheh MS. Treatment of Patella Fractures. Orthopedics. 2018 Nov 1;41(6):e747-e755. doi: 10.3928/01477447-20181010-08. Epub 2018 Oct 16. PMID: 30321439.
Kachare A, Jagiasi J, Jadhav P, Munde K. Achieving Rapid Healing and Low Complication Rates in Patellar Fracture Fixation: The Benefits of Cerclage and Figure-of-Eight Configuration. Cureus. 2023 May 15;15(5):e39059. doi: 10.7759/cureus.39059. PMID: 37323351; PMCID: PMC10267295.
Image: Larangeira, João & Bellenzier, Liliane & Rigo, Vanessa & Neto, Elias & Krum, Francisco & Ribeiro, Tiango. (2015). Vertical Open Patella Fracture, Treatment, Rehabilitation and the Moment to Fixation. Journal of Clinical Medicine Research. 129-133. 10.14740/jocmr2005w.
Dy CJ, Little MT, Berkes MB, Ma Y, Roberts TR, Helfet DL, Lorich DG. Meta-analysis of re-operation, nonunion, and infection after open reduction and internal fixation of patella fractures. J Trauma Acute Care Surg. 2012 Oct;73(4):928–932. doi: 10.1097/TA.0b013e31825168b6. Available from: http://dx.doi.org/10.1097/TA.0b013e31825168b6. [PubMed] [CrossRef] [Google Scholar] [Ref list]
Nathan ST, Fisher BE, Roberts CS, Giannoudis PV. The management of nonunion and delayed union of patella fractures: a systematic review of the literature. Int Orthop. 2011 Jun;35(6):791-5. doi: 10.1007/s00264-010-1105-6. Epub 2010 Aug 1. PMID: 20680273; PMCID: PMC3103972.
Klassen JF, Trousdale RT. Treatment of delayed and non-union of the patella. J Orthop Trauma. 1997 Apr;11(3):188–194. doi: 10.1097/00005131-199704000-00009. Available from: http://dx.doi.org/10.1097/00005131-199704000-00009. [PubMed] [CrossRef] [Google Scholar] [Ref list]
Image : https://www.ruh.nhs.uk/patients/patient_information/ORT051_Advice_after_a_knee_cap_injury.pdf