Patella Fracture

A break in the kneecap is known as a fracture of the patella. A fall from a height, a direct blow to the knee and indirect stress are some of the frequent causes of patella fractures. Severe pain, swelling, tenderness and difficulty in straightening the knee are some of the common symptoms associated with patella fracture. Fracture of the patella is also known as kneecap fracture, broken knee, knee fracture and broken patella.

Causes of a Patella Fracture

• Direct force on the patella can result in fracturing the patella.
  
• A fall from a height or a hit to the knee which is very common in contact sports.
  
• During an automobile accident, when a knee that is bent hits against the dashboard and can lead to a patella fracture.
  
• Indirect stress is one reason that can cause patella fracture.
  
• Twisting of the leg.
  
• Muscle contraction that is violent.
  
• Calcium deficiency due to poor nutrition.
  
• Persons who are obese are more prone to this kind of fracture if they suffer a fall.
  
• Joint diseases such as osteoporosis or bone diseases increase the risk of fracture of this kind.

Severe pain and swelling at the area of the fracture is noticed when a person fractures his patella. It will be difficult to move the leg either forward or backward or extend it. There may be swelling and tenderness around the kneecap along with catching or locking of the knee. If bone fragments split enough to bend or twist normal knee contours, deformity of the knee will be apparent. The patient may experience numbness and chill that extends beyond the site of the fracture, if the blood supply at the site gets affected. In a compound fracture or open fracture, the skin is broken by the bone in extreme cases. Immediate attention should be given to this open fracture to avoid infection. The fracture of the patella is classified into three different types.

• As a result of a direct blow an undisplaced fracture of the patella may occur
  
• A direct blow to the front of the knee or a fall can cause a stellate or comminuted fracture. Compromised anterior skin and subcutaneous tissue may be associated with this type of fracture which may be the result of a direct trauma.
  
• The third type is a transverse fracture where there is a gap between the fragments. There is possibility for this fracture when there is a forced, passive flexion of the knee joint is associated with a contraction of the knee joint extenders or the quadriceps muscles.
  

There should not be any delay in realigning the broken bones to reduce the shock. To determine if the patient has suffered a fracture the physician will request for x-rays and stress films after he examines the knee. To immobilize the fracture site, the physician may realign the broken bones and place the knee in a cast or splint only if the fragments of bones are lined up well. Surgery is the other option to remove broken pieces of the knee. A person who has suffered a patella fracture is more prone to knee problems in the future.

Chondromalacia

Chondromalacia can be defined as the degeneration of the cartilage in the knees. A chondromalacia patella is the softening of the cartilage underneath the patella or kneecap. Generally it is described as a pain beneath or the sides of the kneecap. Chondromalacia is often called Patellofemoral stress syndrome. When softening occurs, the cartilage breaks down causing irregularities along the under surface of the kneecap. Chondromalacia is caused by muscle imbalance like weak quadriceps and strong hamstrings. Excessive pronation as is the case when an arch collapses too much thereby causing the knee cap to twist sideways can also be a source for chondromalacia.

Chondromalacia occurs when the articular cartilage breaks down due to wear and tear process in the body. The patella cartilage is one of the earliest places in the body where cartilage breakdown can occur. This leads to degenerative arthritis or osteoarthritis in the knee joint. Chondromalacia also occurs frequently due to overuse and related trauma. Referred to as runner's knee, chondromalacia occurs in part time athletes and in professional sports person who trains more than usual. Due to overuse cartilage tear occurs and the knee starts giving way. Nagging injuries is also a common cause of chondromalacia in sports persons. Symptoms of Chondromalacia include pain in front of the knee around the kneecap as well as deep-seated pain in the back of the knee. There may be pain on squatting or kneeling. The knees might be tender and there may be swelling around the knee joints. In severe cases of chondromalacia a grating or grinding sensation of the bone are heard when the knee is extended.

After ascertaining the clinical history and a physical examination, the physician orders for x-ray of the knee. Even if the x rays are normal, a special x ray view of the patella view or 'sunrise' view shows the patella displacement or tilted laterally and the muscle (vastus lateralis) looks too tight or over powering.

In most cases of chondromalacia, exercises with or without formal physical therapy are enough to correct the problem. Physicians prescribe physical therapy if the pain persists. Icing an injured body part is an important part of the acute treatment process for Chondromalacia. A physician prescribes NSAID for chondromalacia to reduce pain and swelling. Sports medicine therapists often prescribe knee brace for patients who want to stay active in sports. This brace is known as a patella stabilizing brace. If the pain worsens, surgical treatment is suggested. Arthroscopy is a common orthopedic procedure for diagnosing and treating chondromalacia.

• Trauma and abnormal stress to the knee should be avoided.
  
• The leg muscles, especially the quadriceps and hamstrings should be maintained strong and flexible.
  
• Participation in sports and strenuous activities should be limited until the pain has gone away. Activities that increase the knee pain such as knee bends, should be avoided until the pain improves.
  
• Girls may develop this problem of Chondromalacia Patellae depending on the morphology. Tall and knock-kneed teenagers are more prone to develop chondromalacia especially if they have tightness of lateral muscles.
  

Osgood Schlatter Disease

Osgood Schlatter Disease is a condition that usually affects adolescents, especially boys. It usually settles down on its own sans treatment. Athletic kids tend to be more prone to Osgood-Schlatter disease. It occurs due to overuse and repeated stress on the knee resulting in inflammation of the raised area (tubercle) just below the kneecap. Growing kids participating in distance running, gymnastics, soccer and basketball are likely to face these 'growing pains'. Osgood-Schlatter Disease rarely lasts beyond adolescence.

Pain associated with Osgood-Schlatter Disease is usually triggered by running, kneeling, squatting and climbing stairs. There is tightness in the surrounding muscles and tenderness just below the kneecap. The symptoms of Osgood-Schlatter Disease can be alleviated with NSAIDs like ibuprofen. Ice compress on the affected knee can give relief. A knee brace is fitted on some kids to provide protection to the painful area. Rest is advised during severe discomfort and pain.