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Abstract: The patella, commonly known as the “kneecap,” is located in front of the knee joint and is the largest seed bone in the body. When the knee is extended, the patella is an important fulcrum, so when the knee is suddenly and forcefully straightened, the patella is easily fractured after a momentary muscle pull. In this case, the patient developed weakness in knee extension and difficulty in walking immediately after the patella fracture. After surgery, the knee gradually resumed flexion and extension activities, and walking function was restored.
Basic information】Female, 29 years old
Disease Type】Patella fracture
Hospital】The First Hospital of Harbin Medical University
Date of consultation】January 2022
Treatment plan】Surgical treatment (incision and internal fixation surgery)
Treatment Period】Inpatient treatment for 14 days, regular outpatient follow up
Results】The fracture healed and the walking returned to normal
I. Initial consultation
In January 2022, a young female patient came to the clinic. The patient reported that she was a supermarket employee who fell from a ladder accidentally during a climb to retrieve goods, and suffered knee swelling, pain and difficulty walking at the time of injury. First, I examined the patient and found that an obvious depression could be palpated at the patella, and considering the patient’s difficulty in knee extension, I highly suspected a patellar fracture. In order to clarify the diagnosis, we discussed with the patient and recommended further examination.
II. Treatment history
First of all, the imaging examination was completed, and on the film it could be seen (as shown below) that the patella showed an upper and lower separation and displacement, and there were many small bone fragments around the main bone mass, and the patient was finally diagnosed with patellar fracture. After the fracture end is separated, it is not only difficult to reset, but also easy to embed soft tissues between the fracture ends, so it is relatively difficult to heal the fracture by only relying on extension cast fixation. Surgery can directly restore the patella shape and facilitate early functional recovery, and the patient eventually underwent incisional internal fixation surgery. The treatment was performed for the patient when he was eligible for surgery. Active rehabilitation exercises are also required after patellar fracture surgery to avoid complications such as joint stiffness, osteoporosis, and muscle atrophy. Postoperative passive activities can be performed initially with the help of family members or rehabilitation doctors, and then active activities can be performed as the fracture heals.
III. Treatment effect
About 1 week after surgery, the patient’s swelling and pain at the injured site were obvious; the patient was discharged from the hospital in 14 days of in-hospital treatment, and on examination at discharge, the patient was able to reach 90 degrees of passive knee flexion range, and the knee swelling was basically relieved. The patient was satisfied with the treatment result. At the next outpatient review, the patient’s fracture healed well. Three months after surgery, he was able to perform active flexion and extension exercises and gradually started to walk on the ground. Six months after surgery, walking function was restored. The fracture was completely healed at the follow-up 1 year after surgery.
IV. Precautions
We are glad that the patient’s disease was cured after active treatment. For this patient, who was hospitalized for only 14 days, most of the time without physician supervision, self-exercise is very important. Because internal fixation can stabilize the fracture end, the family can be instructed to perform passive knee flexion exercises and thigh muscle isometric contraction exercises in the early postoperative period as opposed to simple plaster fixation, and walking exercises can be started gradually 3 months after surgery. However, if local swelling and pain occur during the exercise process, you should immediately consult a doctor for follow-up. In daily life, strengthen nutrition, high protein and high vitamin diet, and take nutrition balance as the principle to enhance their resistance and promote the repair of fracture broken end.
V. Personal insight
Patella fracture generally has two injury mechanisms, the first is direct violence, such as kneeling patella hitting the ground, such fractures are mostly comminuted, accompanied by soft tissue contusions. The second is indirect violence, such as a kneeling position when the knee is about to fall, which is mostly a transverse fracture with significant separation and displacement of the fracture and little soft tissue damage. This patient is the second mechanism of injury. Although there is no direct bump, the swelling, pain, and weakness of knee extension in front of the knee are the typical manifestations of patellar fracture and should be treated at the hospital as soon as possible.