Surgery for a kneecap fracture

When knees get fractured, it’s often the kneecap (patella) that suffers the damage. There’s a good reason for that: one of the patella’s key jobs is to protect the soft tissues inside your joint. But this inevitably puts it on the front line for accidents and injuries.

How do people tend to fracture their kneecaps? Perhaps the most common way is a fall – a trip onto the pavement, say, or a bad tumble in a contact sport. Another is from a direct blow to the knee. This sometimes happens in car accidents, when the knee thumps up against the dashboard.

Understanding kneecap fractures

Most fractures are diagnosed with a physical examination and an x-ray. The big question is: what type of fracture have you suffered? The ‘least complicated’ fracture type is one that’s nondisplaced. This is where the broken bone endings are still in close contact with each other. The fracture remains stable as your kneecap begins the recovery process. Many nondisplaced fractures can heal without surgery. But sometimes you’ll be asked to wear a splint or cast to help the healing along.

A displaced fracture, however, is a more significant type of break. Here the broken pieces of bone no longer stay in contact with each other. The joint surface may be damaged and the kneecap itself can become unstable. This may disrupt the connection of the quadriceps muscle to the tibia and the knee can no longer be actively straightened or the leg lifted up in the air. You may also come across the terms transverse and comminuted fractures. This is where the bone breaks into distinct pieces: either two (transverse) or three or more (comminuted). Displaced fractures in the kneecap may well require surgery.

How fracture surgery works

Knee fracture is a complicated area, so the type of surgery you have will vary a lot according to where the break is, the severity of your fracture, and whether it’s causing additional issues, such as an alignment problem. This is something your consultant will discuss with you carefully as they advise you on the best options. Broadly, though, the focus of surgery could be on one or more of these areas:

Realigning the break

If the pieces are out of place, surgery can help to bring them back into alignment. There are several different ways to do this. One is to use “tension-band” surgical wire. This loops around the kneecap, for example in a “figure of eight” pattern, to bind the bone and stabilise the break. Transverse fractures are often treated in this way. Another is by attaching plates to the bone, which keep the broken pieces neatly locked in place while the healing proceeds

Cleaning up the surface

Sometimes the impact of the trauma disrupts the surface of the kneecap. Fragments of bone break away from the patella. During surgery, we may need to remove these pieces because they’re too small to be reattached. Generally, though, the surgeon will look to save as much of the bone as possible

Treating soft tissue damage

If the knee cannot be actively extended or a straight leg raise is not possible, the extensor mechanism is disrupted and the patella must be fixed to rectify this. Kneecap fractures sometimes come bundled with damage to the surrounding soft tissues – for instance, a torn meniscus or a ruptured patellar tendon. These might need repair or reconstruction work too – either during the fracture operation, or at a later time.

After surgery

It can take a little while to recover fully from fracture surgery. Initially, you’ll need to wear a brace. This helps to keep your leg stable while the break heals. The aim is to gradually reintroduce knee movement while allowing the fracture to heal. You’ll also spend time with a physiotherapist, who will advise you on how to build movement and strength back into your leg to avoid stiffness in the knee joint. Some people find that the plates, screws or wires used during the operation can be irritating, or sore. If this happens, you may need a follow-up operation to remove them. But this usually wouldn’t happen for at least 12 months, to give your kneecap the best chance of healing.

If you’re worried about your knees – or experiencing pain and other problems in your joints – it’s always a good idea to have them properly investigated. You can book an appointment with Mr Bailey through our website, or call us direct on 01962 826107. We’ll be glad to get you the help you need.