The femur is the large bone in your thigh which attaches by ligaments and a capsule. As a treatment guide if the same bone is broken, the surgeon can use a standard treatment problem. A transverse fracture is the most common fracture type. At his oneyear followup appointment, the patient notes pain in the peri patellar region that is aggravated by palpation and kneeling. Patellar fracture is a rare but significant complication following anterior cruciate ligament acl reconstruction when using a bone patellar tendonbone bptb autograft. In this article, we will cover rehabilitation and physiotherapy for the patella fracture condition after the. Patella fracture protocol monument orthopedics and sports trauma.
Nonsurgical treatment of patella fractures doctors can sometimes treat people with a patella, or kneecap, fracture without surgery. The intent of this protocol is to provide the clinician with a guideline to establish and progress a patient through post operative rehabilitation. Fractures of the patella may occur as a result of direct or indirect. Detailed step by step description of tension band wiring for complete articular, frontalcoronal simple fracture of the middle and proximal third located in our module on patella with illustrations including patient positioning, approach and aftercare. It improves the mechanics of knee extension, protects the knee joint from direct trauma, and assists in providing nourishment for the articular cartilage of the distal femur. Referring physician will assign patients wb status depending on the type of repair and the quality of patients tissue. Nonsurgical patella dislocation rehabilitation protocol. It is a common fracture in adults, occurring two times more in males than in females 7. Rehabilitation after repair of the patellar and quadriceps tendon the patellar tendon attaches to the tibial tubercle on the front of the tibia shin bone just below the front of the knee.
A patellar fracture is a break in the patella, or kneecap, the small bone that sits at the front of your knee. Nonunion, infection, posttraumatic arthritis, arthrofibrosis, symptomatic hardware, and extensor mechanism insufficiency have all been described following patellar orif, and the risk of their occurrence may be augmented by patient, injury. The patella is the largest sesamoid bone and serves several important functions. Rehabilitation guidelines for patellar orif northwest ohio. When your knee is less painful, you can do the quadriceps stretch and start strengthening the thigh muscles with the rest of the exercises. Maenpaa and lehto 12 studied this issue further by dividing 100 primary patellar dislocations into 3 treatment groups. Worn at all times taken off only for physical therapy sessions converted to hinged knee brace at first post. Anatomy patella largest sesamoid bone plays an important role in the biomechanics of the knee. He was followed for a typical postoperative course and seen on a monthly basis figures 57. Treatment options vary based on fracture displacement, classification, and patient factors.
Orif patella fracture postoperative rehabilitation protocol name. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. A biomechanical study is in progress looking at different methods of patellar fracture repair. Madison, wi 53718 rehabilitation guidelines for patellar realignment the knee consists of four bones that form three joints. He was started on a routine patella fracture rehabilitation protocol with immobilization for two weeks followed by progressive flexion with physical therapy and advancement of weight bearing. Nonsurgical treatment of patella fractures nyu langone. Avulsion fractures are most commonly located at the inferior pole of the patella and often encountered in the pediatric population as patellar sleeve fractures. Patellar fractures make up about 1% of all fractures. However, more commonly, patellar fractures are classified descriptively according to fracture pattern, which may offer in.
Rehabilitation for a broken kneecap can only begin after establishing the type of fracture and treatment options used. Patient will be weight bearing as tolerated in the lrom brace. Fracture break or crack upon the continuity of a solid bone. One of the primary physical therapy goals during rehabilitation is the recovery of quadriceps muscle strength. Because of the subcutaneous anterior location, the biomechanical. The kneecap is susceptible to many fractures and accounts for 1 percent of all broken bones. Patient case example highly comminuted patella fracture in. Patella fractures account for approximately 1 percent of all skeletal injuries in both adults and children. It is not intended to be a substitute for ones clinical decision making. The purpose of these case reports is to describe 2 cases in which patellar fracture occurred during rehabilitation after acl reconstruction using a bptb. Patellar fracture fixation protocol general your surgery was performed through an incision at the front of your knee. The kneecap, or patella, is the bone that protects your knee joint.
It also is attached to the bottom of the patella kneecap. A treatment algorithm for primary patellar dislocations. Epidemiologic studies demonstrated that the incidence in men is twice as high as in women. It is normal to experience some sharp pain in the front of the knee when working on moving your knee. For these reasons, many clinicians advocate a short period of immobilization, followed by rehabilitation of the knee, with or without a patellar brace. Usually, when these tendons rupture, the patella moves upwards on the thigh for patellar tendon ruptures and slips downward for quadriceps tendon ruptures.
Patella fracture during rehabilitation after bonepatellar. We are eager for veterinary surgeons in general practice to contact us if they see. Rehabilitation guidelines for patella orifnon displaced non operative patella fracture quadricep or inferior patellar tendon repair stage 1day 14 weeks. Agerelated incidence of patella fractures tends to be shifted to a mature population. Your leg should be completely straight and relaxed. The following is a guide to be used in the rehabilitation of a patient after a patella fracture, but it is always good to discuss treatment plans with your orthopaedic. A large tendon, called the quadriceps tendon, covers the patella and connects the thigh muscles to the lower leg bone. While the postop dressing is in place, icing should be done continuously. Appointments md follow up visit at 2 weeks post op begin physical therapy for knee rom at 2 weeks post op rehabilitation goals maintain knee ext to allow incisions to. Jazrawi, md associate professor of orthopaedics chief, division of sports medicine tel. Pdf patella fractures can be caused by excessive tension through the. Orif patella fracture postoperative rehabilitation protocol. Farwell, craig zeman, in rehabilitation for the postsurgical orthopedic patient third edition, 20.
Open reduction and internal fixation orif of patellar fractures generally leads to good results. Gentle patellar mobilizations all directionsno forceful passive motions. Patellar and quad tendon repair info boston sports medicine. Because the patella acts as a shield for your knee joint, it is vulnerable to fracture if you fall directly onto your knee or hit it against the dashboard in a vehicle collision. Pdf current treatment strategies for patella fractures. Knee immobilizer will be converted to a hinged knee brace at the first postop visit. The treatment of patella fracture depends upon the type of fracture one has sustained. A simple hairline fracture only requires posterior slab immobilization, but a complicated displaced or comminuted fracture need kwire surgery. Phase 2 26 weeks discontinue crutches none full rom cardiovascular progression, begin closed kinetic chain. To ensure that this program is safe and effective for you, it should be performed under your doctors supervision. Fractures joint replacement sports medicine patellar fracture with orif protocol dr.
Traditionally, nonoperative treatment has been reserved. Use your hands to move your kneecap sideways toward the outside of your leg. Bilateral patellar fractures are rarer, primarily occurring in subjects with underlying pathologic frangibility 3, 10. The therapist needs to take into consideration multiple variables including. Postoperative protocol patella fracture orif, rehabilitation or nonoperative treatment. The authors are performing a study into spontaneous patellar fractures in cats to try to establish an underlying cause and to develop optimal treatment recommendations. Isometric quadriceps, hamstring, adductor, abductor strengthening. Then move it sideways toward the inside of your leg. As a rule, fractures of the patella are caused by direct trauma to the knee. Patella fracture during rehabilitation after bone patellar tendonbone anterior cruciate ligament reconstruction.
Pdf patella fractures can be caused by excessive tension through the extensor mechanism or a direct impact. The gundersen sports medicine patellar fracture orif rehabilitation program is an evidencebased and soft tissue healing dependent program allowing. Patellar fractures account for 1% of all skeletal injuries 9. Patella fracture orif rehabilitation program gundersen health. Rehabilitation guidelines for patellar tendon and quadriceps tendon repair the knee consists of four bones that form three joints. Take immobilizer off only for physical therapy sessions. These injuries account for about 1% of all skeletal injuries and are most prevalent within the age group of 2050 years. Patella fractures can occur in a wide variety of individuals. Fractures of the patella are serious injuries with a broad range of subtypes. Patella fracture is one of the common knee injuries usually post direct trauma to the patella or sudden forceful contraction of the quadriceps muscles in the context of a sports injury. A physical therapist teaches you exercises to help improve movement and strength, and to decrease pain. Treatment of patella fractures is based on ranges of acceptable fracture fragment separation exceeding 3 to 4 millimeters.
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