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Introduction

Knee Pain

Patella Fracture

A patellar fracture is a break in the patella, or kneecap, the small bone that sits at the front of your knee. Because the patella acts as a shield for your knee joint, it is vulnerable to fracture if you fall directly onto your knee or hit it against the dashboard in a vehicle collision. A patellar fracture is a serious injury that can make it difficult or even impossible to straighten your knee or walk.

Some simple patellar fractures can be treated by wearing a cast or splint until the bone heals. In most patellar fractures, however, the pieces of bone move out of place when the injury occurs. For these more complicated fractures, surgery is needed to restore and stabilize the kneecap and allow for the return of function.

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Causes

Patella fractures are injuries often associated with a blow to the knee. Common causes include:

  • Falling directly on the knee, especially on a hard surface such as concrete

  • Sports where the knee may be directly hit by a ball, bat or stick

  • Car accidents where the knee hits the dashboard

  • Gunshot wounds

  • Sudden contractions (pulling) of the quadriceps muscle that causes the tendon to pull on the kneecap and break it apart

Symptoms

The symptoms of a patella fracture may include:

  • Pain around the kneecap or in the knee

  • Bruising

  • Swelling, which can be severe, even with relatively minor kneecap fractures

  • Inability to bend or straighten the knee or to hold the leg out straight

  • Inability to bear weight, stand or walk

  • Deformed appearance of the knee, especially with severe fractures

  • Bone protruding from the skin of the knee in the case of an open patellar fracture

If you have these symptoms after hitting or injuring your knee or leg, call your doctor or visit an urgent care clinic for an examination.

Diagnosis

Your doctor may use some of the following techniques to determine if you have fractured your patella:

  • History: The doctor will ask you about any recent trauma, such as sports injuries, automobile accidents or falls.

  • Physical examination: The doctor will examine the knee and check for deformity that can be felt through the skin such as gaps or edges of bone.

  • The doctor may put mild pressure on the kneecap, and may bend or straighten the leg to see if those actions cause or increase pain or reveal a deformity.

  • X-rays help the doctor identify a fracture and see if there are fragments.

Non-surgical treatments

Nonsurgical treatment is typically recommended for more stable patellar fractures or less severe breaks and may include: 

  • A cast or splint to hold the leg in place while the bone heals

  • Preventing or reducing weight-bearing

  • Pain medications (opioid pain medication may be appropriate for the first few days after a severe kneecap fracture, followed by non-opioid options)

  • Physical therapy and walking aids to help you regain strength and independence.

Surgery