The document provides an overview of knee cap fractures (patella), including types of fractures, causes, symptoms, and treatment options. Non-operative treatment is recommended for undisplaced fractures, while surgical intervention is necessary for displaced or comminuted fractures. Postoperative management and potential complications are also discussed, highlighting the importance of proper recovery and follow-up care.

1. KNEE CAP
FRACTURES
(PATELLA)

2. Dr. A.MOHAN KRISHNA
M.S.ORTHO, MCh ORTH(U.K)
Consultant Orthopaedic surgeon ,
Trauma, Arthroscopy,
Arthroplasty Surgeon
Apollo hospitals, Hyderabad
Consultant Orthopedic Surgeon at
www.drmohankrishna.com
www.healthyjointclub.com
www.bonesandjointsclinic.com

3. KNEE CAP - PATELLA
Knee cap (patella) is a small bone in
front of the knee joint. It protects knee
joint and connects the muscles in front
of thigh to shin bone.
Knee cap acts as fulcrum for the knee
joint movement.
The back side of knee cap and lower
end of thigh bone is covered with
cartilage which helps in smooth
movement of knee

4. KNEE CAP – PATELLA Fractures
Knee cap can fracture in variety of
ways
1. UNDISPLACED FRACTURES
2. DISPLACED FRACTURES
a. Transverse
b. Lower end
c. Upper end
d. Comminuted (Multiple bits)
e. Undersurface of patella
(cartilage)
3. OPEN FRACTURES:
There is break in skin with fracture
is exposed to outside environment.

5. CAUSES: INJURY
MECHANISM
1. Direct blow on knee:
- Fall on knee cap
- Dashboard injuries
2. Indirect injuries
- Sudden pull of thigh muscles can
fracture the knee cap

6. SYMPTOMS
Pain/swelling in front of knee
bruising
Inability to straighten the knee and walk

7. DOCTOR EXAMINATION
deformity swelling contusion

8. INVESTIGATIONS

9. TREATMENT: Non-operative treatment
-
- If the broken knee cap is not displaced
- Even multiple pieces if they are not displaced.
- Knee is put in cast or splint for 6 to 8 weeks
- Not to put weight on the leg until fracture heals.
- Walk with help of crutches or walker.
CYLINDER CAST

10. OPERATIVE TREATMENT
- Displaced and comminuted (multiple
bits) fracture of knee cap need surgery.
- Fractured knee cap bones are usually
separated because of pull of strong thigh
muscles that are attached on the top.
Timing of surgery:
- If skin is intact and healthy surgery can be
done immediately.
- If the skin is bruised contused and
swollen wait for skin to heal.
- If the fracture is open to outside
environment it needs emergency surgery.

11. SURGERY
TYPE OF PROCEDURE DEPENDS ON TYPE OF FRACTURE.
TRANSVERSE FRACTURE:
- Two part fracture with horizontal break in knee cap.
- Figure of eight tension band wiring with wires and pins.
- Screws also can be used in place of pins.

12. SURGERY
COMMUNITED FRACTURE:
- If the knee cap is broken into several pieces and are in place 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

13. SURGERY
PATELLECTOMY : REMOVAL OF KNEE CAP
1. PARTIAL PATELLECTOMY:
When the lower portion of knee cap is broken into multiple bits, these
bits can be removed and tendon can be sutured to the major bit of knee
cap

14. SURGERY
2. COMPLETE PATELLECTOMY:
Total removal of knee cap. In case the bone bits cannot be put
together these bits can be removed and soft tissue of thigh and shin
bone can be sutured back.
There may be weakness of knee function in case of complete removal
of knee cap.

15. POSTOPERATIVE MANAGEMENT:
After patella fixation
Day 1
• Static quadriceps
• Ankle pumps
• Protected weight bearing with walker or crutchs
Day 2
• Discharge
• Gentle knee movements
• If the fracture is multiple bits knee movements are
restricted for 3 to 4 weeks
End of 2 weeks
• Stitches removal
• Exercises as advised
• Full weight bearing after 3 to 4 weeks

16. POSTOPERATIVE MANAGEMENT: After
partial and complete knee cap removal
Day 1
• Patient on Brace or cast for 4 weeks
• Ankle pumps, walking with the help of walker/crutches
Day 2
• Discharge
• Review after 2 weeks
2 weeks
• Stitches removal
• Review after 4 weeks from date of surgery

17. COMPLICATIONS
Delayed
union
Nonunion
Infection
Knee
stiffness
arthritis

18. IMPLANT REMOVAL
In some cases or thin individuals the implants can be felt underneath the
skin, and can cause some discomfort.
In such instances implant can removed after one or one and half year
after the surgery.

19. CONTACT
Dr.A.MOHAN KRISHNA
M.S.Ortho., MCh Ortho(U.K).,
Consultant Orthopaedic Surgeon,
Apollo Hospitals,
Hyderabad.
Appointments: Secretary : 09247258989
09441184590
08332936085
www.drmohankrishna.com
www.healthyjointclub.com
www.bonesandjointsclinic.com
Email: bonesandjointsclinic@gmail.com