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Forum Name: Bone trauma and fractures

Question: Fractured patella?


 JasonR - Sat Apr 11, 2009 9:16 am

(resubmitting with precise title so it will be approved)

About 2 months ago I fell on my knee. I was carrying my daughter and going down some steps to the driveway. Somehow I misstepped off of the first step and fell the final 36 inches. In order to save my little girl from smacking her head, I stuck my knee out and landed full force on it and then rolled. She was fine, but my knee was in excruciating pain. But ... I'm one of those "walk it off" kind of guys so I got up and walked it off. It was quite painful to walk, but not unbearable, however there was a very slight occasional grinding feeling. The knee swelled up pretty bad, but by the next day without ever using ice or a wrap, swelling was down and I was walking with no pain, just minor discomfort. However, I made the mistake of kneeling down. As soon as my knee hit the floor and felt the pressure, the pain was so bad I collapsed. It felt as though my knee cap was in two pieces, and when I knelt on it they went in opposite directions. This was the case for at least 3 weeks - kneeling was not an option. But I followed some tests, such as lying on my back and raising my straightened leg - no problem. Percussion test - fine except for one area of patella on outer side. Mild pressing on various areas of patella caused excruciating pain on outer side of patella traveling diagonally toward the inner side. I assumed that it was a simple fracture of the patella not affecting the cartilage underside.

After only a week, most the swelling was gone and I could walk, jog, run, jump and climb stairs as though nothing happened. Although, prolonged standing or walking would cause the knee to ache later. However, here's the odd part.

It's now 2 months later. I can actually get into a kneel position on the knee VERY carefully but still without full weight/pressure. Walking etc is a breeze. I can be standing/walking all day with no ache later. However, on the medial side of the kneecap near the bottom tip of the patella (and actually partially on the patella), there is a quarter sized raised knot. It's a soft knot that feels very tendon-like, not hard like bone. It sticks out rather noticeably. Despite all the swelling being gone for weeks, this knot has persisted. And I can move it. It doesn't hurt for me to move it medially and press it into my knee beside the patella - where strangely it seems it belongs. Is this just residual swelling, or is it possible that a small fragment of the patella did in fact break off and is now pulled out of position by the patellar tendon? The patella feels completely intact when compared to the right patella, but on the medial side where the knot is, it's hard to be sure that side of the patella is fully intact. I can grasp the patella with my leg propped up and knee relaxed, and can move it without pain in the exact range as the right patella.

So I keep thinking that it's healing just fine, but that knot is really throwing me off. And the knot feels "in the way" when pressure is applied from kneeling ... unless I move it. I apologize for the long post, but I wanted to be thorough. I just need some help in understanding what might be wrong, if anything, because I was laid off and have no health insurance and cannot afford to pay to visit a doctor. Any advice or insight will be GREATLY appreciated. Many thanks.
Jason
 Tom Plamondon PA-C - Mon Apr 20, 2009 6:49 pm

User avatar Hello,
There is a bursa on top of the knee cap called the prepatellar bursa which may be causing the bump on the knee cap.

Often with this type of injury the bone under the cartilage is bruised (pain with kneeling).
This is all beside the point of a possible patellar fracture which can only be diagnosed with an xray.

I do not think the bump is a bone chip but xray is the obvious and only way to know for sure.

Sometimes plica just inside the medial aspect of the patella can become fibrous and feel like a tendon. It is of little concern unless inflamed and causing problems.

Hope this helps give you something to go on.
Take care and keep us posted.
 JasonR - Tue May 05, 2009 10:37 pm

Thank you very much Tom. That does make a lot of sense. I guess my next question would be ... how serious is a ruptured bursa? Is this something that eventually heals itself? Or does it require draining, surgery, etc? It really doesn't bother me much anymore, except when kneeling it may feel "in the way" though not really painful. The patella feels pretty good now. And I'm curious as well ... does this sort of injury lead to stuff like arthritis later on?
Again, thank you very much. I sincerely appreciate your insight and assistance.
Jason
 Tom Plamondon PA-C - Thu May 07, 2009 4:05 pm

User avatar Hello,
I have not heard or read of a ruptured bursa. A swollen and inflamed bursa may be drained and then injected with corticosteroids.
If the articular cartilage under the kneecap was damaged, it may develop chronic inflammation (arthritis) - depends on extent of damage and how well you take care of it.
Take care.
 JasonR - Mon May 11, 2009 8:20 pm

Thank you very much Tom. That was my fault ... I misspoke ... inflamed/injured would have been better than ruptured. And here, now 3 months since the injury, I can say the bump is smaller, albeit still there. But at least no more pain, although I feel the bursa may be still thickened. Hopefully, all will return to normal eventually. Thanks again for all the help.
~ J ~
 Tom Plamondon PA-C - Tue May 19, 2009 7:43 pm

User avatar Hello,

Some moist heat to the area and gentle stretching may help decrease the thickness.

Take care.

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