knee cap (patella) fractures
TRANSCRIPT
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KNEE CAPFRACTURES(PATELLA)
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Dr. A.MOHAN KRISHNA M.S.ORTHO, MCh ORTH(U.K)Consultant Orthopaedic surgeon ,Trauma, Arthroscopy, Arthroplasty Surgeon Apollo hospitals, Hyderabad
Consultant Orthopedic Surgeon at
www.drmohankrishna.comwww.healthyjointclub.comwww.bonesandjointsclinic.com
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KNEE CAP - PATELLA
Knee cap (patella) is a small bone in front of the knee joint. It protects knee joint and connects the muscles in front of thigh to shin bone.
Knee cap acts as fulcrum for the knee joint movement.The back side of knee cap and lower end of thigh bone is covered with cartilage which helps in smooth movement of knee
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KNEE CAP – PATELLA Fractures
Knee cap can fracture in variety of ways1. UNDISPLACED FRACTURES2. DISPLACED FRACTURESa. Transverseb. Lower end c. Upper endd. Comminuted (Multiple bits)e. Undersurface of patella
(cartilage)3. OPEN FRACTURES:There is break in skin with fracture is exposed to outside environment.
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CAUSES: INJURY MECHANISM
1. Direct blow on knee: - Fall on knee cap- Dashboard injuries2. Indirect injuries- Sudden pull of thigh muscles can fracture the knee cap
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SYMPTOMS
Pain/swelling in front of knee
bruising
Inability to straighten the knee and walk
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DOCTOR EXAMINATION
deformity swelling contusion
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INVESTIGATIONS
X-RAYS
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TREATMENT: Non-operative treatment
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- If the broken knee cap is not displaced- Even multiple pieces if they are not displaced.- Knee is put in cast or splint for 6 to 8 weeks- Not to put weight on the leg until fracture heals.- Walk with help of crutches or walker.
CYLINDER CAST
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OPERATIVE TREATMENT
- Displaced and comminuted (multiple bits) fracture of knee cap need surgery.
- Fractured knee cap bones are usually separated because of pull of strong thigh muscles that are attached on the top.
Timing of surgery:- If skin is intact and healthy surgery can
be done immediately.- If the skin is bruised contused and
swollen wait for skin to heal.- If the fracture is open to outside
environment it needs emergency surgery.
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SURGERYTYPE OF PROCEDURE DEPENDS ON TYPE OF FRACTURE.
TRANSVERSE FRACTURE:- Two part fracture with horizontal break in knee cap.- Figure of eight tension band wiring with wires and pins.- Screws also can be used in place of pins.
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SURGERYCOMMUNITED FRACTURE:- If the knee cap is broken into several pieces and are in place it can be
fixed with multiple pins and wires- Some times wire is circled along the knee cap to hold pieces- In this case the knee is kept in immobilizer for 4 to 6 weeks and
started on exercises
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SURGERYPATELLECTOMY : REMOVAL OF KNEE CAP1. PARTIAL PATELLECTOMY: When the lower portion of knee cap is broken into multiple bits, these bits can be removed and tendon can be sutured to the major bit of knee cap
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SURGERY2. COMPLETE PATELLECTOMY:Total removal of knee cap. In case the bone bits cannot be put together these bits can be removed and soft tissue of thigh and shin bone can be sutured back.There may be weakness of knee function in case of complete removal of knee cap.
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POSTOPERATIVE MANAGEMENT: After patella fixation
Day 1• Static quadriceps• Ankle pumps• Protected weight bearing with walker or crutchs
Day 2• Discharge• Gentle knee movements• If the fracture is multiple bits knee movements are
restricted for 3 to 4 weeks
End of 2 weeks• Stitches removal• Exercises as advised• Full weight bearing after 3 to 4 weeks
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POSTOPERATIVE MANAGEMENT: After partial and complete knee cap removal
Day 1 • Patient on Brace or cast for 4 weeks• Ankle pumps, walking with the help of walker/crutches
Day 2• Discharge • Review after 2 weeks
2 weeks• Stitches removal• Review after 4 weeks from date of surgery
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COMPLICATIONS
Delayed unionNonunion
Infection Knee stiffness
arthritis
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IMPLANT REMOVALIn some cases or thin individuals the implants can be felt underneath the skin, and can cause some discomfort. In such instances implant can removed after one or one and half year after the surgery.
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CONTACTDr.A.MOHAN KRISHNAM.S.Ortho., MCh Ortho(U.K).,Consultant Orthopaedic Surgeon,Apollo Hospitals,Hyderabad.Appointments: Secretary : 09247258989 09441184590 08332936085 www.drmohankrishna.comwww.healthyjointclub.comwww.bonesandjointsclinic.comEmail: [email protected]