Patella Fracture PhysiotherapyBy Nigel Chua
A patella fracture is a bone breakage of the kneecap.
to the front of the knee. The patient may also find it difficult or unable to walk. Complications may include injury to the tibia, femur, or knee ligaments (such as anterior cruciate ligament ACL injuries).
It typically results from a hard blow to the front of the knee or falling on the knee. Occasionally it may occur from a strong contraction of the thigh muscles. Diagnosis is based on symptoms and confirmed with X-rays. In children an MRI may be required.
Treatment may be with surgery or conservatively (no surgery), depending on the type of fracture. Stable undisplaced fractures can usually be treated with plaster casting to immobilize the knee and patella (this can be done with thermoplastic splinting as well, which our senior hand therapists can fabricate for patients on the spot).
Some displaced fractures can be treated with casting, as long as a person can straighten their leg without help. Typically the leg is immobilized in a straight position for the first three weeks, and then increasing degrees of bending are allowed. Other types of fractures generally require surgery.
Patella fractures make up about 1% of all broken bones, and it is males who are affected more often than females. Patients also tend to be more commonly in the middle-age group (above 40 to 50 years of age).
Fortunately, outcomes are typically good with knee physiotherapy.
Diagnosis is based on symptoms and confirmed with x-rays.
In children an MRI may be required.
Treatment may be with or without surgery, depending on the type of fracture.
Undisplaced fractures can usually be treated with casting.
Some displaced fractures can be treated with casting, as long as a person can straighten their leg without help. Typically the leg is immobilized in a straight position for the first three weeks, and then increasing degrees of bending are allowed.
Patellectomy (in cases of comminuted fracture) is removal of the entire patella, whereas a partial patellectomy is removal of only a portion of the patella, while any ligaments or tendons that had been connected to the removed portion are connected to the remaining portion.
The fracture may require tension band wiring (in case of a two-part fracture) to unite the fractured bones. With advancements in fixation techniques, comminuted fractures of the patella may be reconstructed (patella saving operations).
An effective rehabilitation program reduces the chances of re-injury and of other knee-related problems such as patellofemoral pain syndrome and osteoarthritis.
Typically patella dislocations are initially immobilized for the first 2–3 weeks to allow the stretched structures to heal.
Rehabilitation focuses on maintaining strength and range of motion to reduce pain and maintain the health of the muscles and tissues around the knee joint.
The objective to any good rehabilitation program is to
- reduce pain
- reduce swelling
- reduce joint stiffness
- increase range of motion.
A common physiotherapy plan is to strengthen the
- hip abductors
- hip external rotators
- quadricep muscles.
Commonly used exercises include isometric quadricep sets, side lying clamshells, and leg dips with internal tibial rotation.
The idea is that because the medial side is most often stretched by the more common lateral dislocation, medial strengthening will add more stabilizing support.
With progression, more intense range of motion exercises are incorporated.
Our senior physiotherapists will also use treatment modalities such as
- cold therapy
- heat therapy
- ultrasound therapy
- radio-frequency Indiba physiotherapy
- stretching therapy
- dry needling
- joint mobilization.