Patella fracture (with audio descriptions)

[0:00]Virtual Fracture Clinic Patella Fracture Hi, I'm Andrew Oppy, an orthopedic consultant at the Royal Melbourne Hospital. At the Royal Melbourne Hospital, the virtual fracture clinic is run by specialist orthopedic consultants and advanced practice physiotherapists. In many cases, we can review your injury and provide care without you needing to come back into hospital. This video will give you the information you need to manage your recovery. The patella, or kneecap, is a small bone at the front of the knee. A patella fracture refers to when this bone is broken. Patella fractures are usually caused by a direct blow, like a fall landing on the knee. You can expect to feel pain and see swelling, redness and sometimes bruising in the area. When your knee is examined, there will likely be a point of maximum tenderness over the fracture site. On your X-ray, we might see a crack or dark line. This is the fracture or break. An orthopedic surgeon can determine if an operation is required. However, in most cases this injury will heal on its own given some time and support. Once a specialist has determined no operation is needed, the most common treatment is to support the knee in a splint for six weeks to limit movement in the knee while the fracture heals. It is safe to bear weight on this injured leg, though this may cause discomfort. Use your pain as a guide to how much walking you do in the first weeks of your recovery. You can expect some discomfort, but feeling very sore is a sign that you should rest more. As with most bone injuries, this fracture is expected to heal in six to twelve weeks. If you are a smoker this can slow healing time, so we advise that you cut down or quit. Some patella fractures need a check X-ray after six weeks. Your specialist will advise if you do. The Virtual Fracture Clinic will organize your X-ray appointment for you. In most cases, you will not need to come back to hospital or have any more X-rays. However, if after three months you still have pain or are walking with a limp, contact the Virtual Fracture Clinic or visit your GP. Can I drive? You should not drive with your injured leg for at least six weeks until you can walk comfortably without the brace, have enough bend in your knee and can safely perform an emergency stop. When can I go back to work? Getting back to work will depend on the job that you do. A desk worker may return in a few days. Someone with a very physical job may need six weeks off. Speak to your doctor if you need a medical certificate. Can I stay active? You can return to playing sports or running after three months. You should have near full motion, at least eighty five percent strength and little if any pain. A physiotherapist can help you with a return to sport exercise program. Care at home Emily, Advanced practice physiotherapist. Hi, I'm Emily and I'm a physiotherapist at the Royal Melbourne Hospital. We're going to demonstrate wearing the zimmer knee splint and some exercises to help your recovery. The wider part is the top of the splint. It can be worn over or underneath your clothing. However, it may slip more if worn over. Position the splint under the leg. The knee cap should line up with this crescent cut-out area. Fasten the straps one at a time and tighten as tolerable. Once the straps are tightened, check the leg looks in alignment. You may need to adjust the straps again once you stand up. It is important that the leg is kept straight at all times for the first four weeks. This means wearing the splint to bed at night. If the splint is removed for showering, the knee must be held straight while it is off. After four weeks, the splint can be removed for exercises and for sleeping, if comfortable. If you need more support, consider using some crutches to assist with walking in the short term. Knee injuries can be very sore. You should make sure to rest, and spend less time on your feet than you usually would. Elevating the leg can help. It is advisable to use an ice pack or frozen peas over the area to help with swelling and pain. If you are still very sore, consider an appointment with your GP to talk about other medications. After two or three days, start these simple exercises to help your recovery. Keeping your leg in the splint, do the exercises three or four sessions throughout the day. Exercise 1 Ankle Range of Motion: Dorsiflexion and Plantarflexion Move the foot up and then down. Move as far as you can within the limit of discomfort. You should feel a bit of a stretch. Repeat this about ten times. Exercise 2 Quadriceps (Thigh Muscle) Tightening Gently tighten the muscle at the front of the thigh, like you are pushing the back of the knee into the bed. Hold for five to ten seconds. Then relax. You may find it easier if you do both legs together. Repeat this about 10 times. Exercise 3 Knee Range of Motion (after four weeks) After four weeks you can add in these new exercises. Remove the splint and slide your heel towards your bottom along the bed. You can use your hands or a towel to assist if you like. Bend as far as you can comfortably. Repeat this ten times. Exercise 4 Knee Extension (after four weeks) Sitting in a chair, straighten out the leg, then bend it again. Hold a few seconds in each position. Repeat this about ten times. After six weeks, when you stop wearing your splint, it is important to advance your exercises to strengthen your leg and improve your balance. You can see your own physio locally or contact the Virtual Fracture Clinic to arrange a physio appointment at the hospital. It is important that you understand these instructions. You are in charge of your own health. If you have any questions about your recovery, contact your GP or the Virtual Fracture Clinic. The Royal Melbourne Hospital.