Patella fracture: treatment in children
Knee injuries in children are common, but a patellar fracture in childhood is relatively rare compared to ligament or meniscus injuries. Nevertheless, it is a serious injury that requires a qualified approach. Prompt treatment of a patellar fracture can prevent long-term problems with leg mobility and joint development.
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Causes and mechanisms of trauma in children
The mechanism of injury depends directly on the child's age. Most often, children suffer such injuries during vigorous play or sports.
Falling on the knee
This is the most common scenario. A direct fall onto a bent knee causes the patella to strike a hard surface. In this case, the patella bears the full force of the impact, which can lead to a fracture.
Direct blow or sports injury
Collisions while playing soccer, hockey, or martial arts can cause a patella fracture. Sports injuries often involve a high impact force, which increases the risk of comminuted injuries.
Sudden strain of the extensor mechanism
Sometimes a fracture occurs without a direct blow. When the thigh muscles contract sharply and forcefully, the muscle pulls the patella upward with such force that it can't withstand the load and breaks—a so-called avulsion fracture.
Symptoms and first signs of a fracture
It's important for parents to recognize the symptoms that indicate a serious childhood knee injury, so as not to confuse it with a common bruise.
Pain, swelling, and hematoma
Severe knee pain occurs immediately after the injury. Within two to three hours, parents may notice swelling of the knee. The skin begins to turn blue, and a hematoma forms. The knee visibly enlarges and becomes hot to the touch.
Limping and limited leg extension
The child cannot bear weight on the leg, and a pronounced limp develops. A key symptom is limited extension: the inability to raise a straight leg while lying down or fully extend it. This indicates that the knee extensor apparatus has stopped functioning.
Signs that require urgent care
Some situations require immediate treatment at the emergency room:
- Visible deformity of the knee joint
- Presence of an open wound in the knee area
- Numbness or coldness of the foot
- Intense knee pain that does not subside with rest
- Rapidly increasing, distending swelling
How does a fracture differ from a bruise and other knee injuries?
Differential diagnosis is crucial, as the treatment strategy for different injuries varies.
Bruise and sprain
With a bruise, a child can usually bend and straighten the leg slightly, although this causes discomfort. The pain from a bruise gradually subsides, while with a fracture, it does not subside even with cold application.
Dislocation and damage to the extensor mechanism
A dislocation of the patella is often accompanied by a lateral displacement. A fracture, on the other hand, is characterized by a disruption of the bone structure, which is often accompanied by a bone crunch (crepitus) at the time of injury.
What helps to distinguish a fracture based on examination and imaging?
During palpation, the doctor may feel a "gap" or gap between the fragments if there is a displaced patellar fracture. Instrumental examination methods provide a definitive answer.
General information
Diagnosing a patellar fracture
Only a specialist can make an accurate diagnosis after conducting a series of tests.
Examination by a pediatric orthopedist
A pediatric orthopedist first assesses the child's range of motion: they need to understand the degree to which the child can bend the leg. Next, they examine the integrity of the ligaments and conduct tests. The doctor also checks the sensation of the limb and the pulsation of the arteries.
Knee X-rays and additional diagnostic tests
The primary diagnostic method is an X-ray of the knee in two projections. This is usually sufficient to confirm a fracture. In complex cases, a CT scan or MRI may be prescribed.
What is important for parents to tell the doctor?
The doctor needs to know: how exactly the knee injury occurred, how quickly the swelling developed, whether the child was able to put weight on the foot immediately after the fall, and whether there have been any previous injuries to this joint.
After recovery, it's important to prevent a recurrence.
How to reduce the risk of falls and impacts
Using protective knee pads when rollerblading or cycling is the best preventative measure. It's also important to teach your child proper fall technique.
When does your child need a follow-up examination?
It's recommended to see an orthopedist six months and one year after the injury for a follow-up examination and to assess the symmetry of the limbs.
FAQ
Is it possible to treat it without surgery?
How long does recovery take?
Is a cast or orthosis necessary?
When can I resume sports?
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What is a patellar fracture?
The patella, or kneecap, is a rounded bone located at the front of the knee joint. It serves a protective function and acts as a lever for the muscles of the front of the thigh. It also enables a person to bend and straighten the leg.
A patellar fracture in children is a disruption of this bone's integrity. It usually occurs due to mechanical damage, such as a blow or a fall.
Why the treatment approach differs in children than in adults
The child's skeleton is highly elastic and has significant regenerative potential. In children, the patella remains cartilaginous for a long time and begins to actively ossify only at 5-6 years of age, completing the process by adolescence. Due to the presence of growth plates and the peculiarities of the blood supply, pediatric orthopedic surgeons always choose the most gentle approach to avoid damaging the tissues responsible for the further development of the limb.
Which knee joint structures can be damaged?
When the patella is damaged, the surrounding soft tissues are also at risk. The extensor apparatus, including the quadriceps tendon and the patellar ligament, is often damaged. Damage to the synovial membrane of the joint is also possible, leading to blood accumulation in the joint cavity (hemarthrosis) and severe knee swelling.