What injuries may be
A fracture, bruise, sprain or even ligament rupture have a number of differences. But in general terms, any damage is not pleasant and can cause similar pain, therefore, to clarify the diagnosis, you need to contact a specialist - he will determine exactly what befell the patient.
First aid
A victim with a knee fracture needs qualified medical care. Therefore, the first task of the surrounding people is to urgently deliver the patient to the nearest emergency room.
To reduce the risk of possible complications, the patient requires high-quality first aid at the scene of the incident:
- In case of an open fracture, bleeding is controlled using an aseptic bandage and tourniquet. If it is necessary to transport the victim for a long time, the tourniquet is removed every 40 minutes in the winter and after 90 minutes in the summer.
- When closed: the injured limb is immobilized, a cold compress is applied and it is fixed with a splint.
Any type of fracture requires high-quality pain relief.
Self-reduction of fragments is strictly prohibited. This action will further injure the patient and worsen his situation.
Diagnostics
There are a number of differences in injuries that can tell you what exactly hit you:
- When a fracture
, it becomes impossible to stand on your leg and severe pain occurs. If nerves are affected, a feeling of numbness may occur. - The stretch
is often accompanied by a slight crunching sound when moving. During the first few hours, there is swelling, a feeling of instability, stiffness, or vice versa - severe looseness of the knee joint. - When a ligament ruptures,
the victim can literally hear a pop during the rupture. There may be bruising and a feeling of instability in the knee, sometimes even a hematoma. Mobility is severely limited or becomes completely impossible.
Rehabilitation
In the process of treating a knee fracture, the final stage is rehabilitation, which makes it possible to make the knee motility fully functional again. Rehabilitation measures include frequent massage, physical therapy, and physiotherapeutic procedures.
All these measures must be prescribed directly by a specialist. Only in this case can you count on a 100% and fastest recovery after such a complex injury as a fracture of the knee joint.
Author of the article:
Kaplan Alexander Sergeevich |
Orthopedist Education: diploma in General Medicine received in 2009 at the Medical Academy named after. I. M. Sechenov. In 2012, she completed postgraduate studies in the specialty “Traumatology and Orthopedics” at the City Clinical Hospital named after. Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery. Our authors
Treatment
First of all, the injured knee needs to be immobilized so as not to add pain and worsen the situation. After the diagnosis has been clarified, the bone and its fragments (if any) are moved into place. This can be done both in closed form and operationally. After reduction, the fracture site is fixed until healing. This may take several weeks or even months. After bone restoration, it is important to undergo proper rehabilitation in order to restore normal functionality of the leg and return to a normal lifestyle.
In any case, a knee injury requires special attention, because only a specialist can determine its seriousness, and if treatment is delayed, the consequences can be disastrous. Enjoy life, not knee pain.
Fractures of the patella (kneecap)
Anatomy
The patella is located in the thickness of the tendon that extends the tibia. This tendon is formed by the fusion of four muscles on the front of the thigh - the so-called quadriceps muscle. Below the patella begins the patellar ligament, which is attached to the front of the tibia (to the tibial tuberosity). Sometimes the patellar ligament is called the patellar ligament. When the leg is extended, the patella “floats” above the knee joint, located in front and above the joint space. But when the knee bends, the patella fits into a special notch (groove) between the two condyles of the femur and begins to work like a block
The inside of the patella is covered with a thick layer of cartilage, which is needed to slide along the cartilage of the femoral condyles. The patellar cartilage is the thickest cartilage in humans - its thickness can exceed 5 millimeters! Naturally, it is thick for a reason, but because the patella experiences very strong loads. You can learn more about the anatomy of the knee joint and the patella in particular on our website.
On the left – the knee is in a flexed position. The patella fits into a groove on the femur, causing it to act as a pulley, increasing the traction efficiency of the quadriceps tendon.
Causes and options for fractures
Most often, a patellar fracture occurs when you fall on a bent knee.
Less commonly, fractures occur with a direct blow to the patella, and sometimes a fracture can occur without a blow, due to too much traction on the tendon, which tears the patella. With the latter option, the lower part of the patella is torn off.
Patellar fracture options
The most common fractures are horizontal. Since the quadriceps tendon is attached to the upper part of the patella, which pulls the patella up, then, as a rule, the bone fragments become separated and a gap appears between them. Such a fracture is already called a displaced fracture.
As we have already noted, tearing of the lower edge of the patella can also occur. With this option, the fracture line passes at the very bottom of the patella, where there is no longer cartilage on its inner surface.
If the blow is high-energy (that is, of great force and at high speed), then a multi-fragmented fracture may occur, which can also be either without displacement or with displacement of the fragments.
A special type of fracture is vertical, in which the fracture line runs from top to bottom. In the vast majority of cases, such fractures do not move, since the muscle pull is directed from bottom to top, that is, along the fracture line. However, world medicine is also aware of rare cases of displacement of such fractures, which can occur when, for example, the condyles of the femur are dysplastic and the patella was initially displaced to the side (usually outward).
And finally, a so-called osteochondral fracture may occur, when a piece of the articular surface is torn off.
Symptoms
A fracture can be suspected based on the following signs:
Pain. With a fracture, pain is almost always present. And it intensifies significantly when trying to lift an outstretched leg or when leaning on it.
Edema. Fractures of the patella are intra-articular, i.e. The fracture line “passes along the sliding articular surfaces. As with any fracture, bleeding occurs, and since the fracture line communicates with the joint cavity, the joint itself soon fills with blood and swells. This condition is called hemarthrosis, which is Latin for “blood in the joint.” Hemarthrosis can lead to a feeling of fullness, and movements can be severely limited due to this.
Inability to straighten the leg or raise a straight leg. This sign does not always occur, depending on the type of fracture.
Deformation. With patellar fractures, you can sometimes see or feel a depression in the area of the patella.
Shortly after a fracture, a bruise can often be seen on the skin, which occurs as a result of blood soaking the tissue. Many people call this bruise a hematoma, but in reality this is not always true. This is not a hematoma, but tissue soaking in blood - that is, just a bruise. Then, over a few days or even weeks, this bruise gradually moves down and may even reach the foot. This is a normal process and there is no need to be alarmed. The extremely rapid growth of such a bruise, increased swelling, and loss of sensitivity should alert you.
First aid
Apply ice, immobilize the limb in a straight position and consult a doctor.
Do not apply ice directly to the skin, but wrap it in a towel!
Diagnosis
The classic symptom that is present with horizontal fractures of the patella (the most common type of fracture) is the inability to straighten or lift the straightened leg.
As with any injury to the knee joint, to make a correct diagnosis, an x-ray is performed, on which the fracture can be seen. Typically, radiography is performed in frontal and lateral projections, and to diagnose vertical fractures, an axial (axial, or Merchant) projection is also performed.
Direct (left) and lateral (right) projections showing a horizontal fracture of the patella with displacement of fragments.
Axial projection. Vertical fracture. Note the step on the sliding surface of the patella that results from the displacement.
Sometimes computed tomography and/or magnetic resonance imaging may be required for a more accurate diagnosis, but in the vast majority of cases, radiography is sufficient.
Treatment
The treatment option is determined by two parameters: the nature of the fracture and the displacement of the fragments.
By nature, fractures can be stable or unstable. Stable fractures are those in which there is no tendency to move, such as vertical fractures. Unstable fractures are those that have either already dislodged or could easily dislodge in the future. The nature of the fracture can be determined by a doctor.
Since the patella slides along the condyles of the femur with its posterior surface, it is very important that this sliding surface remains smooth and nothing interferes with movements. Otherwise, an uneven patella will lead to the development of post-traumatic arthrosis - that is, the cartilage will simply wear off, and the knee will constantly hurt.
So, stable fractures without displacement of fragments can be treated conservatively.
The leg is immobilized in a straight or slightly bent position with a cast or orthosis for 4-6 weeks, during which control radiographs are taken. After this, the cast or orthosis is removed and the joint is worked on, restoring range of motion and muscle strength.
In traumatology, it is pleasant to believe that the displacement of fragments by more than three millimeters, and/or the presence of steps on the articular surface with a height of more than 2 millimeters requires an operation during which the fragments are compared, the articular surface is restored and the patella is fixed (osteosynthesis is performed).
If the fracture is significantly displaced, then such a fracture cannot heal, since the fragments do not touch each other.
Why operate? Unfortunately, if there is a displacement, it is impossible to eliminate it without surgery. And if the displacement is not eliminated, then the patella will either not heal at all and extension of the knee will be impossible (with significant displacement of the fragments), or there will be severe arthrosis of the patellofemoral joint, which is an integral part of the knee joint. In addition, attempts at conservative treatment require prolonged immobilization of the joint, which will then be very difficult to develop. Reliable fixation of fragments will allow you to start moving earlier and preserve the knee joint.
How is the patella fixed? The osteosynthesis option is determined by the type of fracture. In case of a transverse fracture, the fragments can be compared and fastened using a special medical wire (cerclage) and knitting needles. This operation is named after its inventor, Weber.
Sometimes the fragments are successfully fixed with screws, or screws and wire.
In case of a comminuted fracture, it is also necessary to use screws and wires that fasten the fragments to each other.
If there is an avulsion fracture of the lower edge of the patella, in which the fracture line does not pass along the articular surface, then this small fragment is simply removed (partial patellectomy), suturing the patellar ligament.
After the operation, the limb is immobilized with a plaster or orthosis for a period determined by the operating doctor.
Complications
A patellar fracture is a serious injury, and even with perfect alignment of the fragments, arthrosis can develop, which will manifest itself primarily as pain in the anterior part of the joint.
What questions should you discuss with your doctor?
- What type of fracture do I have?
- Are there any other injuries to the knee joint other than a fractured patella?
- What treatment, conservative or surgical, is appropriate in my case?
- If I need surgery, what method of osteosynthesis is preferable and what option of immobilization after surgery is optimal?
- How will this injury affect the function of the joint in the future?
- Can any of my individual factors affect the outcome of treatment (concomitant diseases such as diabetes, etc., bad habits)?
- If post-traumatic osteoarthritis does develop, how can it be treated in my case?
- How fully can I take care of myself after the operation?
- When can I return to work if my job involves...?
- Will I need to take medications to prevent thromboembolic complications? Which ones, how and for how long?
- When should follow-up inspections be carried out?
Rehabilitation
In the postoperative period, as well as during conservative treatment, control radiographs are periodically taken. In any case, in the first few days after surgery, you should try to keep your leg elevated so that the knee joint does not swell. During limb immobilization, it is better to move the foot and toes, which will reduce the risk of thromboembolic complications. Support on the leg during the entire period of immobilization (immobilization), as a rule, is possible according to the principle of pain tolerance - i.e. advance with as much force as you can tolerate due to pain.
Sometimes after surgery you have to give an injection into the joint to remove accumulated blood from it.