Undisplaced patella fracture

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Advice for a recent knee injury

Medication

The Emergency Department (ED) or a Minor Injuries Unit (MIU) may have prescribed you with some pain relief. Take these as instructed to help manage the pain.

If you do not feel that this medication is helping, talk to us during your appointment in Fracture Clinic, or your GP, about an alternative option.

Cold packs

Ice is a great natural anaesthetic that helps relieve pain and controls swelling. Apply ice packs or a bag of frozen peas wrapped in a wet thin towel to your injured area for up to 15 minutes every few hours.

• Do not place ice in direct contact with the skin.
• Do not leave the ice pack on for more than 20 minutes at a time in one hour.

Rest and elevation

It’s important to rest your injured area as much as possible in the first 24 to 72 hours.

It’s normal to experience swelling after your injury which is often worse at the end of the day.

Elevation reduces swelling, which in turn relieves pain and speeds up your healing. Keep your injured area elevated as much as possible during the first 24 to 72 hours.

If you have been given a sling, use it to keep your injured area elevated. You may find it more comfortable to use pillows to elevate it during the evening and at night.

If you have a lower limb injury, try to keep your feet elevated above the level of your hip.

Smoking

Medical evidence suggests that smoking prolongs fracture healing time. In extreme cases it can stop healing altogether. Stopping smoking during the healing phase of a fracture will help ensure optimal recovery from this injury.

For advice on stopping smoking and local support available, please discuss this with your GP or go to the NHS Better Health website.

Helping your recovery

Being healthy can help you recover from your injury faster. Eating well, staying hydrated and keeping as active as possible will all help. We’ve put together a set of videos on all the things you can do to help you recover as quickly as possible.

Care plan

Below we have a care plan, including information that will help you understand your injury, guide you through your rehabilitation and explain what you can do to maximise your recovery.

Your diagnosis should have been made by an orthopaedic consultant or one of the team working under the supervision of the consultant team. The information in this care plan is to help you understand your diagnosis and is not exhaustive.

What is your injury?

It’s a fracture (break in the bone) to your kneecap. Undisplaced means that the bones have not moved.

Healing

This injury will take up to 12 weeks to heal, but this may differ depending on your individual circumstances. You may experience some ongoing pain and swelling for 3 to 6 months.

Follow up

You’ll be referred to our virtual fracture clinic and we’ll tell you whether you need to come to the Fracture Clinic for a see a clinician for a face to face appointment. If you don’t need to come in, but you feel you’d like to see someone at any time in the six months after your injury, you can still book an open appointment by calling 01736 758892. After the virtual clinic, we’ll also send you a letter explaining the next step in managing your injury.

Please call the Fracture Clinic on 01872 253091 if:

• you’re unable to follow this rehabilitation plan
• you have any questions
• you’re struggling with your brace
• you experience pain or symptoms, other than at the site of the original injury or surrounding area.

Using your knee braces and crutches

Advice for how to fit, wear and adjust your brace is different for each type of injury. Please read the information for your injury on this page. You must keep your brace on for all your exercises for at least 6 weeks.

Wearing your knee brace

To protect your knee, you must wear the brace fitted by the Emergency Department (ED) or Minor Injuries Unit (MIU). Your knee brace is called a T-scope.

Only remove the brace to wash your leg daily or apply a cold pack. Keep your knee straight while you wash and replace the brace afterwards.

How do I adjust my brace?

This video tells you how to adjust your T-scope brace.

Walking

You can partially walk on your leg for 6 weeks by putting about 50% of your bodyweight through your injured leg. Try standing on weighing scales and use crutches to assist you. These videos explain how to use crutches for partial weight bearing.

After 6 weeks, you can put your full bodyweight through your injured leg and gradually remove the brace and crutches. Try using one crutch until you can walk without them.

Early weight bearing (putting weight through your injured leg) helps increase the speed of healing. Try to walk as normally as possible. This will help your recovery.

What should I do with my brace and crutches when I no longer need them?

• We can not use the brace again. You should not return it to the hospital.
• You can return crutches to the Fracture Clinic or your local physiotherapy department.

Exercises

If you’ve been given a knee brace, wear it when doing these exercises and only move as your brace allows.

Follow the exercises below within the limits of your pain. These exercises will help the healing process.

Do each of these exercises 3 to 4 times a day. Start straight away. Do not push into pain.

Ankle exercises

Point your foot up and down. Repeat this 10 times.

Static quadricep exercises

More information

You can find out more about your undisplaced patella fracture, and see demonstrations of the exercises in this video from Brighton and Sussex University Hospitals.

Preventing complications

Caring for your wound and stitches

If you’ve had an operation, you’ll need to keep your stitches dry and clean. You should also look out for any redness or signs of swelling, bleeding or pus as these can be signs of an infection.

You can find information about how to care for your stitches, if/when they need to be removed and signs of an infection on our surgery for fractures and soft tissue injuries page.

Blood clots and Deep Vein Thrombosis (DVT)

Because your limb is immobilised and you’ll be moving less than normal, you’re at higher risk of developing a blood clot or Deep Vein Thrombosis (DVT). This can be life threatening if left untreated.

Symptoms of DVT in the leg are:

• throbbing or cramping pain in 1 leg (rarely both legs), usually in the calf or thigh
• swelling in 1 leg (rarely both legs)
• warm skin around the painful area
• red or darkened skin around the painful area
• swollen veins that are hard or sore when you touch them.

These symptoms can also happen in your arm or tummy if that’s where the blood clot is.

More information about DVT

• Watch this video about how to prevent DVT.
• Learn more about DVT including symptoms, who is at risk and how to treat it.
• Find out how to reduce the risk of blood clots when you have an immobilised lower limb (PDF, 108 KB).

Preventative medication for DVT

If you have been told not to put any weight through your leg or to partially weight bear (50%), you should have been assessed in ED or MIU and told if you need to take preventative medication.

If you have not had this conversation please call your GP for an urgent appointment.

Depending on your injury, you may have been prescribed a course of a blood thinner. There are a few different types of medication and they often need injecting into your tummy. You can discuss an alternative with a doctor. Please see the relevant care plan for your injury.

Pressure sores and ulcers

Wearing a boot or plaster cast combined with not moving your limb can lead to pressure sores or ulcers. These are injuries to the skin and underlying tissue caused by prolonged pressure, rubbing or tension.

They often develop gradually, but can sometimes form in a few hours.

Signs and symptoms of pressure sores

These include:

• skin discolouration – red patches for people with pale skin, purple or blue patches for people with dark skin
• discoloured patches that do not turn white when pressed
• a patch of skin that feels warm, spongy or hard
• pain or itchiness in the affected area.

If you have a boot, take it off every day to check your skin and make sure it’s not rubbing.

If you have a plaster cast, look out for a change in colour (red or white) of your skin above or below the plaster, an increase in pain inside the plaster or pins and needles.

• Watch this video to learn how to prevent pressure sores.
• Read more about pressure sores on the NHS website.

If you think you have a pressure sore or ulcer call the Fracture Clinic straight away on 01872 253091.

For out of hours advice please call 01736 758909.

Sepsis

Sepsis (also known as blood poisoning) is a serious infection that can be life threatening. There is no one sign for sepsis so it can be hard to spot.

Call 111 immediately if you develop any of the following:

• Slurred speech or confusion
• Extreme shivering or muscle pain
• Passing no urine in a day
• Severe breathlessness
• It feels like you’re going to die
• Skin is mottled or discoloured.

Find out more about the symptoms of sepsis on the NHS website.

These videos also explain what sepsis is and how to spot the early signs.

Living with your injury

Work

Decisions to return to work are made on a unique basis and should be discussed with the Fracture Clinic, your GP, and your employer.

You may need time off work and when you return, you may need light or amended duties. When you should return to work will depend on your profession and your injury.

If you see us in person at the Fracture Clinic we can give you a fitness for work statement or a sick note. If you don’t come to see us, you can also get one from your GP.

Driving

If you have an injury to a lower limb (foot, ankle, or knee), you can return to driving when you:

• have been told you no longer need your brace, boot or crutches, or your plaster cast has been removed
• can walk comfortably
• can perform an emergency stop pain-free.

Always test your ability to drive with the ignition off and in a safe environment.

If you have a follow-up appointment with us, please wait until your consultant or physiotherapist has given you clearance to drive.

If you’re in any doubt, do not drive until you have spoken to our team.

Sport

You should not do any sports at all for at least 6 weeks.

You must avoid impact sports, jumping, running, dancing, and heavy lifting for at least 12 weeks.

Some injuries will mean you have to wait longer before you can return to sport or impact activities. Please check your specific care plan. If you’re unsure about whether you should do a sport or activity, please call the Fracture Clinic on 01872 253091.