The knee is a joint that provides flexion and extension of the leg, as well as rotation about the axis. Such functions are possible due to the complex structure of the knee joint - it is here, with the help of ligaments, cartilage and tendons, that the femur is connected with the tibial bone and the patella (patella).
Due to the complex structure of the knee joint, it is easy to injure, mechanical fractures of different strength cause fractures. Consider the anatomy of the knee joint, the types and features of injuries, treatment methods and rehabilitation procedures.
Anatomy of the knee
To understand the mechanism of development of fractures of the knee joint, you need to have an idea of its anatomy. See the schematic.
The structure of the knee joint
The contiguous parts of the femoral and tibial bones are covered with special meniscus cartilage. They play the role of a shock absorber, protect the joint from damage when walking and running, and also perform joint-stabilizing functions. Meniscus collapses with a side impact on the knee. This is the most common injury to the knee.
The patella or patella is located in the tendons and covers the joint. This is a kind of protective shell, due to which the joints do not move under normal loads. On the sides of the knee joint there are cruciate ligaments, passing in the immediate vicinity of the patella. They give the knee extra strength.
For the production of synovial fluid, which plays the role of lubrication of the joint and provides easy sliding, there are synovial bags in the knee, the size and number of which is different for each person. Nutrition of the joint is carried out by arteries, and sensitivity - by nerve endings. It turns out that the knee joint is a complex mechanism that ensures the movement of a person. How does a fracture occur?
Fracture development mechanism
Life experience suggests that the more complex the mechanism, the easier it is to break it. Even a slight side or front impact is sufficient with the limb bent and turned inside the tibia to break the anterior cruciate ligament of the knee. Most often there is an injury, which in medicine is called the Turner triad. In this case, the cruciate and internal ligaments are damaged, as well as the internal meniscus of the knee. This injury occurs in football players, wrestlers and skiers.
In the most severe cases, both cruciate and all lateral ligaments are damaged, as well as the capsule of the joint itself. With such a fracture, the symptoms will be as follows:
- sharp pain in the knee,
- increase in joint size
- development of hemarthrosis (filling the joint with blood).
The knee joint loses its supporting and bending functions and the person cannot walk. In rare cases, a fracture of the knee joint does not cause vivid symptoms, and the victim suspects injury only on the basis of a feeling of “looseness” in the knee.
X-ray fracture of the knee joint
In the practice of the traumatologist the most common fractures of the following types:
- fracture of the lower edge of the femur,
- fracture of the upper part of the tibia,
- fracture of the calyx,
- meniscus fracture
- fibula fracture.
In an intraarticular fracture, not only the ligaments, but also the synovial sacs are damaged. Pre-extraarticular fracture cartilage and ligaments are not affected, the knee joint itself is almost not damaged.
Diagnosis of knee fracture
The first conclusions about the nature of the injury the doctor makes on examination. With the help of palpation (palpation) it is possible to reveal which part of the knee is damaged. In addition, when making a preliminary diagnosis, the doctor takes into account the circumstances of the incident and symptoms.
The most effective diagnostic method is radiography. Pictures are made in several projections:
- in straight line
- in the side,
- in axial,
- in the right oblique,
- in the left oblique.
The position of the victim during the x-ray depends on the purpose of diagnosis. So, if the doctor needs to get a side shot of the knee joint in a direct projection, the patient can stand, leaning on a healthy limb, or lie on its side.
If the traumatologist has suspected a fracture of the meniscus of the knee joint, then the patient is referred to MRI (magnetic resonance imaging) or CT scan (computed tomography). A single X-ray examination is not enough here - the cartilage of the meniscus is invisible to the beam, so it is impossible to determine the nature of the damage. Alternatively, an ultrasound scan can be used to further determine if the muscles adjacent to the knee are damaged.
arthroscopy of the knee at fracture
Endoscopic arthroscopy is a modern diagnostic method. For the examination, an endoscope is used - a medical device equipped with a miniature camera with high resolution. The image from the endoscope is transmitted to the monitor, and the doctor can not only assess the nature of injuries of the knee joint, but also try to sew a broken meniscus.
Treatment methods for fracture of the knee joint
It is conditionally possible to distinguish three stages of treatment - preliminary, primary and restorative. First, the victim must be given first aid, without waiting for the arrival of doctors and subsequent diagnosis. For this, it is necessary to ensure the immobilization of the knee with handy means, that is, to prevent mobility by imposing the tire. To prevent the occurrence of pain shock, analgesics should be given. Further treatment is carried out after receiving the results of the examination.
Modern medicine allows for two tactics of the treatment of a fracture of the knee joint: conservative and surgical. The doctor chooses the method, taking into account the following factors:
- the nature of the fracture,
- the presence or absence of displacement of bone fragments,
- existing diseases, especially in nearby tissues,
- lifestyle of the patient
- age, weight and other parameters of the patient.
For example, if a fracture of the knee arises in a young man engaged in active sports, surgical treatment is preferable. Without it, the doctor will not be able to restore the normal functioning of the knee and create the original biomechanical axis of the joints.
If the victim leads a sedentary lifestyle or is a pensioner, the choice can be made in favor of conservative treatment. The exception in this case is such damage that leads to loss of motor and support functions of the limb. Consider both methods in more detail.
Conservative fracture treatment
By conservative treatment is meant the imposition of special pressure (compression) dressings, gypsum or other means, aimed at immobilizing the damaged knee joint. To monitor the recovery of bone and cartilage tissue radiographic examination is used. This approach allows the body of the victim to independently restore the knee joint.
Conservative treatment of knee fracture
As a immobilizer, the doctor may prescribe:
- an orthosis is a special device that allows a small movement in the joint,
- brace - knee pad, which has a therapeutic effect and stimulates faster recovery,
- plaster longet - dressings impregnated with plaster solution.
Recently, bandages with polymeric (plastic) material are widely used, which are analogous to gypsum, but are lighter and are more easily tolerated by the patient.
Conservative treatment is carried out in the following sequence.
- With the help of a puncture, the doctor removes accumulated blood from the joint.
- Injects novocaine or another anesthetic into the knee.
- Examines the knee joint and, if there is no fracture of the meniscus, applies an immobilizing bandage.
The duration of such treatment depends on the nature of the fracture and can reach 30 days.
When treating a fracture of the knee joint by a conservative method, it is important to choose the right time to start the exercise to restore mobility. If you start exercise therapy too early, before the final formation of callus, a false joint may occur, which can only be eliminated by surgery. When postponing the start date of exercise therapy, contracture develops. This is a condition in which adhesions are formed and the joint loses its former mobility.
Surgical treatment of fracture
Surgical treatment, in contrast to the conservative, allows the doctor to accurately combine bone fragments, restore the biomechanical axis and restore mobility to the joint. The operation has a lower risk of complications, and the use of modern methods, for example, osteosynthesis, allows you to start the rehabilitation period in a short time.
The main task of surgery for a fracture of the knee is to restore the joint health. If the fracture is complicated by the violation of the integrity of the edges of the tibia and femur bones, the displacement of fragments is almost never eliminated. Such intervention in the area of the knee will lead to malnutrition of the bones, so the surgeon tries to make a choice in favor of osteosynthesis.
If there is an opportunity to perform arthroscopy in a medical institution, the doctor will prefer this method as the least traumatic. Otherwise, arthrotomy may be required - opening the cavity of the knee joint to provide surgical access.
Osteosynthesis is used for the most favorable healing of a fracture. This is the fixation of fragments with screws, plates and a pin, providing them with immobility and anatomically correct location. The design of modern fixatives allows osteosynthesis with minimal tissue injury, and the use of fluoroscopy during the operation helps the doctor correctly position fragments.
Anesthesia of the knee
Of the minuses of osteosynthesis in the treatment of fractures in the region of the knee joint, it can be noted that it is impossible to use the method in violation of the integrity of the condyles. Therefore, with such an injury, osteoplasty is used - a technique in which the acceleration of the formation of callus is achieved by bone chips.
In cases where the skin or fatty subcutaneous layer was damaged during a fracture, osteosynthesis with pins is not used due to the risk of infection. In this case, the Ilizarov apparatus is used, with which it is possible to achieve temporary fixation of bone fragments. After the healing of wound fractures and the elimination of the risk of suppurative inflammatory processes, the doctor can osteosynthesize the plates. In order to make the right decision, the doctor makes X-rays, which will clearly show whether it was possible to achieve the desired reposition of fragments or not.
Rehabilitation after a fracture of the knee
To develop a damaged knee, the day after surgery, the doctor prescribes exercise therapy exercises. The method of their implementation depends on the nature of the fracture, the patient's age and other factors. Physical therapy has three stages, the first two are the same as in the treatment of a false joint. Therefore, we describe the exercises required in the third stage of rehabilitation.
- Put your feet to shoulder width. Take turns bending one limb while simultaneously transferring body weight to another.
- Holding on to the back of the chair to perform squats.
- Standing on the floor to make a healthy leg back and forth. The same exercise is necessary for the injured limb, but it should be carried out with caution.
- Sitting to clasp the shin of the injured limb with your hands and try to pull it up to the buttocks. At the same time the heel should not break away from the horizontal plane.
- Need a gymnastic wall. You need to put the injured leg on the third or fourth step and perform semi-squats. There should be no pain.
- Walk the stairs so that the injured limb is one step higher than the healthy one (step).
- Carefully climb and descend the gymnastic ladder.
The course of all exercises should be supervised by a medical professional in order to support the patient, if necessary. Starting exercise therapy on your own or terminating exercises ahead of time is prohibited.
Anatomy of the Patella
The patella is a flat, rounded bone that lies on the front of the knee joint. The tendons of the quadriceps located in the thigh are attached to the top of the patella. Also, the attachment is carried out to the bottom of its own patellar tendon. Outside and inside, the bone adheres to the lateral ligaments.
The smooth surface of the patella, located inside, is adjacent to the surface located above the knee. The outer surface is rough. It is covered with tendon fibers. The patella serves to protect the knee in shock and injury.
The main types of fractures
It is accepted to distinguish the following types of fractures:
- Fracture of the patella without displacement. It is characterized by the fact that parts of the damaged bone, without shifting, adjoin one another. For injuries of this type, the bone remains in place throughout the treatment.
- Fracture with the presence of bias. It is characterized by the displacement of parts of a broken patella in relation to each other. In the overwhelming majority of cases, surgical intervention is required to reunite the fragments.
- Fracture with multiple fragments. It is characterized by the fact that the patella is fragmented into more than three fragments. This fracture is considered the most severe and requires long-term therapy.
Open and closed fracture forms
Fracture of the patella is divided into open and closed type.
When the fracture is closed, the skin at the fracture site is not damaged. She remains whole.
With an open type, there is a strong violation of the structure of the skin, from which fragmented bone can be seen. In addition, the open type causes serious disturbances in the structure of nearby ligaments, tendons and muscles.
How does the fracture occur?
Usually a fracture of the patella is the result of a direct injury when falling on the knee in a bent state or hitting a sharp or hard object. Indirect injury is possible with a sudden reduction of the quadriceps femoris.
A mixed-type mechanism is distinguished, in which a fracture occurs when a combination of elements of direct and indirect damage occurs.
Patella fracture is often combined with damage to the bending apparatus, located on the side (tendon fibers of the quadriceps located in the thigh).
When the tendons rupture, there is a discrepancy between the bone fragments in the patella.
Symptoms of damage
What is a patella fracture?
Symptoms are as follows:
- When the knee is damaged, there is a pronounced swelling in the area of the knee joint.
- On palpation, sharp painful sensations are revealed, there is a gap between the debris, hemarthrosis (streamed blood in the knee joint) occurs.
- Often revealed pathological mobility and the presence of crepitus (crunch) of bone fragments.
- Pain when trying to bend the knee sharp. Active extension is impossible or becomes sharply limited.
- In case of injury without displacement, the patient does not lose the ability to walk, but movements are accompanied by sharp combat sensations.
- Fracture of the patella with the presence of displacement makes walking impossible. Also, the patient cannot lift a limb in a straightened state and produce active movements of the joint.
Diagnosis of a fracture is carried out by a traumatologist on the basis of the clinical picture that is characteristic of this type of lesion. Also actively used data obtained by X-ray studies.
Additional methods for diagnosing trauma are magnetic resonance imaging of the affected joint. Hemarthrosis is confirmed by a diagnostic puncture of the joint.
A fracture of the calyx of the knee joint is differentiated from a rupture of the knee ligament, a rupture in the quadriceps tendon, as well as the presence of arthritis of a traumatic nature or prepatellar bursitis. In all the above cases, the presence of a gap between the bone fragments is not traced.
Fracture of the patella has to be distinguished from the abnormal development of the joint (divided patella). In contrast to a fracture, there is no trauma or sharp pain in this pathology. The gap between the bone fragments is even and smooth. As a rule, such a disease is detected on both sides.
The choice of a particular method of therapy depends on two main indicators: the nature of the fracture and the type of debris displacement.
Fractures are stable and unstable. With a stable form, there is a tendency to bias. The unstable form suggests the presence of fractures in which the bones have already shifted or can shift after a while.
Principles of conservative therapy
Many are interested in how a patella fracture is treated? Treatment in the presence of an offset of more than 0.5 cm is carried out by a conservative method. To carry out such therapy, local anesthesia of the fracture is primarily carried out through the introduction of anesthetics.
The affected limb is fixed by means of a plaster splint. The patient is allowed to move on crutches. After removing the tire, it is recommended to conduct massage procedures, physical therapy classes. Also carried out physiotherapy (electrophoresis, magnetolaser, etc.).
In the absence of displacement, the injured limb is fixed in a straightened state. A plaster splint is applied to the upper thigh right up to the ankle. As a rule, the duration of such a fixation is 4-6 weeks. Showed control radiographs.
Conservative treatment involves prolonged immobilization of the joint, the development of which is a long and painstaking process.
According to traumatologists, a fracture of the patella with a displacement of the patella fragments more than 2 mm requires an operation, during which fragments are matched, the articular surface is restored and the patella is fixed. Elimination of such a condition without a surgical method is impossible.
During surgery, various methods can be applied using a soft tissue suture, bone suture and tendon muscle repair.
The Berger-Schultz operation, in which fragments are brought closer together with the subsequent piercing of the nearby tissues of the patella, was a method that scored particular popularity. The duration of immobilization after surgery is 1 month. After removing the tire from the plaster, massage, physiotherapy and therapeutic exercises are prescribed.
For fractures with the presence of many fragments and the impossibility of restoring the patella, excisional surgical procedures are used, which involve the removal of bone fragments or the patella.
If there is a possibility of preserving the joint, such operations are not recommended.
How quickly is a patella fracture treated? The duration of treatment depends on the degree of fracture of the joint. As a rule, the restoration of working capacity occurs within 2 months. If blood has collected in the joint, it should be removed by puncture of the patella. With simple forms of fractures, full recovery usually occurs within 3 months.
Rehabilitation and physiotherapy
After removing the tire from the gypsum, it is necessary to undergo recovery measures, which include a set of special physical exercises, exercise therapy, as well as massage. It is important that all rehabilitation activities, their frequency are set by the attending physician.
An important role is played by the systematic implementation of exercises, as they serve as an excellent way of developing an injured joint.
The set of exercises used might look something like this:
- A healthy leg is wound up under the injured leg, active movements are performed in a circle at the knee joint.
- The patient is standing near the wall. Behind his back is a large ball, with which squats are performed.
- Walking on the treadmill in the opposite direction. The speed should be no more than 2 km per hour.
- A set of exercises is performed on a stationary bike with pedals no longer than 10 cm. The seat must be positioned so that the injured leg can fully stretch.
- Jumping on the injured leg. An important condition is the absence of pain.
What can cause a fracture of the patella? It should be noted that with a conservative method of treatment, the risk of improper accretion of bones in the knee joint is very high, which, in turn, can impair its functionality and lead to the development of such severe pathological conditions as gonarthrosis or osteoarthritis of the patella.
Fracture of the patella is a serious injury. It should be noted that this condition appears quite rarely. As a rule, fragmentation occurs with strong shocks or accidents. If a similar pathology occurs, you should contact a traumatologist as soon as possible. With proper diagnostic procedures, the doctor will be able to determine the extent of joint damage and select the appropriate treatment strategy.
Kinds of knee fractures, their causes
Treatment and rehabilitation of trauma depends on broken parts of the bones. There are 4 forms of knee fracture:
- condyle fracture of the hip,
- fracture of the patella (patella),
- intraarticular fracture of the fibula and condyles,
- tibia and condyles.
The main causes of the fracture are usually caused by a direct blow of a blunt object to the knee or a sharp contraction of the quadriceps femoris (occurs when the body turns sharply and the ligaments of the knee joint do not cope with a powerful load).
Symptoms of injury
Fracture of the patella is characterized by symptoms:
- Local, acute pain immediately after injury, extending to the knee and hip. Sometimes pain gives to the area below the knee.
- The pain does not stop, gradually turns into a dull, aching, sensitivity is broken. On palpation, pressure on the condyle a sharp pain syndrome occurs.
- Attempts to lift or move the leg increase pain.
What is dangerous fracture
As a result of an accident, a blow with a hard object, or a street injury, a fracture of the patella occurs with the displacement of bone fragments. The degree of complexity depends on the characteristics: closed or open. Unlike a closed fracture, when the skin is not damaged, with an open fracture, muscles, tissues, tendons, ligaments are torn, sometimes bone is visible.
Strong shifts in the bones of the patella or fragments represent a great danger: the fracture is characterized by the displacement of parts of the broken calyx in relation to other bones. The degree of severity of displacement is different, depending on the strength of the lateral tensile tendon injury that occurred in the extensor apparatus. The displacement is usually horizontal - the muscle tendon pulls the patella up. Due to the contraction of the muscle, the upper fragment or fragments form a large bruise, eventually falling down to the foot. The shards disintegrate, forming a cleft.
A fracture with displacement is multi-sheeted, treatment is performed by surgery. The consequences of the non-surgical method are irreparable: the risk of improper healing of the bones is possible. This leads to a violation of the mobility of the joint in the future, disability. The operation is carried out with the help of bolts and wire. The rehabilitation of the broken leg is extremely long, repeated surgery to remove bolts and wire is performed only after 2 years.
Severe pain, the inability to turn or bend the leg, extensive knee swelling and internal hematoma are the main signs of fracture.
Symptoms of patellar fracture with displacement are manifested:
- crunch, audible at the fracture, with subsequent unbearable pain, extending to the knee, just below the knee, to the thigh,
- reduction of the injured limb (noticeably even with the naked eye),
- bone mobility in unnatural directions,
- damage to muscle, even skin tissue, if debris is strongly displaced.
Important: fragments of bones should be connected in time, avoiding serious consequences: it will be extremely difficult to restore knee functions, a person will not be able to move normally.
First aid measures and treatment methods
Symptoms are a signal for immediate medical attention. If the victim, for example, is in the forest, where there is no opportunity to quickly get to the emergency room, and the signs of severe injury are clearly expressed, it is necessary to give the patient first emergency aid. Consists of a number of stages:
- Remember the importance of transporting the victim to the hospital immediately.
- Do not adjust the knee alone, the action is fraught with serious complications. You can not bend and unbend the knee.
- If the fracture is open, stop the bleeding by imposing a tourniquet. Knotted just above the fracture. Remember or record the exact time of application of the harness. The harness is made from any available tools, even from a torn shirt.
- The leg should be fixed in a stationary position in order to avoid additional displacement of the joint or a fragment of the bone. Now it is allowed to transport the patient to the emergency room.
Treatment of injuries of the knee joint depends entirely on the type of fracture. Before treatment, a thorough X-ray trauma analysis will be required. The doctor will eliminate the absence of pathologies, then prescribe a course of therapy. If necessary, a puncture of the joint or MRI is prescribed to clarify the diagnosis. If the fracture is simple, without bias, treatment is conservative:
- Anesthesia of the injured part of the limb with local anesthetics.
- Straightening and fixing a damaged limb to real estate.
- Overlaying the plaster on the leg to the ankle.
Fracture is usually treated 4 to 6 weeks. During the specified period, the sore knee cannot be loaded, the patient is recommended to use crutches for movement. After conservative treatment, the patient needs long-term rehabilitation, to restore joint mobility and muscle strength is often difficult.
In case of a severe fracture of the knee cap with a displacement (more than 2 mm), with a plurality of fragments, it is impossible to remove the displacement without an operation, the doctor’s actions:
- With surgical intervention, the doctor repairs the joint, folding it from debris.
- With the help of the needles is fixed patella. When rebuilding the joint, bolt and wire are used.
- Multiple fragments are sewn with a special cord from Dacron, small fragments are removed.
- A plaster cast is applied for up to one and a half months.
In the postoperative period, you will need to perform a number of measures:
- in order to avoid edema, keep your foot up
- reducing the risk of thrombosis and embolism, move the fingers and foot,
- when allowed to walk, lean on the leg with maximum permissible strength, avoiding severe pain.
For the result of treatment to be quick and positive, rehabilitation of physical and psychological health is necessary. If necessary, a psychologist works with patients who have suffered serious injuries.
During the treatment, control radiographic images are taken to avoid pathologies. Remember, the timing of treatment depends on the degree of complexity of the fracture.
After the removal of the gypsum, rehabilitation of the leg injury in the form of physiotherapy, physical therapy - to minimize complications is shown. If you do not comply with the requirements of the doctor, leg mobility can be restored for many months. Rehabilitation involves the removal of blood from the joint with a special injection.
Methods of recovery procedures
Recovery measures using exercise therapy, special types of massage contribute to the fact that rehabilitation takes place quickly, and the functions of the musculoskeletal system are restored. The regularity of the procedures is important.
As a rehabilitation treatment, exercises with a ball (squats), sports simulators (treadmill, exercise bike) are often used. Therapeutic exercises should be carried out strictly under the supervision of a physiotherapist.
Accurate compliance with the instructions of the doctor, timely rehabilitation, good nutrition will help to quickly restore the lost functions of the body and live a full life.
Symptoms of a knee fracture
The following signs are characteristic of a fracture of the patella:
- strong pain,
- the inability to move the leg in the knee area (the inability to bend and straighten the limb),
- significant increase in knee size,
- hematoma formation.
First aid for fracture
In case of fracture of the knee, the victim must be delivered as soon as possible to the nearest emergency room. Before that, give him first aid. The main task is to fix the injured leg in one position. Knee fracture is an extremely painful injury. Therefore, first prepare everything you need for fixation (tires, bandages), and then proceed with the imposition.
If you see a protruding bone at the fracture site, in no case should you try to reposition it yourself. This can seriously aggravate the situation.
How to treat such a fracture
The choice of treatment for a fracture of the knee joint depends on the severity and type of injury. After the traumatologist determines the type of fracture, appropriate therapy will be given. Used for the diagnosis of radiography or computed tomography.
If a fracture with displacement of fragments is diagnosed, then, most likely, surgical treatment will be applied, which provides for the comparison of bone fragments and fixation of the patella.
If the fracture of the knee is stable and without displacement, then conservative treatment methods are applied, the main purpose of which is to immobilize the limb with a plaster cast or a special orthosis.
Knee splint with knee injuries
The medicine is gradually moving away from the use of classical gypsum dressings and, with injuries, where possible, begins to use all sorts of alternatives to gypsum. One such alternative is the knee splint, which has obvious advantages over a conventional plaster cast:
- better fixes the knee joint
- walking in it is more comfortable
- possesses corrective property with possible change in the shape of the limb,
- Sore leg is less loaded and is in complete peace of mind.
Depending on the treatment required, the splint can be used for:
- fixing the limb
- adjustments for deformations.
Complications and consequences
As a rule, the most frequent complications that occur specifically at the site of injury may occur — these are processes of suppuration of a wound infection if the fracture is open. There may also be dysfunctions in the functioning of body systems, for example, there may be disturbances in the work of the heart and blood vessels. Complications can arise, both because of incorrectly rendered first aid, and after the operation.
A reminder of the injury may remain only a slight lameness. In cases where the patient is in too much of a hurry to restore the locomotor activity of the injured knee, and does not control the load on him, he risks remaining incapacitated for the rest of his life.
The knee joint is very fragile, so it is quite easy to injure it. It is distinguished by its large size, it immediately unites 4 bones: the femoral, large tibia and small tibia, and the patella. So, the number of components, so unusual for a joint, causes its fragility, because for its normal operation it is necessary that 4 bones function harmoniously.
Also, soft tissues are involved in the knee joint, such as cartilage, ligaments, menisci and, of course, muscles. If any of these components damage, the knee will no longer function normally. So, on the tibia bones there are condyles, which are necessary for the attachment of muscle tissue. If you overstretch the muscles, the condyles may be damaged or even break.
Localization and nature of injury
Based on the presence of the functional components of the joint, types of fractures are distinguished in terms of their localization:
So, these bones are rather fragile, so you need to be as gentle as possible to overload them if you overdo it, then problems cannot be avoided.
In addition to the localization of the injury, they also distinguish the nature of the injury itself:
- An intra-articular fracture that is characterized by damage to the bone tissue, which practically does not affect the soft, for example, joints,
- External fracture is characterized by the fact that it concerns not only bones, but also soft tissues, the so-called synovial sac or joint sheath. This injury is more serious.
Correct and prompt determination of the location and nature of the injury guarantees successful therapy.
There are several main reasons why you can get such a nasty injury. Here are the main ones:
- A blow in the direction of the patella (patella), which literally splits the bone, this can also occur when falling onto a hard surface,
- Fall from a great height
- Bruises associated with this area.
Types of fracture
If the injury is caused by a stroke, several types of fracture are distinguished:
- Low energy. With this fracture, the bone usually cracks or splits, but there are not many small parts, that is, the force of the blow was small. This type is most common with similar trauma in the elderly,
- A high-energy fracture of the knee joint is characterized by traumatizing under the action of a powerful force, which leads to splitting of the bone into small parts that are difficult to assemble into a single whole.
Naturally, a low-energy fracture requires less effort in terms of treatment, however, it also provides for many nuances. High-energy fracture often requires surgical intervention.
Attention! In order to get qualified medical assistance as quickly as possible, you need to carefully monitor your body, because the symptoms of the injury will tell you about the nature of the injury.
A fracture of the knee joint differs from other injuries by the following symptoms:
- The acute pain that occurs when you try to walk, as well as during palpation,
- The inability to move, bend and straighten the knee,
- Puffiness in the area of the knee joint,
- Often there are bruising, because not only the joints are broken, but also the vessels.
As soon as you have identified a complex of these symptoms, you should immediately consult a doctor, because only a medical specialist can provide adequate and effective assistance. In no case should not try to "straighten" the joint or perform any other manipulation, because it can lead to even more complications.
Important! So that you do not get a similar fracture, you must adhere to the following rules.:
- Do not overload the knee
- Avoid hitting the knee,
- Before exercise, do a good workout to warm up your muscles.
If you follow these simple safety rules, it will be easy to avoid unpleasant injury.
So, a fracture of the knee joint is a serious injury that can be caused even by domestic causes. If symptoms of this damage are identified, immediately consult a doctor, keeping the joint in a straightened, motionless state. Follow all medications for treatment and recovery and follow the rules for injury prevention.
How does a fracture of the knee
The pearl of the knee bones can be isolated (only one bone is drawn into the process) or combined (if two or more bones are damaged). Isolated fractures of the patella and nausea of the femur are more common.
Hip fracture occurs under severe vertical load. For example, when landing after a jump on straight legs. Also, damage occurs after a strong impact of direct traumatic force (a blow to the lower part of the thigh). Fractures namyshelkov hip are T-shaped and Y-shaped. Read more about the causes of the fracture of the patella read here.
The tibial bone breaks down by the same mechanism as the nasal caps of the femur, but there are some peculiarities. People with valgus or varus deformities of the knee joint are more likely to undergo a fracture of the lateral or medial part of the tibial bone.
Part of the fibula, which is part of the knee joint, is damaged by the direct mechanism of injury. Or combined, at the fracture of the tibia with lateral displacement.
There are factors that increase the risk of a knee fracture:
- metabolic diseases of the musculoskeletal system (rheumatism, arthritis, rickets, collagenosis),
- knee instability (possible damage to the epicondyle with cartilage tissue),
- lack of vitamins D and C,
- age after 45 years (especially in women during menopause).
People who have a fracture of the knee against the background of instability are very difficult patients in terms of treatment. In 95% of cases, such a fracture is accompanied by damage to the capsule of the knee joint, rupture of the ligaments and menisci. Read more about the causes and methods of treatment of knee ligament rupture, read here.
Types and classification
Allot closed and open fracture knee joint. More important is the classification of the localization of injury and its scale. Localization fractures are divided into:
- intraarticular knee fracture (fracture or crack of the cartilage surface of the knee joint),
- extraarticular (bones are damaged over the attachment point of the knee joint capsule),
- mixed (occurs both in the cartilaginous surface and outside the joint).
The scale of damage distinguish the following options:
- knee fracture with displacement,
- knee fracture with dislocation,
- fragmentation fracture
- fracture with a torn ligament or meniscus,
- fractures and dislocations of the patella,
- bone fractures that form the joint, and articular cartilage cracks,
- fracture of the knee with damage to the neurovascular bundle.
The most dangerous are fragmentation fractures with displacement, since under this variant of injury, nearby tissues (vessels, nerves, ligaments) are easily damaged. Cracks in the knee and articular cartilage have long-term effects in the form of osteoarthritis of the cartilage, loss of knee function.
A fracture of the knee emit common symptoms that occur with injury to any of the components of the knee. There are exact or local symptoms. You also need to be aware of the fact that at fractures there are reliable and relative signs of injury.
Reliable features include:
- Deformation of the bone. Bone deformity is a clear sign of fracture, but should not be confused with joint deformity. A change in the shape of the knee joint can also occur with dislocation, hemarthrosis or rupture of ligaments.
- Feeling crepitated (sounds of a small crunch), which occurs when palpating or trying to bend the knee.
- Change the length of the limb. This symptom can be observed in case of sprains, but then in the area of the knee joint there will be a protrusion of the femur or tibial bone without signs of crepitation and mobility.
- Pathological limb movement above or below the joint space. If the leg moves forward or backward - a sign of rupture of the cruciate ligament. If there is a displacement above or below the joint space, this is a sign of a fracture of the epichelles of the hip or tibia.
Relative signs include: hemarthrosis, edema, severe pain, dysfunction of the knee, increased local temperature. All of them are found with sprains, sprains and meniscus injuries.
The clinical picture is accompanied by such signs:
- sharp pain on palpation
- the impossibility of bending and bending the knee,
- joint swelling,
- local temperature rise.
When the nerve structures of the popliteal fossa are damaged, numbness, loss of sensation, and decrease in muscle strength may occur.
Crack symptoms somewhat different from the symptoms of a fracture of the knee. Small cracks of cartilage tissue are accompanied by a sharp pain at axial load, and the motor function of the joint may not be damaged.
Cracks in the femoral, tibial bones and the patella occur more pronounced. The clinic is similar to the fracture clinic, but the manifestations of edema and hemarthrosis are less pronounced. There are no deformities of the limb and knee joint, but barely audible crepitus may occur.
If a hip tip is diagnosed, then there is instability of the patella and its balloting (mobility, displacement). Therefore, this symptom is often mistaken for tearing off the patellar ligament. Depending on what part of the epicondyle breaks, there is a displacement of the tibia inward or outward. The clinical picture of a fracture or a patella crack in children and adults is of a specific nature, read more about it here.
Shard injuries and displaced fractures accompanied by damage to the periosteum (bone membrane), tendons, muscles, ligaments and nerves. In fragmentation fractures, parts of the bone penetrate the joint cavity, destroying cartilage, cruciate ligaments and menisci. Such trauma is manifested by edema (due to hemarthrosis), the complete absence of passive and active movements with a pronounced pain syndrome.
Elimination of pain at home
Before you begin to treat pain and discomfort after an injury, you should understand the cause of their occurrence. Post-traumatic pain syndrome may occur due to improper imposition of metal fixatives, incomplete tissue repair. One reason may be osteoarthritis with ossification (accumulation of calcium in the tissues).
Read more about the causes and treatment of pain after a fracture read here.
Treatment of pain at home occurs with the use of traditional medicine or traditional methods. The first option is more efficient and simpler, since it does not require long preparations and devices. To traditional medicine include:
- Acceptance of NSAIDs and chondroprotectors. Ibuprofen is prescribed in a dosage of 400-600 mg 2 times a day, Diclofenac 50-100 mg 1 time a day (in the form of injections or tablets). Chondroprotectors can be used all, where the active substance is chondroitin sulfate.
- Ointments with anesthetic and anti-inflammatory components (Badyaga or Deep Relief).
Several recipes of traditional medicine ointments against pain after a knee injury:
- On 1 tablespoon of melted fat, add half a teaspoon of turmeric and 10-15 drops of propolis. Rub the knee once a day before bedtime. To prolong the effect it is necessary to attach cotton and wrap it with a bandage.
- Tincture of 40-45% alcohol solution, mustard powder and pepper. To 100 ml of alcohol solution add 3-5 grams of black pepper, 3-5 grams of mustard powder, mix well. Tincture is necessary to rub once a day at night. In case of reddening of the skin and severe itching, the knee should be washed, and the concentration of pepper in the tincture should be reduced to 1-2 grams.
If the pain syndrome lasts more than two weeks after the fracture is fully restored, it is necessary to contact a traumatologist for radiotherapy. Radiography or CT is done in order to ensure the soundness of the callus, identify foci of post-traumatic inflammation.
The recovery period for fractures of the hip bones is 3.5–4 months. The deadline for returning to full physical exertion is from 6 months.
In case of damage to the nibs of the tibia, the load on the knee can be done from 3 months, and the full recovery occurs from 4 months.
Restoration of the patella has its own characteristics, read more about it here.
In older people, the timing of callus formation and fracture adhesions are different from the timing in young people. Regeneration of tissues with combined fractures with displacement may last more than 10 months.
In case of mild fractures, drug therapy and limb fixation are prescribed.
Fracture of the condyle of the knee joint without displacement and damage to the skin can be removed non-invasive method. Painkillers are used to help arrest the painful symptoms and other unpleasant manifestations. Local anesthetic drugs are applied to the affected area of the knee. The patient leg is straightened, then it is fixed in a static state. The doctor applies a plaster cast from the hip to the foot. In case of less serious damage, it is possible to use an orthosis on the knee joint.
During treatment it is important to exclude any strain on the knee. It is recommended to use crutches to facilitate movement. On average, the period of conservative therapy takes 1-1.5 months. After treatment, a long-term rehabilitation after a fracture of the knee mobile joint follows, allowing to restore the functional tone of the joints and strengthen the muscles.
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During the operation, the crushed areas of the bone are fixed.
Most often, with a similar injury, an operation is performed on the knee cap, which allows the motor ability to be fully restored. Surgery is especially necessary in case of an open knee injury or offset. During operative manipulation, the surgeon restores the damaged bone from the debris, fixing it with needles or metal plates. To restore the knee joint using a bolt with a coupler or wire. The operation can be performed in 2 ways:
- Open. The skin is excised and the procedure is carried out with a scalpel and special fixation devices.
- Closed. Manual techniques are used that are less traumatic and require less time to recover.
After surgery, an elastic or plaster bandage is applied, fixing the limb in the correct position.When cartilage tissue is damaged, therapy is added by taking chondroprotective medications that contribute to its strengthening and regeneration. After surgery, anti-inflammatory drugs are often prescribed, since complications with the development of autoimmune processes are frequent.
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Consequences of a knee fracture
Fracture of the kneecap with displacement threatens with severe complications without timely therapy. The resulting fragments damage the sharp edges of the muscles, ligaments and tendon fibers. If the treatment is not carried out in time or incorrectly, then an incorrect accretion of the bone structures is possible, which will affect the motor function of the limb. In the future, a person may remain disabled and will not be able to move independently. Complications may occur after prompt elimination of a knee fracture. Often occur on the background of injury diseases of the cardiovascular system. Danger is represented by local effects, manifested in the form of infection or suppuration.
The knee is one of the most complex and large joints of the human body. Thanks to the thickest cartilage, which is located on the patella and reaches up to 0.5 cm in thickness, the knee can withstand tremendously serious loads.
Often, a person relies on his knee during a fall. However, such an inert effect can lead not only to bruises and abrasions, but also to fracture of the knee bone. Fracture of the knee joint is considered to be a rather severe trauma of the musculoskeletal system. This is primarily due to the fact that numerous complications and the unsatisfactory outcome of prolonged treatment are not uncommon. In order to avoid an unfavorable outcome, it is recommended not only to diagnose the injury in time and prescribe treatment, but also to develop the knee joint according to the advice of the attending physician.
Fracture of the knee bone can occur as a result of a strong blow with a not sharp heavy object, a sharp fall on the bent knee. A rarer case is the rupture of the patella as a result of a sharp contraction of the quadriceps femoris.
Of course, the treatment of injury will be prescribed only after one of the fracture types has been diagnosed by a specialist:
- Fracture condyle of the knee
- Patella fracture
- Intra-articular fracture of the tibia
- Intra-articular tibial fracture
Signs of fracture are different, depending on its type. Immediately contact the injury point or call an ambulance if you find yourself experiencing the following symptoms:
- Immediately after injury, a sharp local pain syndrome appeared in the knee area, which spreads to the thigh and below the knee area.
- Over time, the pain does not go away and does not fade away, but goes into nagging and taut
- The sensitivity of the damaged limb disappears.
- Even with light pressure on the condyle, acute pain occurs.
- Movement of the injured limb causes pain.
- Changes in the structure of the patella are visually noticeable and the deformation causes unnatural mobility of the joint. There is a painful wobble in the knee joint.
- Severe edema or hematoma has arisen in the knee area, so it may appear that the knee is “bursting”
- I can't bend my knee
A fracture of the knee bone with a shift in symptoms is even more pronounced: acute pain, severe swelling and hematoma, reduction of the injured limb, rupture of muscle fibers, and even skin.
Because of the strongest blow, accident or fall, such a severe form of injury as a fracture of the patella with displacement of bone fragments can occur. Such a fracture can be both closed and open, during which sharp fragments tear muscles, ligaments, tendons. The displacement of bone fragments usually occurs at a horizontal fracture of the kneecap, because with a vertical line of damage, the thrust is directed upwards.
Since as a result of a fracture a multitude of bone fragments may appear, treatment is performed only by surgical intervention, otherwise an abnormal accretion of the knee bone is possible, which in the future may lead to impaired joint motor function and disability. Recovery from a fracture of the knee with displacement takes several years, so it is important that all bone fragments are timely.
Important: In order to properly diagnose a fracture form, an x-ray should be taken. Usually they take a picture not only in the direct projection, but also in the side, because all the features of the patella are just that.
If you suspect a fracture of the knee bone, firstly it is necessary to ensure the immobility of the injured limb. If the situation is such that there is no possibility of injury to a point, and signs of fracture are pronounced, emergency assistance can be provided on the spot. Follow these guidelines:
- Do not try to adjust the knee bone, do not bend or move the knee.
- With an open fracture, you must first stop the bleeding. To do this, apply a harness from improvised means above the knee and be sure to record the time of application of a pressure bandage.
- You can relieve pain and stop limb swelling with ice, but you can keep it for no longer than 20 minutes
- To ensure complete immobility of the knee, apply a splint from other materials. Secure any hard, elongated surface on your leg with bandages or cloth patches.
- Remember that first aid will not replace hospitalization, so it is important to transport the victim to the hospital as soon as possible.
Of course, before prescribing treatment and carrying out the appropriate procedures, the specialist must make a diagnosis with 100% accuracy. Sometimes, it is not enough to do an X-ray. So, to clarify the diagnosis, the attending physician may prescribe an MRI or a puncture of the joint.
For the treatment of a closed type fracture without displacing the patella, conservative treatment methods are applied:
- The doctor anesthetizes the damaged area of the limb using local anesthetics
- The injured limb is straightened and fixed in a static state.
- A plaster cast is applied to the entire leg up to the ankle.
After treatment and the complete accretion of the victim's bone, a prolonged rehabilitation awaits, during which the motor function of the joint and the strength of its muscles will be restored.
Important: Conservative treatment of a knee bone fracture lasts from 4 to 6 weeks. At this time, the load on the sore knee should be completely excluded, so it is better to use crutches for movement.
If a displaced knee cap fracture is diagnosed and multiple debris is detected, the treatment will be carried out in accordance with the following steps:
- During the operation, the doctor restores the knee bone, collecting it from numerous debris
- The doctor fastens the patella with the help of the needles or the plate. With the help of the bolt and the wire is restored knee
- Small bone fragments are removed from the wound, and the remaining ones are stitched with a Dacron cord
- A plaster cast is applied to the entire limb.
In order to ensure a positive result of treatment, follow the following rules during the postoperative period:
- Try to keep the limb on a raised surface so as not to cause edema.
- Move your feet and fingers to keep blood from stagnating.
During treatment, control radiographic images are taken regularly to avoid pathologies. In addition, during the rehabilitation period it is possible to carry out injections into the knee in order to remove blood accumulated there.
After the gypsum is removed, the patient is prescribed physiotherapy and exercise therapy. The combination of these two methods of rehabilitation allows you to quickly restore the mobility of the joint.
The course of medical physical culture should begin with elementary exercises: bending and unbending the knee joint, walking with a high lifting of the knees, later squats can be included in the course. All exercises must be performed under the supervision of a specialist. Do not risk your health!
Of course, an integral part of rehabilitation is natural activity. The load must be deliberate and portioned. Start with walking for short distances, you may need crutches at first.
Often a special massage is added to such restorative procedures, which will restore the blood supply in the damaged area and speed up the regeneration of all tissues.
Try to make your diet so that food in every way helps restore the body. Use foods that contain large amounts of calcium: milk, dairy products, cottage cheese and cheese. Also, do not bypass the gelatin, because it contains collagen, which is the basis for cartilage tissue.
Thus, timely rehabilitation and diagnosis of the fracture, as well as compliance with all the conditions of the doctor will help to fully restore the lost functions of the body and return you to mobility.