Patella Fracture

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 Group Members are:
Jalil Khan BSCN02161014
Nargis Mansha BSCN02161011
Shaista Kausar BSCN02161007

Presented to;
Mr. Muhammad Azhar

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 Objectives
At the end of this presentation the learners will be
able to;
o Understand the introduction of the topic.
o Discuss the assessment related to the fracture of
left patella.
Health history and general survey.
Physical examination.
o Enlist the nursing diagnosis related to the fracture
of patella.
o Explain the medical diagnose.

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 Conti…
o Describe the nursing management related to diagnose.
o Discuss the nursing care plan for the fracture of
patella.
o Conceptual mapping.
o Summarize the topic.
o References .

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 What is Patella Fracture
Definition:
A Patella fracture is a breakdown of the
knee cap.
A thick, circular-triangular bone
which articulates with femur
(thigh bone) and covers and
protect the anterior articular
surface of the knee joint.

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 Anatomy
• The Patella (knee-cap) is located at the front of
the knee joint, within the Patellofemoral groove of
the femur. It attaches superiorly to the quadriceps
tendon and inferiorly to the patellar ligament.

• It is classified as a Sesamoid type bone due to its

position within the quadriceps tendon, and is the
largest sesamoid bone in the body.

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 Conti…

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 Pathophysiology
• Patella fractures account for approximately 1% of
all skeletal injuries. They become problematic if the
extensor mechanism of the knee is nonfunctional,
articular congruity is lost, or stiffness of the knee
joint ensues.

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 Types of Fracture
Types of Patellar Fractures:
o Stable Fracture
o Displaced fracture
o Comminuted fracture
o Open fracture
o Transverse fracture

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 Etiology
Patellar fractures are most often caused by:
• Subcutaneous location of the patella makes it prone to
the injury.
• Falling directly onto the knee
• Receiving a sharp blow to the knee, such as might
occur during a head-on vehicle collision if your
kneecap is driven into the dashboard.

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 Conti…

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 Epidemiology
• ~ 1% of all skeletal injuries.
• More common in people of 20 to 50 year old.
• Men are twice as likely as women to fracture the
kneecap.

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 Manifestations
• Symptoms may include:
• Severe pain in and around the kneecap.
• Swelling.
• Pain when moving the knee in both directions.
• Difficulty extending the leg or doing a straight-leg
raise.
• A deformed appearance of the knee due to the
fractured pieces.
• Tenderness when pressing on the kneecap
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 Diagnostic Test

• X-Ray
• CT scan
• MRI
• Bone Scan

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 Treatment
Non-surgical Treatment:
• Braces and Casts
• Electronic Bone Stimulation
• Physical Therapy
• Medication
Surgical Treatment:
• Tension Band Wiring
• Canulated lag-screw with tension band

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 Conti…
• Himawri method for comminuted patellar
fracture.
• Partial Patellectomy
• Total Patellectomy

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 Conti…
• Pharmacological Treatment:
Drugs used to treat fractures are generally
nonsteroidal anti-inflammatory drugs(NSAIDs),
analgesics, and anxiolytics.
• Non Pharmacological Treatment:
Ice helps decrease swelling and pain.
Massage therapy may help relax tight muscles and
decrease pain.
Physical therapy teaches you exercises to help
improve movement and strength.

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 ROM(Up, Down)

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 Clockwise and Anti-Clockwise

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 Complications
• Knee Stiffness
̶ Most common complication
• Infection
̶ Rare, depends on soft tissue compromise
• Loss of Fixation
̶ Hardware failure in upto 20% of cases
• Osteoarthritis
̶ May result from articular damage or incongruity

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 Conti…
• Nonunion < 1% with surgical repair
• Painful hardware
̶ Removal required in approximately 15%.

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 Introduction of the Patient
Scenario:
A 25 years old male patient Mr.Waqas Waheed
came into the hospital on 14 November 2017, with
the complain of left patella fracture due to road traffic
accident last night. The patient is complaining of 9/10
pain in his left patella, worse with even minimal
ROM of the left foot. The patient was admitted in the
Surgical Orthopedic Ward for anesthetic assessment
and special nursing care.

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 Baseline Data
• Name: Mr.Waqas Waheed
• Age/Sex: 25Y/M
• MR No: 025996-17
• Weight : 51kg
• Admission date: 14/11/2017
• Temperature : 98.6 °F
• Pulse: 88/m
• Blood Pressure: 120/80mmhg
• Respiration: 20/m

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 Presenting Complains
Patient having complain of following;
Severe pain
Inability to walk
Swelling
Stiffness
Deformity of limb
Weakness

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 Health history
Present History:
• Chief complain: Patient come with complain that
inability to walk and pain in left patella.
• Duration: It was from last night.
• Severity: Pain on pain scale 9/10.
• Location: Left patella.
• Past medical record: Patient has no past medical
record.
Personal history:
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 Conti…
• Diet: Simple liquid (water, milk, yakhni) bread, rice.
• Micturation: No burning urine.
• Bowel habits: Abnormal.
• Smoking: No habit.
 Family History: In his family no family member have
any osteoporosis, osteoarthritis, bone tumor or any other
disease.
 Past surgical history: No any history of surgery.
 Allergies history: Patient has not known drug allergy.

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 General survey
 Patient was conscious to environment.
 Well groomed.
 Well oriented with time,
place and person.
 His mood was sad.
 His memory was intact.
 His computation ability and
abstract ability was good.

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 Conti…

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 Health Assessment
• Prior to performing the procedure, introduce self and
verify the client's identity using agency protocol.
Explain to the patient that what you are going to do,
why it is necessary, and how he can participate.
Perform hand hygiene, done gloves. Provide privacy
and start assessing fracture sight for color, texture,
warmth and skin integrity.

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 Conti…

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 Conti…
Inspection:
Inspect the skin for color, size, symmetry and
swelling.
Findings :
By inspecting the patient I have assessed
that there is redness and swelling due to fracture.

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 Conti…
Palpation:
Palpate the sight of fracture to
evaluate the signs of edema and tenderness.
Findings:
By palpating the patient feels severe
pain (9/10) and discomfort due to immobility.

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 Conti…

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 Nursing Care Plan
Assessment
Subjective Data:
Patient verbalizes that “I have severe
pain in knee joint due to road accident.
Objective Data:
• Limited range of motion (ROM).
• Anxiety
• Discomfort

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 Conti…
Vital signs taken as;
• Temperature: sometime moderate fever 100̊ F
• Pulse: 88/m
• Blood Pressure:120/60mmhg
• Respiration: 20/m

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 Planning
• Short Term:
After 3-4 hours of nursing intervention the
patient will be able to relive from pain, discomfort,
limited motion and anxiety.
• Long Term:
After the 5-7 days of nursing intervention the
patient will be able to demonstrate relieve from all
symptoms.

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 Nursing Diagnose
 Acute pain related to fracture as evidence by pain
grading on pain scale 9/10.

 Impaired physical mobility related to pain as

evidence by limited range of motion (ROM).

• Impaired skin integrity related to fracture as evidence

by reports of itching, pain, numbness, pressure in
affected/surrounding area.

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 Nursing Intervention
Intervention Rational

Maintain immobilization of Relieves pain and prevents

affected part by means of bone displacement and
bed rest, cast, splint, extension of tissue injury.
traction.

Elevate and support injured Promotes venous return,

extremity. decreases edema, and may
reduce pain.
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 Conti…
Assess degree of
immobility produced by
injury or treatment and
note patient’s perception of
immobility.
Patient may be restricted
by self-view out of
proportion with actual
physical limitations.

Encourage use of isometric Isometrics contract

exercises starting with the muscles without bending
unaffected limb. joints or moving limbs and
help maintain muscle
strength and mass.
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 Conti…
Instruct patient or assist
with active and passive
ROM exercises of affected
and unaffected extremities.
Place in supine position
periodically if possible,
when traction is used to
stabilize lower limb
fractures.
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Increases blood flow to
muscles and bone to
improve muscle tone,
maintain joint mobility;
prevent contractures or
atrophy .
Reduces risk
of flexion contracture of
hip.
42
 Open ROM

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 Conti…
Improper positioning may
Assess position of splint
cause skin injury or
ring of traction device.
breakdown.

Place protective padding Minimizes pressure on

under the leg and over these areas.
bony prominences.
Remove skin traction every Maintains skin integrity.
24 hr, per protocol; inspect
and give skin care.
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 Evaluation
Short Term:
After the 3-4 hours of nursing intervention
the patient was able to demonstrate relieve from
all the symptoms of pain, discomfort, immobility,
anxiety, depression and fluid loss.
Long Term:
After the 5-7 days of nursing intervention the
patient was able to demonstrate relieve from all
symptoms.
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 Def.
Risk Factor A break in the
Advance Age,
Concept
Obesity, continuity of Map of
Osteoporosis,
Decrease
the bone Patella
Muscle Maas, Fracture
Post menopause
CONCEPT MAP
Patient Name Waqas
• Etiology Waheed
Age 25 Years Sign and Symptoms
• Direct Blows Pain or Tenderness,
Sex Male
• Crushing Diagnosis Left Patella Loss of Function,
forces Deformity, Crepitus,
Fracture Shortening,
• Sudden Complication Swelling,
twisting Shock, Fat Embolism, Discoloration
motion Infection,
• Extreme Compartment
muscle Syndrome, DVT,
contraction Delayed Union,
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Avascular Necrosis,
 Summery
A Patella fracture is a breakdown of the knee cap.
Types of Patellar Fractures:
o Stable Fracture
o Displaced fracture
Etiology of patella fracture include receiving a sharp
blow to the knee.
Symptoms may include Severe pain in and around the
kneecap and Swelling.

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 Conti…
• Diagnostic Tests are X-Ray CT scan MRI and Bone
Scan.
• Complications are Knee Stiffness and infection
• Non-surgical Treatment consist of Braces and Casts
• Surgically can be treated through Tension Band
Wiring

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 References
• Waugh, A,. & Grant, A. (2011). Ross and Wilson:
Anatomy and Physiology in Health and Illness
(11thed.). Hong Kong: Livingstone.
• Chintamani. (2010). Lewis’s Medical Surgical
Nursing: Assessment and Management of Clinical
Problems (1sted.). India: Elsevier.
• Smeltzer, C.S. et al. (2010). Brunner & Suddarth’s
Medical Surgical Nursing (12thed.). India: Wolters
Kluwer/Lippincott Williams & Wilkins.

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 Conti…
• Porth. M. C. (2011). Essentials of Pathophysiology
(3thed.) Lippincott: Williams&Wilkins. Chap 43, page
416-422.
• pharmacology and Therapeutics by Jim E. Riviere
and Mark G. Papich(Ed.). 9th Edition

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 ss

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