A patella fracture is a break in the kneecap that most commonly occurs in people aged 20-50. It can result from direct impact to the kneecap or indirect force through knee flexion. Fracture types include transverse, comminuted, and pole fractures. Diagnosis involves physical exam and x-rays. Treatment may involve immobilization in a cast or brace for undisplaced fractures, or internal fixation with screws or wiring for displaced fractures. Physical therapy focuses on reducing swelling, regaining quadriceps strength and full range of motion.

1. PATELLA FRACTURE
- Presented by Neetu Bargayary, BPT 4th Year.

2. INTRODUCTION
Definition
• A patella fracture is a
break in the kneecap.
Epidemiology
• 1٪ of all fractures.
• Most prevalent within
the age group of 20–50
years.
• incidence in men is
twice as high as in
women.

3. CAUSE/MECHANISM OF INJURY
• The patella may be fractured due to –
 Direct injury
 Indirect injury
 Combined injury
Direct injury
• Results from – a blow on the anterior aspect of the flexed knee
(e.g. RTA) or fall onto the knee.
• Results in – Stellate fracture or comminuted fracture of the
patella.

5. Indirect injury
• Results from – forced passive
flexion of the knee when the
quadriceps muscle is in a state
of contraction.
• Example – fall on the feet.
• Results in – transverse fracture
of the patella
Usually displacement of
fragments occurs
Active knee extension is
impossible

6. TYPES
• Based on type of fracture displacement
Undisplaced fracture
Displaced fracture
• Based on type of fracture pattern
Transverse fracture
Upper or lower Pole fracture
Comminuted fracture
Vertical fracture
Osteochondral fracture

7. • Figure – Patterns of patellar fracture

8. DIAGNOSIS
Clinical Examination
• Pain, tenderness, swelling
and/or bruises over the knee.
• In comminuted fracture –
crepitus is felt.
• Displaced fracture of patella –
 One may feel palpable gap
between the fracture
fragments
 Inability to actively extend
the knee joint.

9. Radiological examination
X-Ray – AP, lateral and/or skyline view of the patella.
• AP and skyline view x-ray of the patella – Longitudinal
or Vertical fracture.

10. • Lateral view x-ray of the patella – transverse or
horizontal fracture.

11. Conservative treatment
Indication
• Undisplaced or minimally
displaced (>2mm)
fractures except
osteochondral fracture.
• Extensor mechanism is
intact.
• Can perform active SLR.
Procedure
• Immobilization of knee
using POP cylinder or
above-knee POP cast (3-
4 weeks).

12. • Hinge knee brace: 4-6 weeks (right figure).
• Lidocaine injection – pain relief.
Operative management
Indication
• Displaced patellar fracture
• Inability to do SLR
Procedures
• Internal fixation
• Patella excision

13. Operative treatment
Internal fixation
– Transverse fracture
Screw fixation
Tension band
wiring
Patella
excision
Complete
patellectomy
- Severely
comminuted
fracture
- Elderly
patients
Partial
patellectomy
- Pole fracture

14. Figure – Internal fixation
1. Screw fixation 2. Tension band wiring

15. Figure – Excision of the patella
1. Complete patellectomy 2. Partial patellectomy

16. PT treatment
Basic principles
1. To reduce effusion, pain and inflammation.
2. To provide the effective quadriceps mechanism.
3. To regain maximum possible ROM of flexion-extension.
PT for undisplaced fracture: treated conservatively
• POP cast is used for immobilization (3-4 weeks).
• Icing is used until effusion resolves.
• Day 1-1 week – Quadriceps contractions.
• By 2-3 weeks – Assisted SLR.

17. • Weight bearing and crutch walking are started immediately the
next day, and the patient resumes work in 3-4 days.
• POP cylinder cast is removed after 4-6 weeks and knee flexion
is initiated. Knee flexion may be preceded by thermotherapy or
cryotherapy and made vigorous to attain early movement.
• Correct weight-bearing and gait pattern should be re-
established to avoid limp.
• Full function should be regained by 8-12 weeks.
PT for displaced fracture: treated by IF (screw or TBW)
1-10 days
• Limb immobilization using plaster cast or pressure bandage.

18.  Maximal elevation + ice for 3-5 days.
 Vigorous ankle toe movements and relaxed passive
movements to the hip should be given.
 Isometrics to the quadriceps, knee and ankle by day 3-4.
 Graduated painless assisted SLR by day 3-4.
 NWB crutch walking should be initiated as soon as it is
painless.
Mobilization: 10 days onwards
• Small range movements with or without CPM.
• Strong isometrics to the quadriceps

19. By 6 weeks
 Gradual weight-bearing should be initiated in parallel bars
 Weight transfers
 Progression to canes
 PRE and prone kneeling
PT for comminuted fracture: treated by patella excision
First week
• Strong ankle & foot movements with the leg in elevation
• Mild indirect quadriceps contractions by putting a soft wedge
under the knee
• Electrical stimulation for quadriceps re-education
• Assisted SLR

20. Second week
• PWB and making the previous exercise programme vigorous
 Mobilization
 Small range, self assisted movements
 CPM or relaxed passive movements
Third week
• Graduated weight bearing
• In patients treated with posterior splint, the splint should be
removed and reapplied for walking
• In patients treated with POP cast, NWB facilitates them to go
back to work as the POP cylinder is continued upto 6 weeks
• Hydrotherapy
• PRE
• Proper gait training and functional positions