Patellar Injuries: When to Seek Medical Attention After a Fall

Falls and patellar issues?

Currently, the individual in the UK fell forward on an escalator on July 23, impacting the right angle of the stairs just below the midline of the left patella, resulting in a wound approximately 1 cm in diameter that likely extends into the dermis.
After the fall, there was significant pain, making it difficult to stand, but the individual managed to walk a short distance despite the pain.
After resting for 4 hours, there was mild pain at rest in the knee, and walking also elicited slight discomfort.
The individual can flex and extend the knee independently, but experiences pain rated at about 4 out of 10 during full flexion or extension.
Upon manual examination, the patella appears intact, with slight crepitus noted during both lateral and medial pressure on the affected patella.
Rotating the ankle joint also produces slight crepitus when touching the affected patella.
There is tenderness at the site of injury, mild swelling, and low-grade fever that is not pronounced.
Questions:
1.
Given that the individual is abroad and will return to Taiwan in 7 days, is there a possibility of a patellar fracture or dislocation? Should this condition be monitored, or is it necessary to obtain an X-ray locally?
2.
If monitoring is sufficient, considering that walking is currently manageable, but there are more walking activities planned for the weekend, should the individual reduce walking to prevent further strain, or are there other precautions to take?
Thank you very much, doctor, for your patience in reviewing this description, and I wish you all the best!

Gill, 20~29 year old female. Ask Date: 2019/07/24

Dr. Li Yongheng reply Orthopedics

Hello, 1.
If there is slight swelling at the affected area and the bruise is not prominent, the likelihood of a patellar fracture is low, and you can apply ice and monitor the situation.
2.
It is important to reduce walking and avoid squatting, kneeling, and bending the knee joint to prevent a hairline fracture from becoming a displaced fracture.

Reply Date: 2019/07/24

More Info

When it comes to patellar injuries, especially after a fall, it’s crucial to assess the situation carefully to determine whether medical attention is necessary. Based on your description of the incident and the symptoms you are experiencing, here are some insights and recommendations.

1. Possibility of Fracture or Dislocation: Given that you experienced a direct impact to the patella (kneecap) and are experiencing pain, swelling, and tenderness, there is a possibility of a fracture or dislocation. While you mentioned that you can flex and extend your knee, the presence of pain during these movements, especially if it is significant, raises concerns. The fact that you felt a "fine friction" sensation when palpating the patella could indicate underlying issues, such as cartilage damage or a fracture that may not be visible without imaging.

2. When to Seek Medical Attention: It is advisable to seek medical attention if:
- You experience significant swelling that does not improve.

- The pain worsens or becomes unbearable.

- You notice any deformity in the knee or difficulty in moving it.

- You develop a fever or any signs of infection (increased redness, warmth, or discharge from the wound).

- You have difficulty bearing weight on the affected leg.

Given that you are currently in the UK and will be returning to Taiwan in a week, it might be prudent to get an X-ray while you are there, especially since you have a deep wound that could potentially lead to complications. An X-ray can help rule out any fractures or dislocations, providing peace of mind before you travel.

3. Observation and Activity Modification: If you decide to observe the injury for now, it is essential to manage your activities wisely. Since you mentioned having more walking planned over the weekend, consider reducing your walking distance and frequency to avoid exacerbating the injury. Use supportive footwear and avoid uneven surfaces that could increase the risk of further injury. If you experience increased pain or swelling, it would be wise to rest and elevate your leg as much as possible.

4. Wound Care: Since you have a wound that penetrates to the dermis, ensure that it is kept clean and covered to prevent infection. Monitor for any signs of infection, such as increased redness, warmth, or discharge. If you notice any of these symptoms, seek medical attention promptly.

5. Follow-Up Care: Once you return to Taiwan, it would be beneficial to follow up with a healthcare provider to reassess your knee. They may recommend physical therapy to strengthen the knee and improve mobility, especially if there is any lingering pain or instability.

In summary, while it may be tempting to wait and see, the combination of pain, swelling, and the mechanism of injury suggests that an X-ray could be beneficial to rule out any serious injuries. Prioritize your health and safety, and don’t hesitate to seek medical attention if your symptoms worsen or if you have any concerns. Safe travels and take care!

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It is advisable for you to discuss the above situation further with your attending physician. Thank you, and wishing you good health!