A patella fracture is a break of the kneecap. Symptoms include pain, swelling, and bruising to the front of the knee. A person may also be unable to walk. Complications may include injury to the tibia, femur, or knee ligaments. It typically results from a hard blow to the front of the knee or falling on the knee.

1. Submitted by
Joel Rajan u
Group – 57
Bukovina state Medical university
Ukraine

2. Anatomy
The patella is a small bone located in front of knee joint — where the thighbone (femur) and
shinbone (tibia) meet. It protects knee and connects the muscles in the front thigh tibia.
The ends of the femur and the undersides of the patella are covered with a slippery substance called
articular cartilage. This helps the bones glide smoothly along each other as you move your leg
PATELLA FRACTURES
kneecap (patella) acts like a shield for knee joint, it can easily
be broken. Falling directly onto knee, is a common cause of
patellar fractures.
These fractures are serious injuries and often require surgery
to heal. Over the long term, they may cause arthritis in the knee

4. • Severe pain in and around the kneecap.
• Swelling.
• Pain when moving the knee in both directions.
• Difficulty extending the leg or doing a straight-leg
raise.
• A deformed appearance of the knee due to
the fractured pieces.
• Tenderness when pressing on the kneecap

5.  This type of break is very unstable. The bone shatters into three
or more pieces
 It can be fixed with Multiple Pins and Wires
 Some times wire is circled along the knee cap to hold pieces
 In this case the knee is kept in immobilizer for 4 to 6 weeks and
started on exercises

7. A 36 year-old smuggler, Named -Sagar Alias Jacky, presented to a Bethel
Multi-Speciality hospital, after the vehicle he was driving was involved in a
head on collision with another on-coming vehicle. His left knee hit the
dashboard of the car on impact.
Sagar Alias Jacky

8. Examination revealed a patient in pain but with stable vital signs. There
was a deep laceration on the anterior aspect of the knee joint which was
communicating with an underlying comminuted patella fracture. The
patient had lost his ability to extend the left knee against gravity

9.  X-rays were done and revealed displaced, comminuted left knee
patella fracture but intact tibia and femur articular surfaces.(fig1)
Figure 1
Fig 1 shows Knee radiographs, lateral and
anteroposterior views, showing the extent of patella
displacement and comminution

10.  The patient was prepared and taken to theatre where severe
comminution of the patella fracture was evident with disruption of the
extensor mechanism. By gentle manipulation of fragments, the
fracture was reduced and fixed with wires (Figure 2).
Figure 2
Figure 2 shows An immediate post-operative
radiograph, anteroposterior view, showing the
wires configuration

11.  The patient was put on a cylinder cast, with knee in about 10 degrees
flexion, which was subsequently replaced, at four weeks, with a ranger
knee brace. Partial weight mobilization on crutches and graduated range
of motion exercises were started after the application of the knee brace.
Follow-up radiographs showed progressive union (Figure 3).
Follow-up
Figure 3
Figure 3 shows Radiographs at six months, post-operative,
reveals significant union

12. The wires were removed one and a half years after clinical and
radiological union of the fracture (Figure 4).
Figure 4
Figure 4 shows An immediate post-
operative X-ray after removal of wires
showing fracture union
At this particular time, the patient was on full
weight bearing without walking aid, had full
extension of the knee and could achieve flexion
of up to 80 degrees. The knee flexion
progressively improved and at 8 years, had no
pain, flexion was at 140 degrees and had
resumed his pre-accident activities.
Radiographs done at 8 years showed significant
remodelling of the patella. There was
heterotrophic ossification of the patella tendon
which was asymptomatic.

13. Figure-5
Figure 5 shows Radiographs done at
8 years showing remodelling of the
fracture. Note the heterotrophic
ossification of the patella tendon
which is asymptomatic
Figure-6
Although there was initial wasting of
the quadriceps muscles, the patient
has now complete extensor
mechanism, as good as the opposite
side (Figure 6)
Figure-7
Figure 7 shows The picture reveals
flexion of 120 degrees while seated
and is able to reach 140 while
squatting

14. Comminuted fracture patella can be managed with patella preservation as above case study indicates.
The reduction and fixation with wires, applied using tension band wiring technique, though difficult and
may not produce accurate anatomic reduction, gives reasonable stability needed to start early mobilization.
In this particular protected with a cylinder cast before replacement with a ranger knee brace. However,
partial weight bearing was started early; 1stday post-operative. The early mobilization helped to maintain
the muscle strength and bone density whereas range motion exercises, started after the cast removal, were
essential in reestablishment of the knee function.
Although he developed heterotrophic calcification of his patella tendon, which is asymptomatic, and has
not fully regained full flexion, he has sufficient function to perform his daily routine which involves a
significant amount of walking as per his salesman’s duties. Above all, he is painless and highly satisfied with
his knee function. This may not have been the case had we opted for patellectomy as the primary mode of
management.
The remodelling process took long, as shown by post-operative X-rays, but this was not clinically significant
as he was absolutely pain free at 3 months, post-operatively.
The patient is still on follow up and how much more flexion he regains as well as whether he develops
patellofemoral osteoarthritis shall be of interest. Patient, the fixation was initially

15. Patella preservation is an option in management of comminuted
displaced fractures of patella and has several advantages relative to
patellectomy as a mode management. This is a case study which should
lead to a randomized controlled study to validate this method of
management.

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