Patella Fracture Treatment Guidelines Handout

What is a patella fracture?

A patella fracture, commonly known as a kneecap fracture, is a break in the patellar tendon, a small bone at the front of your knee. This type of fracture can range from a minor crack to a severe shattering of the bone and typically results from direct impacts to the knee, such as falls onto the knee or high-velocity strikes from motor vehicle accidents. It can also occur indirectly from sudden contractions of the quadriceps tendon that overwhelm the patella.

Causes

The main causes of a patella fracture include direct trauma from falls directly onto the knee, sports injuries, or motor vehicle accidents. Indirect patellar fractures may result from a muscular contraction in which the kneecap is pulled apart.

Types of patellar fractures

There are several types of patellar fractures:

• Displaced: This type of fracture occurs when the patella breaks into two or more pieces and the fragments are not aligned properly. This can happen due to direct impact or indirect trauma, such as a sudden twist or rotation of the knee.
• Non-displaced: In this type of fracture, the patella remains intact but there is a crack or break in the bone. It may not cause any significant changes in alignment and can often be treated non-surgically.
• Comminuted: A comminuted fracture refers to multiple fragments or pieces of bone resulting from a high-energy impact. This type of fracture is more complex and may require surgery for proper realignment.
• Closed and open patellar fractures: These are two categories of patellar fractures based on the skin and soft tissue involvement. Closed fractures occur when the bone breaks but the skin remains intact, while open fractures involve a break in the skin and potential exposure of the broken bone.
• Non-comminuted: A non-comminuted fracture is a type of fracture where the bone remains in one or two large pieces, without breaking into multiple fragments.
• Hairline: A hairline fracture is a small, thin crack in the patella that may not be visible on x-rays. This type of fracture can be difficult to diagnose and may require further imaging or examination to confirm.
• Transverse: A transverse fracture refers to a break that occurs horizontally across the patella, resulting in two separate pieces.
• Vertical: In contrast, a vertical fracture runs vertically down the length of the patella, causing it to split into two parts. This type of fracture may be caused by sudden forceful contraction of the quadriceps muscle or direct impact.
• Stress fractures: Stress fractures are tiny cracks in the bone caused by repetitive strain or overuse. While they are more common in weight-bearing bones such as the shin or foot, they can also occur in the patella.

Symptoms

Symptoms of a patella fracture include immediate and severe pain, swelling, and bruising around the knee. Patients may also notice a visible deformity or inability to straighten the knee and difficulty walking. In some cases, the kneecap may move out of place, making the knee joint itself feel unstable.

How to treat and manage a patella fracture

The approach to treating and managing a patella fracture, whether it's a comminuted fracture or a transverse fracture, depends largely on whether the fracture is displaced or nondisplaced and the integrity of the extensor mechanism. Below are the standard treatments employed for a patellar fracture to ensure proper healing and rehabilitation.

Nonsurgical treatment

Treatment typically involves immobilization for nondisplaced fractures or when the extensor mechanism is intact. A hinged knee brace or cast is used to keep the knee straight and prevent movement that might hinder healing. The knee is usually immobilized for 4 to 6 weeks. Rehabilitation includes gentle range-of-motion exercises to prevent stiffness and isometric exercises to maintain muscle strength.

Surgical treatment

Displaced fractures, significant articular step-off, or compromised extensor mechanisms often necessitate surgical intervention. The most common procedure is Open Reduction and Internal Fixation (ORIF), where the bone fragments are realigned and secured with hardware. This method is particularly effective when a transverse patella fracture occurs, and a tension band wiring technique is needed. Postoperative care mirrors nonsurgical approaches but includes a more intensive rehabilitation phase to regain full knee function.

Rehabilitation

Rehabilitation is critical regardless of the treatment approach. It begins with limiting weight-bearing and gradually progresses to include more strenuous exercises. The goal is to restore full knee flexion and extension, with activities eventually incorporating strength training and joint stabilization exercises to facilitate a return to normal activities.

What is a Patella Fracture Treatment Guidelines Handout?

Our handout is a resource designed to guide healthcare professionals through the optimal methods for managing and treating patella fractures. This handout typically includes detailed descriptions of different types of patella fractures, recommended treatment protocols for each type, specific surgical and nonsurgical management strategies, and post-treatment care instructions. It also outlines the rehabilitation process in phases, providing exercises and milestones to aid recovery.

Healthcare professionals such as orthopedic surgeons, physical therapists, sports medicine specialists, and emergency medicine doctors will find this handout particularly useful. It is a practical reference to ensure consistent and effective treatment of patella fractures, adhering to the latest standards and research in orthopedic care.

The handout should be used at the point of initial assessment of a patient with a suspected or confirmed patella fracture. It helps decide the appropriate treatment pathway based on the patellar fracture type and the patient's overall health status. Furthermore, it is invaluable during follow-up visits to adjust treatments as needed and to educate patients and their caregivers about the recovery process, expected outcomes, and any necessary lifestyle adjustments during rehabilitation.

How to use our treatment guidelines handout template

Our template for patella fractures is designed to assist healthcare professionals in delivering structured and effective care for patients with this specific injury. By following this template, you can ensure comprehensive management from initial assessment through recovery. Here's how to use the template effectively:

Step 1: Assess the fracture type

Start by determining whether the patella fracture is displaced or non-displaced. This initial assessment will guide the choice of treatment—nonsurgical or surgical—and is crucial for planning the appropriate care.

Step 2: Implement the recommended treatment protocol

Use the detailed treatment approaches outlined in the handout. There are surgical and nonsurgical strategies discussed which will help healthcare professionals choose the best option for their patients.

Step 3: Follow post-treatment care instructions

Depending on the chosen treatment approach, adhere to the postoperative or nonsurgical care guidelines to support healing. This includes specific instructions for immobilization, rehabilitation exercises, and gradual reintroduction of weight-bearing activities.

Step 4: Monitor recovery and adjust treatment as necessary

Regular follow-up appointments are essential to monitor the patient’s progress, assess the healing via physical exams and imaging, and adjust the treatment plan based on the patient's recovery status.

Step 5: Educate the patient

Ensure that patients and their caregivers are fully informed about the nature of the injury, the expected recovery timeline, and any potential complications. Provide them access to this handout so they can refer to the guidelines at home, which can help them adhere to the recovery plan and manage their expectations.

Benefits of using this handout

Using the patella fracture treatment guidelines handout provides several benefits for healthcare professionals and their patients:

1. Standardized care: The handout offers a standardized approach to treating patella fractures, ensuring that all patients receive care that aligns with current best practices and evidence-based medicine. This consistency improves treatment outcomes and reduces variability in care.
2. Efficient reference: It serves as a quick and efficient reference for clinicians, including orthopedic surgeons, physical therapists, and emergency room staff, allowing them to swiftly determine the best treatment pathway for different types of patella fractures.
3. Better communication: The handout facilitates clearer communication with patients by explaining the treatment process, expected recovery timeline, and rehabilitation stages. This enhances patient understanding and engagement, which is crucial for compliance and successful recovery.
4. For educational purposes: It is an educational tool for new staff and students in orthopedic and rehabilitation settings, enhancing their learning and ensuring they apply correct treatment protocols.