Intra-articular fracture - symptoms and treatment
Complications of intra-articular fractures are divided into local (only in the fracture zone) and general (located in any part of the body).
Local complications include bleeding into the joint cavity (hemarthrosis). The accumulation of blood in the joint requires additional therapeutic manipulations - removing it from the joint. Lack of treatment for hemarthrosis leads to impaired movement in the joint in the long term [8].
A common local complication is injury to blood vessels or nerves , the result of the mechanical impact of fragments and tension of soft tissues at the time of fracture. A vessel or nerve passing near a fracture may be crossed or compressed by the sharp edges of the fragments. Sometimes unnatural stretching of muscles after a fracture leads to tearing of blood vessels and nerves, which significantly affects the healing process [1].
Case syndrome is another local complication. Its name is associated with an anatomical feature: all the muscles of the limb are located in dense, inextensible sheaths (fascia). When a fracture occurs, the muscles may swell and become enlarged, causing them to become compressed in the stubborn fascia. This leads to cessation of blood circulation and gradual death of muscles.
A complication such as fat embolism can not only aggravate the patient’s condition, but also lead to death. The complication is associated with droplets of fat: normally they are located inside the bone, but are released during a fracture. Drops of fat enter the lumen of small vessels injured by a fracture. The flow of blood carries fatty inclusions to distant parts of the body (for example, the brain or lungs) and disrupts their blood circulation, clogging the capillaries [2][9].
Thrombotic embolism is a common complication with a similar mechanism. Only in this case, it is not a drop of fat that migrates and blocks blood circulation, but a blood clot. A thrombus initially forms in the injured limb due to damage to surrounding vessels and concomitant blood stagnation [6].
Traumatic shock is another common complication associated with blood loss and intense pain from a fracture. The occurrence of traumatic shock with several fractures is especially natural [7]. Shock develops as a result of stimulation of a huge number of receptors. Their massive response leads to an extreme load on the nervous system - the flow of pain and other sensitive impulses from the fracture zone causes excitement of the entire body, including hormonal systems.
During traumatic shock, the blood vessels of the extremities spasm: this allows peripheral blood to be collected and brought to vital organs - the brain, heart and lungs. This stress response allows you to save life in conditions of significant blood loss and pain. At the same time, the patient appears active and underestimates the severity of his injuries, which can be falsely perceived as a satisfactory state after injury. The duration of this condition is up to several days.
Traumatic shock without treatment goes into a phase of oppression, when the body’s strength is depleted, until the onset of a terminal state (death). In this phase, the patients' behavior changes sharply towards inhibition and indifference to the environment.
General complications of an infectious nature occur only with an intra-articular fracture with damage to the skin by fragments, that is, with an open fracture. In this case, a septic condition cannot be ruled out when infecting bacteria enter the blood from the wound. This condition is due to the fact that the infection is spread by contaminated blood throughout the body.
There is a separate group of complications of intra-articular fractures - “late” complications [6]. They develop weeks and months after injury:
- displacement of fragments occurs (with an initial fracture without displacement);
- the fracture does not heal properly;
- the fracture heals too slowly;
- lack of healing of the fracture;
- joint stiffness;
- the muscles of the limb atrophy;
- deforming arthrosis of the joint is formed.
Types of fractures
There are several types of patellar fracture:
- without offset . The parts of the broken bone fit tightly to each other and do not move to the sides. This type is considered the easiest, since it does not require reposition, and its treatment is relatively quick;
- with offset . In this type of injury, the bone is divided into two fragments, one or both of which are displaced relative to each other. Reposition is required to connect them.
- comminuted . In this case, the patella is divided into three or more smaller parts that are displaced and unstable (can move). The most difficult type to treat.
Open and closed fractures are also classified depending on the presence of skin disruption.
Symptoms of a fracture include severe pain immediately after the injury, swelling and deformation of the knee joint, and bruising or open bleeding. If these signs occur, you should immediately contact a clinic or call emergency help. The doctor will conduct an initial examination and X-ray examination, as a result of which he will determine the type of fracture and prescribe the appropriate treatment.
Important! With age, the risk of a patellar fracture, like other fractures, increases. This is because bones become more fragile over time. Therefore, older people should be as careful as possible.
Clinical picture
The injury is accompanied by a number of characteristic signs.
- It is always intra-articular.
- Hemarthrosis is present.
- The damaged area swells.
- The victim is forced to hold his leg in a certain position, slightly bending it at the knee and pointing it to the side.
- If the ligamentous apparatus is damaged due to mechanical impact, it is impossible to lift the leg, and movements in the lower leg are also impossible.
- On palpation, the patella balls out.
- If a fracture occurs with the appearance of fragments, they are located at a certain distance from one another and cause sharp pain.
Remember! Only a specialist can make an accurate diagnosis. To determine the specifics of the injury, X-ray diagnostics is required. This is the only way to determine the complexity of the damage, the number of fragments and the degree of their displacement.
Rehabilitation after a knee fracture.
Rehabilitation after a knee fracture includes several basic rehabilitation and control measures. In particular, control radiographs are taken throughout the entire period of restoration of joint function after a knee injury. Also, rehabilitation after such a displaced fracture includes periodic injections to suck out the blood accumulated in the joint. When performing exercises aimed at recovery after such a fracture, the doctor and the patient work together, since the intensity of the exercise is set according to the principle of maximum tolerance - that is, you need to step on the leg or bend it with the effort that is acceptable due to pain.
Rehabilitation after a fracture of the patella contains exercises such as flexion and extension of the sore leg using the healthy leg or arms; also, as the joint recovers after fractures of the patella (kneecap), new exercises are added. These are bending, walking, running and jumping. When performing exercises, the performance of the diseased and healthy leg is compared, thus drawing conclusions about whether rehabilitation after a fracture is effective.
In addition to exercises, rehabilitation after fractures involves taking special restorative medications, including vitamins, as well as calcium, iron and other minerals. For each patient, rehabilitation after a fracture requires its own therapeutic nutrition regimen.
After the knee regains its motor function, the attending physician evaluates the success of rehabilitation and decides whether to extend it or discharge the patient.
Unicondylar - partial endoprostheses
The field of endoprosthetics has been actively developing for a long time. Now modern prostheses meet all basic requirements. They can become a complete replacement for the knee joint.
What does it look like after surgery?
Basic requirements for a high-quality endoprosthesis:
- Biocompatibility. The components from which the implant is created must be hypoallergenic and not cause a “rejection” reaction (when the body rejects the implant, causing autoimmune aggression).
- Anatomical. The prosthesis must be suitable in size and exactly repeat the features of the bone structure of the joint.
- Compliance of characteristics. The materials must be durable and withstand the usual loads on the joint. The smoothness of the surfaces of the prosthesis ensures fairly easy sliding of the components.
- Functionality. A well-made prosthesis should provide a good range of motion without limiting the mobility of the knee.
- Shape retention and high wear resistance. The endoprosthesis should not wear out or lose shape, while providing the wearer with a good quality of life for 15-20 years to come.
Zimmer
A major representative in the supply of materials for orthopedic products. In particular, endoprostheses.
Zimmer Hihg-Flex.
The implant is intended for unicondylar knee replacement. Placing such an implant in 98% of cases guarantees a high quality of life in the next 10 years.
Zimmer Hihg-Flex
Zimmer Gender Solutions Patello-Femoral Joint.
Used in minimally invasive interventions in the surgical treatment of deforming osteoarthritis.
Zimmer Gender Solutions
Biomet
Another big company. Its production is focused on the orthopedic, traumatological, dental and sports industries.
Vanguard.
It is a total knee prosthesis with a cementless type of fixation. The implant insert is impregnated with vitamin E.
Vanguard.
Oxford.
The endoprosthesis has increased strength and wear resistance.
Oxford Knee Biomet.
Aesculap
The company from Germany, existing since 1967, has a number of endoprostheses in its wide product line.
Aesculapial partial knee.
You can also highlight other manufacturing companies: Johnson & Johnson (with its DePuy Synthes), Stryker (Scorpio NRG).
Treatment
In the early stages, they try to treat chondromalacia with conservative methods:
- limiting physical activity;
- wearing a special orthopedic patella to stabilize the joint;
- anti-inflammatory agents and hyaluronic acid preparations to combat pain and inflammation;
- physiotherapeutic treatment;
- physical therapy to strengthen leg muscles.
If these methods do not produce results, surgical intervention is performed. During arthroscopy, the doctor inserts special instruments into the joint and corrects the shape of the cartilage.