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Knee fracture

What is knee fracture surgery?

A knee fracture, is a broken bone in or around the knee joint. This can affect the tibia (leg), the kneecap (patela) or the femur (thigh bone) where they connect with the knee.

Knee fracture surgery (knee osteosynthesis) is a surgical procedure performed to correct the position of broken bones (anatomical reduction) in or around the knee to restore normal function, stability and movement.

The kneecap is a bone that connects the bones of the thigh and the leg.. The function of the patella or patella, is to facilitate the extension of the knee, and also protect the joint, acting as a shield. Thigh bones, kneecap and legs, on their surfaces, are covered with articular cartilage and synovial fluid, that allow smooth movement of the bones when walking. Because the kneecap is a shield, you can be injured by falling or tripping. Knee fractures vary not only in the damaged area, but also in the extent of the damage. The kneecap could slightly snap or break into pieces. It could happen at the top, central or lower kneecap. It could also exist in many parts of the patella. Other variations may be stable fracture, displaced fracture, open fracture and comminuted fracture. In stable fracture undisplaced fracture, broken pieces would line up and also stay in place during the healing or consolidation process. In a displaced fracture, broken pieces are not aligned but separated. Often, this requires surgical correction.

In open fractures, the skin can be opened to make the bone visible. This occurs during excessive damage and is complicated by the risk of infection.. Comminuted fractures, is called, when the bone breaks into three or more pieces, usually require surgery.

Knee Fracture in Bogotá

La mayoría de las fracturas de rodilla se producen por un golpe directo . Las causas más comunes de fracturas de rodilla incluyen caídas, accidentes automovilísticos (frecuente en caídas o colisión en motocicletas) actividades deportivas (ciclismo) o incluso contracciones musculares severas en casos raros.

Algunas de las cirugías habituales empleadas para el tratamiento de una fractura de rodilla incluyen:

  • Reducción abierta y fijación interna de una fractura de fémur, tibia o patela (rotuliana – rótula rota): este procedimiento, el cirujano hará un corte sobre el hueso (fémur, tibia y rotula) para exponer y observar el hueso roto. El cirujano volverá a ensamblar las piezas con ayuda de pinzas y pequeños clavos metálicos. Cuando los fragmentos de la fractura están en adecuada posición y el hueso recupera su forma natural, el cirujano fijará con clavos, tornillos o placas metálicas. Esto ayudará a mantener el hueso en su lugar mientras sana (consolidación) . Luego, se cerrará los cortes con grapas o puntos.
  • Osteotomía: La osteotomía, es una cirugía, que tiene como fin corregir la posición de un hueso, que después de una fractura, consolido o sano en un lugar inadecuado, lo cual puede producir deformidades o incluso artrosis. También se realiza para corregir, deformidades , o para evitar el desgaste cuando una zona de la rodilla esta perdiendo el cartílago de forma prematura, redistribuyendo el peso de una sección de la rodilla a otra.
  • Reemplazo total de la articulación: En algún tipo de fracturas, en especial en pacientes mayores con artrosis (desgaste del cartílago) previo, el reemplazo de la rodilla puede ser una opción de tratamiento. La articulación de la rodilla, se reemplaza con frecuencia. En este procedimiento, se retiran las superficies deterioradas en el fémur, tibia y rotula, los cuales, se reemplazan por superficies metalicas que se articulan con un polietileno de alta resistencia, que evita el roce entre ellos, y el desgaste. Lo que garantiza, recuperar la longitud, forma, alineación y función adecuada de la rodilla. El reemplazo de rodilla es una opción cuando el daño articular irreparable interviene con la función y causa dolor constante.
  • Reemplazo parcial de rodilla: esta cirugía implica que se realiza una pequeña incisión y solo se extrae la sección dañada o desgastada de la rodilla y se reemplaza con una prótesis, dejando intacta la sección sana de la rodilla. Este tipo de cirugía se recomienda cuando la pérdida de cartílago se limita a una pequeña porción de la articulación de la rodilla.
  • Artroscopia: es una cirugía de rodilla mínimamente invasiva, se realiza por incisiones pequeñas (heridas en la piel para ingresar a la articulación) con ayuda de un lente (artroscopio) y fuente de luz (sistema de iluminación) y una pequeña cámara se transmiten las imágenes del interior de la rodilla a un monitor de alta resolución. magnificar e iluminar las estructuras dentro de una articulación. Lo que permite, examinar y corregir las estructuras lesionadas. La artroscopia se puede utilizar para:
    • Reparar o remodelar meniscos desgarrados
    • Retire el tejido sinovial inflamado
    • Retirar fragmentos sueltos, cartílago o hueso
    • Corregir el cartílago articular dañado
    • Tratar los problemas de la rótula
    • Reconstruir ligamentos rotos
  • Reparación / Reconstrucción del ligamento cruzado anterior (LCA) / Ligamento cruzado posterior: La ruptura del ligamento cruzado anterior y del ligamento cruzado posterior, son muy comunes en los traumas de alta energia, y se pueden encontrar en algunas fracturas de la rodilla. En casos agudos, con ayuda de artroscopia, se puede reparar o reconstruir estos ligamentos, importantes para la estabilidad de la articulación. El uso de injertos propios, que generalmente son tendones , como el tendón del cuádriceps, el tendón rotuliano o los tendones de los músculos isquiotibiales, se usan para reconstrucciones en lesiones crónicas de los ligamentos. Esto ayuda a estabilizar la rodilla y le proporciona un rango de movimiento completo.

Luxación de la rodilla
Se trata de una lesión relativamente rara, pero de gran importancia, es le resultado de la perdida de las relaciones normales entre el fémur y la tibia. Es casi siempre causado por eventos traumáticos de gran intensidad, caídas de gran altura, accidentes en deportes extremos, accidentes en motocicletas o automóviles. Se pueden asociar a fracturas e incluso a lesiones vasculares, como el daño de la arteria principal de la rodilla (arteria poplítea), que puede comprometer la extremidad. una lesión vascular grave. La luxación de la rodilla es una urgencia, que debe ser tratada de inmediato para evitar complicaciones.

Luxación rotuliana / Luxación de la rotula
Esto es común, especialmente en individuos activos jóvenes, mas frecuente en mujeres. Existen diversas causas, entre ellas los traumas directos, y así mismo, existen factores que puede predisponer a una persona para tener luxación de la rotula, cómo son loa displasia femoral (alteración congénita en el desarrollo del fémur). La mayoría de las luxaciones son laterales y se acompañan de dolor, limitación para la movilidad y efusión o hinchazón. El daño a los ligamentos mediales es común. La luxación o dislocación también puede ocurrir cuando el pie se ancla o planta en el suelo y se produce un cambio rápido de dirección o una torsión en la rodilla . Por lo general, existe laxitud ligamentosa preexistente y, cuando la luxación rotuliana ha ocurrido una vez, puede reaparecer debido a la consiguiente lesión del ligamento. La reubicación en el surco rotuliano suele ser espontánea cuando se extiende la rodilla.

Lesión o ruptura de ligamentos laterales (ligamento colateral medial y ligamento colateral externo) Los ligamentos de la parte interna y externa de la rodilla, son muy importantes, permiten y contribuyen a la estabilidad de la rodilla cuando estamos de pie o caminando.

Los ligamentos de la rodilla en la parte interna son conocidos como complejo ligamentario o esquina postero interna o posteromedial, de igual forma , los ligamentos de la parte externa o lateral de la rodilla se conocen como complejo ligamentario o esquina Posterolateral.

La ruptura de los ligamentos, se produce casi siempre por traumas de alta energía como caídas de alturas, accidentes de tránsito, deportes extremos, o incluso en prácticas deportivas comunes cómo el fútbol.

En fracturas complejas de la rodilla, estos ligamentos pueden estar comprometidos, para lo cual es necesario, realizar la reparación de los tejidos lesionados. Cuando la ruptura de los ligamentos, no se trata, y existe inestabilidad, la reconstrucción con injertos es necesario.

Knee Fracture in Colombia
Knee Fracture in Bogota +

Knee Fracture in Colombia

Femur fracture

The femur is the thigh bone, connects hip to knee. It is a strong bone that supports significant loads. Fractures of this bone, they are usually traumas of significant magnitude.

Tibial fracture

The tibia is the main bone of the leg, is closely related to the fibula, connects the knee to the foot at the ankle . It is a strong bone that supports significant loads. Fractures of this bone, they are usually traumas of significant magnitude.

Patella

Patella (patela) it's a sesamoid bone, is located on the front of the lower limb, acts as a shield for the knee joint, and also, like a lever on the knee. You are exposed to direct trauma.

Knee fractures, are serious injuries and often require surgery to heal (consolidation). Long-term, can cause osteoarthritis in the knee, by the loss of articular cartilage.

Types of fractures

Knee fractures vary, from undisplaced fractures, multiple fractures (break into many pieces) and open fractures, high-energy with increased likelihood of complications.

Knee fractures can occur, search for, within the joint or combinations of the two above, or even, can occur in more than one bone.

Stable fracture. This type of fracture does not move. The broken ends of the bones stay together and are aligned. In a stable fracture, bones generally remain in place during healing or healing.

Displaced fracture. When a bone breaks and shifts, broken ends come apart and don't line up. This type of fracture often requires surgery to reattach the fragments..

Comminuted fracture. This type of break is very unstable. The bone breaks into three or more pieces.

Open fracture. In this type of fracture, the skin opens and the bone is exposed to the environment, which implies a higher risk of complications.

Knee fracture refers to fractures of any of the parts of the bone involved in the joint itself. This includes fractures of:

  • Ball joint : more common from direct trauma, like motorcycle accidents.
  • Femoral condyles: tend to fracture when the knee is stressed and internal or external trauma is suffered .
  • Tibial eminence : are associated with trauma to the proximal tibia when the knee is flexed, or if it is hyperextended during an accident. It is generally seen in patients with 8 a 14 years.
  • Tuberosidad tibial : more common in young men than adults; often in athletes, especially those involved in jumping sports.
  • Tibial plateau : compression fractures of the articular surface, typically by extreme force, such as falling from a height or being hit by a vehicle, although minimal force may be necessary in patients with osteoporosis.
  • Second Fracture : is an avulsion fracture on the lateral tibial surface just beyond the articular surface with the knee. Although not directly part of the knee joint, occurs in association with anterior cruciate ligament tears (LCA), medial meniscus and lateral capsular ligament.

A fracture of the femur - the strongest bone in the body - is usually obvious because it takes a lot of force to break. But fractures of the tibia - the most weight-bearing bone in the lower leg - and the bone along the tibia, below knee (fibula) they can be more subtle.

Signs and symptoms of a knee fracture may include the following:

  • Intense pain, that can get worse with movement
  • Swelling
  • Sensitivity
  • Hematomas
  • Obvious deformity or shortening of the affected leg
  • Inability to walk

Fractures around the knee are common in children, but the pattern of knee fractures is different. The relatively high proportion of cartilage in growing children can make diagnosis difficult, especially on plain radiographs, and stress x-rays or MRIs may be necessary

Knee Fracture Procedure

Non-surgical treatment

If the fractured bone fragments, have not been displaced by the force of the injury, you may not need surgery. Cast or splints may be used to maintain position, and thus avoid its displacement. Similarly, You will limit yourself to putting weight on your leg until the bone is completely healthy..

Surgical treatment

If the bone fragments, they shift and lose their continuity, you will most likely need surgery, in order to reposition , and get back in shape, length and function, for which, usually, the use of fixation devices is necessary, that hold the fragments in position, while the fracture heals.

Time of surgery. If the skin around the fracture has not been broken, your doctor may recommend that you wait until the abrasions have healed before having surgery. Nevertheless, open fractures expose the fracture site to the environment. They need an urgent cleaning and require immediate surgery.

Procedure. The type of procedure that is done often depends on the type of fracture you have. Before the surgery, your doctor will talk with you about your procedure, as well as possible complications.

  • Transverse fracture. These two-part fractures are usually fixed in place by pins and wires and a tension band setting in “figure eight”. Figure eight band presses the two pieces together.

    This procedure is best for treating fractures near the center of the kneecap.. The fracture fragments at the ends of the patella are too small for this procedure. Breaks in many parts can be over-compressed by the tension band.

    Another approach to a transverse fracture is to secure the bones with small screws., wires and pins. In many cases, these wires and pins will need to be removed approximately one to two years after surgery.

  • Comminuted fracture. In some cases, the top or bottom of the kneecap can be broken into several small pieces. This type of fracture occurs when the kneecap is separated from the injury and then crushed by falling on it..

    Because the bone fragments are too small to put back in place, will be extracted. Your doctor will attach the loose tendon to the remaining patellar bone..

    If the kneecap is broken into many pieces in its center (and they are separated), your doctor may use a combination of wires and screws to fix it. Removing small portions of the patella can also have good results. Complete removal of the patella is the last resort for treating a comminuted fracture.

Bogota Knee Fracture

Knee fracture

PATELLAR FRACTURES (KNEES)

Because the kneecap (ball joint) acts as a shield for the knee joint, can be easily broken. Fall directly onto the knee, for example, is a common cause of patellar fractures.

These fractures can be treated with a brace or surgery., depending on the severity of the injury. Long-term, some kneecap injuries have an increased risk of developing knee arthritis.

Patella fracture

Patella, which in anatomy is called the patella, is a small, flat, triangular-shaped bone found in the front of the knee, articulated with the tibia and in contact with the femur and covered by cartilage, whose function in the joint is to facilitate flexion and extension movements.

It is the most exposed part of the kneecap and actually acts as a bumper for the knee., therefore the risk of fracture is important in the event of strong direct trauma, such as those that can occur in a traffic accident or in sports, like football, rugby or ski. Sometimes the patella fracture can occur indirectly as a result of a violent pulling movement of the quadriceps (stress fractures, that usually occur in athletes).

The patella fracture requires immediate attention, fundamentally due to causing acute and intense pain and a more than significant functional disability of the joint. Other common symptoms are knee inflammation, feeling popping and abnormal mobility. Its clinical classification is made according to the place and direction of the tear and whether there has been greater fragmentation.

For diagnosis, palpation would often suffice, as the fracture line can be identified with the finger, but X-rays provide greater diagnostic precision, since they allow to determine if there is multiple fragmentation of the bone. The scanner provides the precise image of all the fragments originated by the fracture. On the other hand, in the event that the bone breakage has been caused by stress or indirect trauma, MRI will allow an assessment of the knee joint to assess other possible ligament or meniscus injuries.

Frequently Asked Questions about: Knee fracture

Common Questions and Answers about Knee Fracture

A knee fracture is a type of injury that involves the kneecap or the bone that makes up the front of the knee. (also known as patella). It can be as mild as a small partial crack in the bone or as severe as a complete tear from the top of the kneecap to the bottom.

Knee fractures are usually caused by a specific sudden injury, like a fall or a high speed collision. Most people know that something is wrong as soon as the injury occurs.

A fractured kneecap tends to cause immediate pain, as well as other symptoms, What:

  • Immediate swelling and bruising
  • Difficulty bending the knee or placing weight on the affected leg
  • A scraping or grinding sensation during movement.
  • Muscle spasms

In some cases, the broken bone will be visible through the skin. In other cases, knee looks the same as always, but it doesn't work normally.

A fractured kneecap should always be immediately evaluated by a doctor. A simple knee fracture can heal on its own, although a cast may be necessary to prevent parts from moving. A more complex fracture, on the other hand, may require surgery to secure the bones in place and restore stability to the knee. An orthopedic physician who specializes in diagnosing and treating knee injuries can provide a personalized treatment recommendation..

If you recently injured your knee and think you may be dealing with a fracture, You can turn to Advanced Orthopedics and Sports Medicine for rapid diagnosis and treatment. We offer comprehensive imaging services on site, as well as surgical and non-surgical treatments. From custom braces and physical therapy to medication management and laparoscopic surgery, we offer the latest therapies for common and complex knee injuries

The kneecap can fracture (break) in various ways, for example, if it falls on the knee; gets hit while playing sports like soccer or rugby; or during a car accident.

Symptoms include:

  • Bruises
  • Not being able to stretch or lift the knee while it is straight
  • Can not walk

Patella (ball joint) is a triangular bone in the front of the knee. Various tendons and ligaments connect to the patella, including those attached to the bones of the upper leg (femur) and the lower leg (tibia).

Although the kneecap is not necessary for walking or bending the leg, makes muscles more efficient and absorbs much of the stress between the upper and lower leg. Climbing stairs and squatting can put up to seven times your normal body weight on your kneecap and the joint behind it.

Patella fractures represent approximately the 1 percent of all skeletal injuries. The kneecap can be fractured in many ways: partial or completely, in a few or many pieces. Sometimes, when the kneecap is fractured, ligaments or tendons attached to it can twist or break.

Symptoms can include:

  • Severe pain in and around the kneecap.
  • Swelling
  • Pain when moving the knee in both directions.
  • Difficulty extending the leg or lifting the straight leg
  • A deformed appearance of the knee due to fractured parts.
  • Tenderness when pressing the patella.

Two types of surgery can be done to repair a fractured kneecap:

Open reduction-internal fixation surgery (ORIF): the surgeon opens the skin and reattaches the broken bones with wires, metal nails or screws. Pieces of broken bone too small to be repaired are removed. If the kneecap is so badly fractured that it cannot be repaired, it may be fully or partially removed.

Once the bones have joined, the opening closes, a sterile bandage is placed over the area and the knee is placed in a cast or other device so that it cannot move while it heals.

Sometimes, especially in thin patients, The wires, dowels or screws can be irritating. In this case, the devices will be removed after the patella has fully healed.

Total or partial pathelectomy: this two-hour procedure removes all or part of the patella. If your surgeon finds that the fracture is too severe to repair, remove damaged bone pieces.

Surgery preserves the quadriceps tendon above the patella, the patellar tendon below and other soft tissues around the patella. After this surgery, will be able to extend the knee, but the extension will be weaker.

Once your kneecap has healed, strengthening the muscles around the knee can help prevent further injury. Playing contact sports or doing other activities that put pressure on the knee can increase the risk of another kneecap injury.. You should avoid these activities or wear a knee brace to cushion the blow when playing contact sports.

Physiotherapy , learning ways to avoid stress on the knee and continuously strengthening and conditioning the leg muscles can help prevent further knee injuries.

Best exercise options are low-impact and weight-bearing, like stationary bikes and certain weight lifting programs, so that the knees do not have to absorb the impact.

Stable fracture. This type of fracture does not move. The pieces of bone may stay in contact with each other or be only a millimeter or two apart. In a stable fracture, bones usually stay in place during healing.

Displaced fracture. In a displaced fracture, the broken ends of the bone pull apart and don't line up properly. The normally smooth joint surface can also be broken. This type of fracture often requires surgery to reattach the pieces of bone..

Comminuted fracture. In this type of fracture, the bone breaks into three or more pieces. According to the specific pattern of the fracture, a comminuted fracture can be stable or unstable.

Open fracture. In an open fracture, the bone breaks in such a way that bone fragments protrude through the skin or a wound penetrates to the bone. An open fracture often involves damage to the surrounding soft tissues and may take longer to heal..

Open fractures are particularly serious because, once the skin is broken, there is an increased risk of infection both in the wound and in the bone. Immediate treatment is required to prevent infection.

Son fracture-dislocation. The fracture trace begins at a tibial plateau, crosses the base of the spine and ends in the cortex on the opposite side. May be associated with ipsilateral lateral ligament tear. Internal ones are more frequent than external ones.

  • Extraarticulares, supracondylum o metaphysicians: They are those that settle in the area of ​​widening of the medullary canal. They are usually displaced due to muscle traction. The popliteal vascular-nerve bundle may be compromised.
  • Intraarticulares, epiphysicians or condyleas: They are produced by a shear mechanism, two forces acting in opposite directions. Depressions affecting the growth plate in children are rare. We distinguish:
  1. Complete.
  2. Incomplete:
  • Unicondíleas in the sagittal plane: They affect only one of the joint plateaus. Cruciate ligament can tear on the same side.
  • Fractura osteocondral: The patella strikes the condyle tangentially.
  • Hoffa fracture: Unicondílea (only affects one articular condyle) in the frontal plane, where the condylar cap is rotated, pulled by the twin.
  • Supraintercondíleas o bicondíleas: They are given in a V shape, Y o T. They usually occur in high-energy trauma, which in the most severe forms lead to comminuted fractures, with small pieces, then requires surgical treatment. The shaft fragment of the femur usually ends in a beak, and rips the quads and the skin, inside out.
  • Epiphysiolysis: They affect the growth plate. They are produced by traffic accidents in children and sports accidents in adolescents. They are classified according to grades I to V of Salter and Harris.

Patella is a triangular shaped bone that protects the anterior part of the knee like a shield, in addition to having an aesthetic function, serves as a fulcrum for the quadriceps tendon: This increases your lever arm and allows you to stretch and flex your knee properly.

It is part of the family of "sesamoid" type bones (smooth bones, rounded and small that are embedded in a tendon). In fact, is the sesamoid bone larger of the human body and is designed to withstand very high loads. Thanks to her we can walk, run and jump normally

  • External tibial plateau fractures: They are the most frequent. According to the fracture line they are divided into:
    • Linear in the sagittal plane. They are normally associated with a fracture of the head of the fibula.
    • Hulten's or subsidence fractures. Joint surface sags, but the outer cortex is preserved. In the most severe forms, the meniscus slides into depression.
    • Mixed fractures. They are the most serious. They are associated with the rupture of the external lateral ligament, and sometimes, the articular surface collapses en bloc and breaks into multiple fragments, which greatly worsens the prognosis of functional recovery.
  • Internal tibial plateau fractures: They are less frequent than the previous ones. Are divided into:
    • Linear in the sagittal plane: those with the fracture line going below the insertion of the internal lateral ligament will have the best prognosis, since they can be reduced by orthopedic maneuvers.
    • Subsidence fractures: the least frequent in this group.
    • Mixed: similar to those on the outer plate.

The knee is stabilized by the lateral ligaments, cruciate ligaments, other smaller ligaments and the joint capsule. When a knee dislocation occurs, it means that multiple ligaments have been injured and stopped performing their function.

This injury occurs from high energy injuries, sports accidents and traffic accidents. Its treatment is complex, because no two dislocations are ever the same, the number of injured ligaments always varies (it can be three, four…). The only thing that is certain is that in more than one 90% of the cases will require a surgical intervention for their recovery. In this video we will give you more details about knee dislocation.

Non-surgical treatment

If the pieces of bone are not out of place (displaced), you may not need surgery. Your doctor may put you in a cast or splint to keep your knee straight and help prevent movement of your leg.. This will keep the broken ends of the bone in the proper position while they heal..

Depending on your specific fracture, you may be allowed to put weight on your leg while wearing a cast or brace. Nevertheless, with some fractures, weight bearing is not allowed during 6 a 8 weeks. Your doctor will discuss weight bearing restrictions with you..

Surgical treatment

If the pieces of bone are out of place (displaced), you will most likely need surgery. Fractured patellar bones that are not close together often have a hard time healing or may not heal. The thigh muscles that attach to the top of the kneecap are very strong and can pull the broken pieces out of place during healing.

Time of surgery. If the skin around the fracture has not been broken, your doctor may recommend that you wait until the abrasions have healed before having surgery.

Nevertheless, open fractures have an increased risk of infection and are scheduled for surgery as soon as possible, usually in a few hours. During surgery, injury cuts and bone surfaces are thoroughly cleaned. In general, the bone will be repaired during the same surgery.

Surgical procedures

The type of procedure that is done often depends on the type of fracture you have. Before the surgery, your doctor will talk with you about your procedure, as well as possible complications.

Transverse fracture. These two-part fractures are most often fixed in place using screws or dowels and wires and a tension band setting in “figure eight”. Figure eight band presses the two pieces together.

This procedure is best for treating fractures near the center of the kneecap.. The fracture fragments at the ends of the patella are too small for this procedure. Breaks in many parts can be over-compressed by the tension band.

Another approach to a transverse fracture is to secure the bones with small screws or small screws and small plates..

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