Although bones are incredibly resilient, everything has its breaking point. Every year, about two percent of us will suffer a fracture. The most common ones tend to involve the collarbone, spine, ankle, forearm and hip. But of course it’s possible to fracture your knee too.
So how does that typically occur? And if you have fractured your knee, what should you do about it?
How fractures happen
The vast majority of fractures happen because of an injury. Although it’s possible to suffer a fracture without an accident, in practice this is very rare. Unsurprisingly, sport is one of the biggest causes of fractures, usually through a direct blow to the knee, or a twist that brings the bone to breaking point. Other common causes are an awkward fall, or a car accident where the knee thumps up against the dashboard. The fracture can happen to any of the four main bones around the knee:
- the kneecap (patella)
- the shinbone (tibia)
- the calf bone (fibula)
- the thighbone (femur)
What fractures do to the knee
Fractures vary significantly in terms of the damage they do. At the mild end, you might suffer a hairline break that will easily heal by itself (see below). A much more severe fracture would be a multi-point break that wrenches the bones out of alignment. We tend to place fractures in two main groups:
1. Fractures outside the joint
This kind of break (an “extraarticular” fracture) affects the bones surrounding the joint. The type of accident often dictates the exact pattern of the fracture. A high-energy break from something like a motorcycle crash, for example, will look quite different to a low-energy impact after a fall.
2. Fractures inside the joint
This kind of fracture (“intraarticular”) happens inside the knee joint itself and often involves damage to the cartilage and soft tissue. Damaging the cartilage has long-term implications for the knee, because it raises the risk of future osteoarthritis (where the bones rub painfully against each other).
Of course it’s also possible to suffer a mixture of damage, for instance a main fracture outside the joint with impacted cartilage inside.
What fractures feel like
A fractured knee usually causes immediate pain after the injury, followed by rapid swelling and bruising. Other symptoms can include function and mobility problems (eg difficulty bending or straightening your leg), a grating or catching feeling inside the knee, or not being able to walk or bear weight on your leg. The knee could even look visibly disjointed or misaligned.
How we treat fractures
Diagnosis – Before we do anything else, we’ll want to look at your knee in detail to determine precisely what kind of damage you’ve done. We’ll do a physical examination and take some scans. X-rays and CT scans are usually effective at confirming the presence and extent of fractures. But we may also want to look at damage to the cartilage and soft tissue as well; for this you might need an MRI scan or an ultrasound. Putting all this together will allow us to plan the next steps…
Without surgery – Some fractures can be treated conservatively. At the mild end, you might just need to rest and treat any pain with simple painkillers like paracetamol or ibuprofen. If we think your fracture needs support, we might put your knee in a non-weight-bearing plaster cast while the fracture heals naturally (this usually takes about a month to six weeks). We will probably also recommend that you have some physiotherapy to help build up strength in the muscles around your knee
With surgery – Severe fractures almost always need surgery. This can involve placing surgical plates and screws in your knee to physically hold the broken pieces of bone together. We may also need to repair or reconstruct soft tissue damage, such as a torn ligament or meniscus. Sometimes it’s possible to do this at the same time, but we may ask you to come back in for a separate operation. Following surgery, you will need to wear a brace while the bones heal – this may need to be in place from a few days to a few months, depending on the type of injury.
Keen to find out more? You might find these articles helpful…
Learn more about how the knee works
Get more detail about fractures in our Conditions section
Read about surgery for cartilage repair
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