Delayed Diagnosis of Patella Fracture in Active Young Adult

Case at a Glance

A 28-year-old active male athlete presented with chronic knee pain following a hiking injury, ultimately diagnosed with a patellar fracture after several months of continued sports participation.

Patient's Story

The patient sustained a knee injury in March while hiking when he fell and landed directly on a rock. Despite initial pain, he was able to complete the hike without significant distress. Over the following months, he experienced mild persistent knee discomfort (3/10 pain intensity) particularly during kneeling, sprinting, and directional changes while playing rugby. He continued athletic activities for several months post-injury before seeking medical attention due to a palpable depression in the patella.

Initial Assessment

The patient presented to physiotherapy with complaints of chronic knee pain and a noticeable defect in the patellar contour. Physical examination revealed a palpable indentation in the kneecap beneath the skin. Given the persistent symptoms and physical findings, imaging was recommended to rule out structural damage.

The Diagnostic Journey

Plain radiographs of the knee were obtained, which demonstrated a fracture of the patella. The patient had been participating in high-impact sports including rugby for months following the initial injury, unaware of the underlying fracture. The delayed presentation was likely due to the initially mild symptoms and the patient's ability to continue normal activities.

Final Diagnosis

Patellar fracture with delayed presentation, sustained during hiking accident with continued athletic participation despite underlying injury.

Treatment Plan

Patient scheduled for orthopedic specialist consultation to determine appropriate treatment approach. Management options under consideration include conservative treatment versus surgical intervention, depending on fracture pattern, displacement, and functional requirements given the patient's active lifestyle and participation in skiing and rugby.

Outcome and Follow-up

Patient awaiting specialist evaluation to determine definitive treatment plan. Prognosis and return to high-level athletic activities including skiing will depend on fracture characteristics and chosen treatment modality. Patient expressing concern regarding impact on future sports participation.