Knee Cap Fractures: Its Causes, Diagnosis and Management

A short presentation on knee cap fractures its causes, diagnosis and management. This also gives brief idea about different methods of treatment for knee cap fractures.

Krishna Dr. A. Mohan Krishna, M.S. Ortho, MCh Orth(UK) is currently a consultant orthopedic surgeon at Apollo Hospitals, Jubilee Hills. He is part of the orthopedic team and he specializes in fracture management, arthroscopy, primary hip and knee arthroplasties, and paediatric orthopedics. He has presented papers in the orthopedic specialty.
Presentation used with permission from Dr. A. Mohan Krishna.

Presentation Transcript

  1. KNEE CAP FRACTURES (PATELLA)
  2. 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.com www.healthyjointclub.com www.bonesandjointsclinic.com
  3. 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
  4. KNEE CAP – PATELLA Fractures Knee cap can fracture in variety of ways 1. UNDISPLACED FRACTURES 2. DISPLACED FRACTURES a. Transverse b. Lower end c. Upper end d. Comminuted (Multiple bits) e. Undersurface of patella (cartilage) 3. OPEN FRACTURES: There is break in skin with fracture is exposed to outside environment.
  5. CAUSES: INJURY MECHANISM 1. Direct blow on knee: - Fall on knee cap - Dashboard injuries 2. Indirect injuries - Sudden pull of thigh muscles can fracture the knee cap
  6. SYMPTOMS Pain/swelling in front of knee bruising Inability to straighten the knee and walk
  7. DOCTOR EXAMINATION deformity swelling contusion
  8. INVESTIGATIONS
  9. TREATMENT: Non-operative treatment - - 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
  10. 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.
  11. SURGERY TYPE 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.
  12. SURGERY COMMUNITED 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
  13. SURGERY PATELLECTOMY : REMOVAL OF KNEE CAP 1. 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
  14. SURGERY 2. 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.
  15. 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
  16. 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
  17. COMPLICATIONS Delayed union Nonunion Infection Knee stiffness arthritis
  18. IMPLANT REMOVAL In 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.
  19. CONTACT Dr.A.MOHAN KRISHNA M.S.Ortho., MCh Ortho(U.K)., Consultant Orthopaedic Surgeon, Apollo Hospitals, Hyderabad. Appointments: Secretary : 09247258989 09441184590 08332936085 www.drmohankrishna.com www.healthyjointclub.com www.bonesandjointsclinic.com Email: bonesandjointsclinic@gmail.com
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