Randon Hall, MD
Christian Yelich Patella Fracture
Brewers Christian Yelich with an unusual patella fracture in tonights game. A few different types of patella fractures can occur, here is a look at the injury in-depth. Typically occurs from the counter pull of your quadriceps tendon in your upper leg and the patella tendon in your lower leg. This mechanism leads to a classic horizontal fracture of the knee cap. Most common types are vertical and horizontal which are treated very differently. Unfortunately, Yelich's looks to be a stellate patella fracture, likely multiple fragments which occurs from a direct impact to the knee cap. (Photo)
General approach depends on the direction of the fracture, as well as the spacing between the fracture fragments. If the fracture fragments are greater than 2 mm apart, surgery should be considered, including pins across the fragments to bring everything together. A patella fracture that goes vertically (top to bottom) typically can have less aggressive treatment as the fragments are less likely to pull away from each other. However, a patella fracture that is horizontal (side to side) needs to be treated with aggressive restriction of bending the knee to limit any further separation of the fragments. Typical immobilization should be around 4-6 weeks.
The biggest concern with patella fractures is that they occur across the cartilage underneath the knee cap and can present long standing issues and pain, if not treated appropriately.
Return to Play
Return to play after a fracture varies significantly based on the severity of the fracture and the overall health of the individual. In a young and healthy individual, with a vertical fracture, typical healing time is estimated to be around 8 weeks if treated non-surgically. If the fracture is vertical, the length of time until full return is usually less, as there will be less forces on the healing fragments of the fracture. In a fracture that is horizontal treatment can extent to 3-4 months if treated non-surgically. When the fracture is horizontal there will be tugging on both sides of the fracture and therefore return to play will be longer and more gradual. If surgical treatment is needed return to play can extend up to 6-9 months.