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Knee Fractures

Patella Fracture

The patella (kneecap) is fairly susceptible to a fracture due to its location.  The patella is located on the front of the knee.  It is responsible for connecting your quadriceps muscle on the front of your thigh to your shin bone allowing for extension of the knee.  The patella is often fractured as a result of a direct blow or fall onto the knee.  Although less frequently, a patellar fracture can result from a violent contraction of the quadriceps muscle pulling the patella apart.


If you have suffered a fracture of your patella, you may experience significant pain, swelling and bruising on or around the front of the knee.  Additionally, you may have difficulty with knee motion and walking.  The amount of displacement usually dictates the course of treatment.  If there is no displacement (no separation between broken fragments), usually a patellar fracture can heal on its own with a period of immobilization keeping the knee completely straight.  If there is some displacement of the broken fragments, surgery is usually indicated to secure the fragments and offset the pull of the strong quadriceps muscles.  Surgery to stabilize the fracture usually requires a combination of wires and screws depending on how many fragments are present and the exact location of the fracture on the patella.  Occasionally, if the fragments are too small to stabilize, some pieces of bone may be removed during the surgery.  Your doctor can discuss these different options with you and help choose what is right for you.


Recovery from a patellar fracture, regardless of treatment rendered, will require a period of immobilization, non-weight bearing and rehabilitation.  Rehabilitation will be key in preventing muscle atrophy (shrinking) and restoring motion once this is approved by your doctor.  The rehabilitation specialist will guide your progress with the doctor’s approval for progressing motion, strength and weight bearing.


Proximal Tibia / Tibial Plateau Fracture


A fracture of the upper (proximal) end of the tibia or shin bone can result from a variety of different mechanisms of injury.  A motor vehicle accident, fall from a height, high velocity injuries (such as sporting accidents) or simply tripping over a curb can cause fractures of this bone.


The tibia makes up the lower portion of the knee joint and therefore is exposed to high levels of impact as the knee is the largest weight bearing joint in the body.  The top of the tibia is a relatively flat surface and is called the tibial plateau.  This area is susceptible to fracture because of its location as well as the composition of the bone.  This portion of the bone is cancellous (like a sponge) and is more fragile than the shaft of the tibia which is cortical bone (thick and rigid).  Additionally, fractures can be present just below the joint line on the tibia.  Regardless of the location of fracture, maintaining appropriate joint surfaces is critical in the treatment of tibia fractures.


If you have suffered a proximal tibia fracture, you may experience significant pain with weight bearing, swelling, bruising, point tenderness around the knee and deformities around the knee.  Additionally, numbness and/or cold and paleness in the foot are potential symptoms.  If you experience any of these symptoms, blood or nerve damage can be present and evaluation at the emergency room is warranted.


Evaluation of any tibia fracture will require an x-ray to assess the congruity of the joint line and amount of displacement of the fragments.  These types of fractures can be treated either non-operatively or surgically.  The decision to operate will depend on patient age, health, fracture location and degree of displacement.  If treated non-operatively, it is likely that the leg will be immobilized with a brace and crutches will be required for a period of non-weight bearing.


If surgery is the appropriate intervention, location of the fracture will dictate the type of stabilization.  If the upper ¼ of the tibia is fractured but the joint space is not affected, surgery may consist of a rod or plate and screws to stabilize the tibia.  If the joint space is involved in the fracture and the joint surface is depressed, the depressed portion may need to be lifted then stabilized with a graft.  This graft can be synthetic or a graft from a bone bank.  Typically this procedure occurs in conjunction with a plate and screws for further tibial stabilization.  Your doctor can discuss these different options with you and help choose what is right for you.


Recovery from a proximal tibia fracture can be a long process and it is imperative that the patient follows the doctor’s recommendations.  Proper compliance is critical due to the fact that the tibia is a major weight bearing bone.  Regardless of surgical or conservative management, rehabilitation will be an important component to recovery.  The rehabilitation specialist will guide your progress with the doctor’s approval for progressing motion, strength and weight bearing.