Knee fracture is a rather complicated injury, because four bones take part in the formation of this joint. Due to the vulnerability of this area, the knee joint is broken in 10% of cases of the total number of fractures. Moreover, this injury is equally affected by men and women. The age category also varies: from 20 years and more.
Symptoms of a knee fracture
Signs of a general nature for all injuries of the knee joint should be considered:
the identification of acute painful sensations that increase in the process of palpation of the joint, as well as in the attempt to make any, even the most insignificant, movement in the area of the knee,
systematic formation of puffiness in the knee joint,
taking into account the main role of the injury in the occurrence of the fracture and its location, bruising begins to appear,
there is a violation of the functioning of the joint, in connection with this, the injured cannot perform any movements of the injured limb, and also cannot step on the affected leg.
Causes of knee fracture
The main factors for the occurrence of a fracture of the knee joint are forceful influence on it or significant pressure. The most common fracture of the patella (patella) occurs in the process of falling on the knee, which was in a bent position.
More rare are cases of fracture with a direct blow to the patella area, and in some situations a fracture can occur without force. Sometimes, too much traction on the tendon causes injury, which destroys the knee bones and surrounding muscles. With this option, in 90% of cases there is a complete separation of the lower region of the patella, while in the rest 10% - partial.
Types of knee fractures
Fractures in the knee joint are divided into the following categories:
trauma to the tibia
injury to the small tibia,
In accordance with the division into types, it is customary to distinguish such fractures of the knee, as the extra- and intra-articular. In the latter case, the rupture of the synovial sac occurs, which covers the outer part of the joint, and in the first variant, only the bone is damaged, without affecting the articular part.
Accurate diagnosis of any bones or joints fracture can only be performed using X-ray examination. It is with the help of X-rays that the fracture line is correctly determined, as well as the likely displacement of parts of the knee joint relative to each other.
A fracture in the area of the cartilage of the knee joint is characterized by a less vivid clinical picture. It is characteristic of this injury that the painful sensations begin to intensify with the exercise of the movements. In a state of rest the pain syndrome is not observed. X-ray, in most cases, does not reveal even the most minor deviations.
A significant role in the diagnosis of knee injuries is arthroscopy. This procedure involves visualizing the joint area with endoscopic equipment. This method makes it possible to consider a crack in the cartilage tissue, which is the main cause of the impaired optimal functioning of the muscles of the knee joint. Similar to the described clinical manifestations, symptoms are also characteristic of a meniscus fracture, which is determined during arthroscopy.
Knee fracture treatment
The treatment process should begin immediately after the diagnosis has been made. At the same time, at any stage of therapy, the volume and characteristics of the process may be different, depending on the necessary actions.
For example, first aid involves the immobility of the joint by any means available. The purpose of maintaining immobility is the need to prevent further injury to the joint. In addition, at this stage it is desirable to introduce analgesics that prevent pain shock. After immobilization and anesthesia, all actions of the first stage of treatment can be considered complete.
The next step in treatment is carried out with the support of a traumatologist. This stage implies the necessity of matching the bone fragments in the anatomically correct order, as well as their fixation in the optimal position. This will help create the most favorable conditions for the healing process.
The described mapping can be carried out:
closed method, that is, without surgical intervention using manual techniques,
open - in this case, the operation is carried out with further fixation of bone tissue with the help of special devices.
As a rule, after a fracture of the knee, it is necessary to apply an elastic bandage, which ensures the immobility of the joint. If the articular cartilage has been damaged, at the second stage of treatment it is necessary to use chondroprotectors - medicines that help restore the structure of the cartilage tissue.
In some situations it is necessary to use anti-inflammatory agents. For example, a fracture in the area of the condyle of the knee joint, the treatment of which is very often accompanied by the intake of such drugs, in 70% of cases is complicated by autoimmune processes. Anti-inflammatory drugs are used to suppress them.
In the process of treating a fracture of the knee joint, the final stage is rehabilitation, which makes it possible to make the knee motility again full-fledged. Recreational activities include frequent massages, physical therapy, and physiotherapy.
All these measures should be assigned directly by a specialist. Only in this case, you can count on a 100% and the fastest possible recovery after such a complex injury as a fracture of the knee joint.
Education: Diploma in "General Medicine" received in 2009 at the Medical Academy. I.M. Sechenov. In 2012, completed a postgraduate course in the specialty "Traumatology and Orthopedics" in the City Clinical Hospital. Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
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What types are there?
Damage to the knee are of different types, which affects the symptoms. Also, with various forms of fracture, therapeutic measures and rehabilitation periods will differ. A fracture of the leg in the zone of the knee joint is classified into open and closed. The latter is characterized by the integrity of the skin and the bone does not come out. An open patella fracture occurs with damage to the skin and soft tissues. Given the localization of the injury, there are such types:
- condyle damage to the femur,
- lesion of condyles and fibula in the intraarticular region,
- tibial trauma,
- injured patella.
A comminuted fracture is also isolated, with and without displacement, in which the bone structures remain immobile. Compression type of violation in the area of the knee is characterized by a lighter course, because it is not complicated by the fragmentation and movement of bone fragments. It is required to immediately contact a doctor who will determine the type of knee injury and prescribe a suitable treatment.
How to determine? Main symptoms
Pathological manifestations in a fracture in the knee is difficult not to detect, since they are pronounced. Fracture of the calyx of the knee joint is accompanied by severe pain, which manifests itself directly in the affected area. After some time, pain syndrome radiates to the thigh and ankle. Soreness gradually becomes dull and aching in nature, but does not pass. The patient's sensitivity decreases or disappears altogether. There are other signs of a fracture of the knee:
- inability to lift or move a limb,
- the size of the kneecap changes, it becomes hypermobile,
- unstable feeling around the knee,
- swelling that grows with each passing hour
- hemorrhage in the popliteal area,
- inability to bend a leg at the knee.
A person can independently detect the symptoms of knee damage, but it is impossible to find out its severity and type without medical assistance. All fractures of the knee require radiography, which shows a trauma line, displacement and other necessary details. Also, with complex diagnostics, arthroscopy is performed, which is more informative than x-rays. During manipulation, the articular area is visualized by means of endoscopic devices.
How to provide first aid?
It is strictly forbidden to try to cope with the pathology, especially if there was an open fracture. Incorrect bone reposition, unnecessary leg movements can complicate the problem and lead to irreversible complications.
At the first sign of damage, it is necessary to know what measures to take in order not to further harm. First of all, the injured lower limb is immobilized. Then the following actions are carried out:
- Stop the flow of blood in case of open injury of the knee. Put a harness using the tools at hand. Be sure to record the time of imposition of a tight bandage.
- An ice compress or any cold object is applied to the affected area. Do not hold it for more than a quarter of an hour, so as not to cause hypothermia.
- Impose from scrap items tire, which will fix the leg in one position. To do this, use any long object, which is fixed by means of a bandage or flap of fabric.
- Give an anesthetic.
- The victim is taken to a medical facility.
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 movable joint follows, allowing to restore the functional tone of the joints and strengthen the muscles.
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.
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.
Do you still think that it is impossible to cure the joints?
Judging by the fact that you are reading these lines now - the victory in the fight against cartilage tissue inflammation is not on your side yet.
And you already thought about inpatient treatment? This is understandable, because pain in the joints is a very dangerous simtom that, if not treated promptly, may result in limited mobility. Suspicious crunch, stiffness after a night of rest, the skin around the problem area is stretched, swelling in a sore spot. All these symptoms are familiar to you firsthand.
But perhaps it is more correct to treat not the effect, but the cause? We recommend reading the article on modern methods of treatment of joints. Read the article >>
Fracture condyle of the knee
The tibia and femur are powerful levers that move the joint in the knee. For attaching the muscles at the ends of the bones there are special bone thickenings - condoms. In some cases, a knee injury affects one or both condyles. Trauma can be combined with dislocation of the leg or fracture of the hip. If the broken bones have shifted from their place, then this is a fracture with an offset. It is dangerous in that the surrounding tissues are damaged.
Injuries of condylar joints occur under the influence of heavy physical exertion or as a result of a strong direct blow. Particularly susceptible to this type of injury:
- elderly people,
- menopausal women.
After injury to the condylar joints, it is necessary to give a person first aid and hospitalization. The healing and rehabilitation of the condoms occurs within 5-6 months.
Meniscus fracture of the knee joint
In the knee there are 2 menisci - lateral (internal) and medial (external). Damage to the first occurs more often because it is more mobile. Meniscus rupture may be due to injury or degenerative causes. Injuries are more often received by young people or athletes. Degenerative changes in the meniscus occur in old age. Damage is characterized by severe pain, limited mobility, characteristic clicks in the joint.
If the cause of the rupture of the meniscus was caused by degenerative changes in the bones, without injury, then the pain symptoms decrease with time. In this case, the operation is not performed.
The most common cause of traumatic injury is falling on a bent knee. Sometimes a direct blow to the patella causes a fracture, or a strong tendon tension leads to the separation of the lower part of the patella. Other causes of injuries:
- falling from height,
- playing sports
- violation of bone tissue metabolism,
- complications after arthroplasty.
Among all bone and joint injuries in the knee, the most numerous are cartilaginous injuries and horizontal fractures with or without dislocation.
Adverse symptoms of bone damage may not appear immediately, but after a while. It may be:
If the bone is damaged if it is damaged, then severe pain will be felt in the knee area. If a fracture or fracture occurs, hematomas appear that indicate vascular ruptures. In some cases, the hematoma spreads to the entire leg. The deformity of the patella, the unnatural position of the bones indicate a displacement of the bone structure.
Compression fracture, or closed, is characterized by indentation of the bone. When this occurs, the longitudinal gap without displacement of the bones.
When providing first aid before the arrival of the doctors, you should put a splint from your ankle to thigh on your leg. The affected joint is fixed in the unfolded position. Ice wrapped in cotton fabric is applied to the place of injury.
The injured person must be taken to a trauma center, and the on-site doctor will determine the severity and nature of the injury.
Prescribed treatment by a medical professional can be conservative or operative.
The choice of treatment depends on the nature of the injury and displacement of the bones. Traumatologist compares bone fragments, if any, fixing them in the desired position. This is carried out in a closed way, without surgery or open, with surgical intervention. After the fracture, a plaster bandage is applied to the damaged surface, ensuring the immobility of the bone connection. If necessary, prescribed drugs. In the future, rehabilitation procedures are carried out to develop knee mobility.
In the case of a fracture without displacement or if the separation of bone fragments does not exceed 3 mm, then conservative treatment is prescribed. It includes procedures:
- puncture in a damaged area to remove accumulated blood,
- applying a plaster cast using a cotton-gauze bagel,
- UHF assignment after 4 days,
- the use of drugs.
In the future, based on the condition of the patient, the complexity of the injury, but no more than 7 days later, you should give a statistical load to the muscles. A month later, the plaster cast is removed, and the patient can walk, first with the help of crutches, and then independently.
Operational methods are used if the displacement of bone fragments is greater than 3 mm. During the operation, physicians restore the surface of the joint, using temporary fixation with the spokes.
Various operational techniques are used:
- stitching soft tissue
- circular bone seam,
- tendon-muscle plastic.
The postoperative period and the restoration of normal life takes from 2 to 6 months.
Treatment of extra-articular fractures
Treatment of periarticular fractures is a complex problem of traumatology and orthopedics. The principles of treatment include anatomically accurate comparison and fixation of bone fragments, early movements of the knee joint. At the present stage, the priority direction in the treatment of extra-articular fractures is the operative method. This is a method of fixing the limbs with rod devices for transosseous osteosynthesis.
Treatment of intra-articular fractures
Injuries to the distal femur are rare. They relate to intraarticular fractures of the knee joint. There are fractures of one of the condyles or both femoral condyles.
In order to accurately diagnose damage to the condyles of the femoral and tibial bones, an x-ray examination is performed.
Fractures of the distal femur without displacement of debris are treated with a plaster cast, which is applied for 4-6 weeks. Sometimes the technique of I. R. Voronovich is used: lateral compression osteosynthesis with spokes with stop pads.
The optimal method for the treatment of intraarticular knee injuries is osteosynthesis according to G. A. Ilizarov.
For fractures of the internal or external condyle of the tibia with the indentation of fragments, an operation is carried out with the insertion of Schantz screws.
Thus, in the treatment of fractures in the knee, surgical methods are often used, including the replacement of the knee with a bone graft. Conservatives are used only in patients with fractures without displacement of fragments. In determining the tactics of treatment should focus on the severity of the patient’s general condition and the presence of associated injuries, the type of injury, the condition of the soft tissues around the injury.
With the right treatment - conservative or operational - the consequences should not be. But sometimes complications arise:
- aching pain in the leg,
- weakness of the quadriceps thigh
- incomplete extension of the leg at the knee.
In some cases, treatment with conservative methods leads to arthrosis of the lower extremities.
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). Hip fractures of the 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,
- fracture of the knee 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 with sprains, but then in the area of the knee joint there will be a protrusion of the femur or tibial bone without signs of crepitus 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.
Conservative treatment is indicated in the absence of nimischestv displacements. Blood and fluid must be pumped out of the joint. For this purpose, a puncture is made in the anterior-lateral surface of the joint, pumped out the contents. For the same needle, a 1% or 2% solution of novocaine is injected into the joint cavity.
After anesthesia, a plaster cast is applied to the entire leg (from the middle of the upper third of the thigh to the heel). How much to walk in a cast at a fracture of the knee depends on how severe the injury was. On average - 4-6 weeks.
If a patient has a crack with effusion, then a puncture is shown in the joint cavity with the subsequent imposition of gypsum for a period of 4 weeks. The patient is prescribed NSAIDs (nonsteroidal anti-inflammatory) and chondroprotectors.
If there is an offset, but it is easily reset, you can do without surgery.
How to treat a fracture in the knee, read here.
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 ingredients (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 3-5 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.
The main types of fractures (localization):
- near the neck,
- head damage,
- breaking the big skewer
- near the neck,
- head damage,
- breaking the big skewer.
There are protrusions (constrictions) on it, they can also be broken:
- single or double fracture,
- the displacement of the tuberosity of the bone itself,
- open fracture of the lower half, causing severe pain, and requiring long treatment.
Knee injuries according to the International Classification of Diseases are designated S80 - S90.
This bone is damaged quite rarely, traumatologists work with such cases:
- spiral fracture
- cross scrapping,
- comminuted disruption of structure
- oblique fractures.
The most vulnerable spot is the fragile lateral ankle, its violation is almost always accompanied by dislocation of the foot.
People know him with a patella, fortunately rarely damage it. The nature of such injuries may be as follows:
- a simple fracture, when bone fragments fit one another,
- with offset
- comminuted fracture of the knee, in which the cup is divided into three or more parts. The most difficult case.
For the first time for medical purposes, the needles were used in 1885. An innovative method for those years was first tried by American military doctors.
Leafing through a medical card, you can see symbols like C3 or B1. This is also a classification, but it is used by professionals. Scientifically, these codes indicate the nature of the injury:
- A1 - simple fractures of the tibia bones,
- A2 —A metafizarny wedge (a piece of bone, as it were, clings to its main part, but without displacement),
- A3 - the fracture is complicated by a large number of fragments,
- IN 1 - “clean” damage without scattering of the tibial bone pieces or incomplete scrapping of the condyle,
- AT 2 - intraarticular disorder, supplemented by indentation,
- IN 3 - splitting with indentation from a strong point strike,
- WITH - displacement, such damage is called complete, requiring the work of a surgeon.
As we can see, the most unpleasant are injuries associated with the displacement of bone elements relative to each other (regardless of location).
Causes and symptoms
As for the causes that lead to damage, they are the same as for all other fractures, both open and closed:
- severe bruise (or several)
- directed bounce
- fall from a height or sports load.
- fall from a height or sports load.
Several minor injuries may increase the risk of fracture. In such cases, the break between these mini-injuries is not important.
For young age is characterized by high-energy damage, obtained during exercise. There is a very high risk of bias. In an older person, the injury will be of a low-energy type - the bones weaken with age.
- a sharp pain when trying to move, which can go into shock,
- gradual swelling of edema near the knee,
- the bruise, which is especially visible when the patella is broken,
- deformity of the joint, expressed in a noticeable (up to 3 cm) reduction of the foot,
- the foot instantly turned pale and cold to the touch,
- the victim immediately throws into heat.
Everyone can determine open fractures - the skin will be damaged, which is accompanied by bleeding of different intensity. Recognizing and accurately identifying closed damage is more difficult, in such situations it is better to provide all possible assistance and to call a doctor.
When selecting a recovery program, specialists try to take into account the complexity of each individual case. But there are general recommendations that should be followed:
- Massage should be warming. At this stage it is important to restore the tone of the vessels and muscles of the damaged area. It is also useful for fabrics.
- Moderate activity will only benefit if the load is gradual. Immediately after surgery, crutches may be needed - with proper splicing, this is not for long.
- Nutrition is adjusted in favor of foods containing calcium. Milk, cheese, cottage cheese are useful for bone material, while homemade jelly is rich in collagen used to “build” tissue.
- Physiotherapy procedures require regular consultation with the use of X-ray materials.
The complex of physical therapy will require the patient to be careful and understand the essence of the exercises. Often they are prescribed to begin 2-3 days after surgery. Of course, these are simple exercises, but over time they will become more complex, and the number of repetitions will increase.
Conventionally, physical therapy techniques for such problems can be divided into three groups. And if the first two are aimed at overcoming pain and combating atrophy, the third is already a “pure development” of a limb:
- By standing on the floor, they carry a healthy foot back and forth. Damaged, too, it is desirable to attract to such attacks, but with the utmost accuracy.
- Flexion of the limb with the transfer of weight to the second.
- Squats are usually performed while holding the chair.
- Sore leg is placed on the 3-4 step of the gymnastic ladder and do squats.
- Pull the foot can be just walking up the stairs so that a healthy foot was a step lower.
- Crouching, wrap the shin with his hands and gently pull up to the buttocks, leaving the heel motionless.
Recall that the self-activity for such serious fractures is not suitable, as well as an unauthorized increase in loads. It is also undesirable to take long breaks in classes.
We figured out what are fractures of the knee, and how to treat them. We hope that such injuries will bypass you.
Knee fractures cover more than half of all bone injuries. This is directly related to the load that the lower limbs carry, namely the knee joints, which not only help the person to move, but also serve as a kind of shock absorber.
A lot of attention is paid to the treatment of a fracture, because after an injury a person is not only incapable of going to work, but he cannot even get out of bed.
To understand the mechanism of knee fracture, you need to know the anatomy and physiological features of the knee joint.
The knee joint is a connection of the tibial, peroneal, and femoral bones with the patella (calyx). The cartilaginous tissue, which envelops the joint bag, acts as a shock absorber and protects the bones from excessive contact with each other.
The knee joint includes several ligaments:
- cruciform (located inside, between the bones).
The connection is located in the articular membrane, which acts as a joint protection from external influences (loads, shocks). Inside the protective capsule is synovial fluid, which helps eliminate the effects of bone friction. In some cases, the fluid becomes low, which leads to the gradual destruction of bone surfaces.
The knee joint has another education for more stable work while walking and running. This meniscus is an interarticular cartilage that fills the gaps between the contacts of the bone surfaces. It helps to ensure optimal sliding of the bones inside the knee joint. Superficial fracture of the muscular-ligamentous apparatus is due to such frequent fractures of the knee joint.
- load on the knee, exceeding his abilities (typical for sports with weight lifting, for example, bodybuilding or just an intense workout in the gym),
- an unsuccessful fall to your feet, for example, during a jump,
- other reasons (fight, falling to his feet in icy conditions, etc.).
General clinical picture
Fracture of the knee has its own symptoms. Anyone who, after a knee joint injury, sees these signs, should immediately see a doctor:
- Acute pain in the hurt place. Fractures are accompanied by the inability to straighten the leg in the joint due to severe pain.
- Raise the lower limb fails. This is called "blocking." The joint is temporarily unable to perform their musculoskeletal functions.
- Increased swelling and swelling. A fracture of the knee joint, like any other, is accompanied by internal hemorrhage into the joint bag. The blood begins to press on the tissue receptors, causing additional pain and "bulging" inside the volume.
- Bruise at the injury site. Appears a little later than the rest of the signs and is formed by soaking the soft tissues with leaked blood.
- Knee strain. One of the reliable signs of a fracture of the knee joint. Occurs as a result of sticking of the patella and soft tissue deep into the wound.
Time provided first aid - a pledge of the speedy recovery of the knee joint. If the wound is open, blood loss occurs, which means you need to stop the bleeding as quickly as possible.
To do this, you need to attach ice, snow or any frozen product from the freezer, after wrapping them with a piece of cloth (so as not to harm the already injured skin around the wound).
If there is no hope for the arrival of the Ambulance, then take actions according to the following algorithm:
- Fix sore limb in one position. This is necessary for the prevention of further discrepancy of bone fragments (fracture with or without displacement, can be found only after x-ray, and before that it is necessary to take preventive measures).
- Make a tire out of scrap items. They can be two planks, branches that hold the leg in one position with the help of bandages, a scarf or other tissues attached to a limb.
- If waiting for the ambulance for a long time, you can drink analgesics yourself. It can be "Paracetamol", "Ibuprofen" or any other anti-inflammatory drug that is found in the medicine chest.
- Do not try to put the bones in place. If you are not a surgeon or traumatologist, the probability of a complication is high: your well-being will worsen, unbearable pain will appear, even painful shock. A specialist doctor will deal with the fracture.
- After the previous measures, attach a cold to the knee joint.
- If there is no “cold” at hand, then firmly bandage your leg with bandages or another clean cloth to reduce bleeding. When the Ambulance arrives, report all actions taken by yourself so that employees can fully assess your condition and their further measures of assistance.
The knee is injured quite often, but in spite of this, the doctor cannot immediately determine which treatment to prescribe to the victim. This is due to the fact that there are as many as 4 types of damage:
- cup injury,
- fracture of tibial and / or fibula bones and their condyles,
- fracture of the femur and its condyles,
- meniscus damage.
Quite rare damage to the knee joint, is typical for the elderly. Causes of injury - falling on a leg bent at the joint or a sharp blow to the knee with a hard object. Another reason could be a sharp reduction in the quadriceps muscle ligament of the thigh, which breaks the calyx and leads to irreversible consequences. In some cases, the lateral tendon ligament is damaged.
Important! Patella fracture is accompanied by acute pain, unnatural mobility of bone formations and crepitus (crunching) of bone fragments in the hurt place.
Treatment of a patella fracture depends on the type of injury and the presence or absence of displacement of bone debris. If there was no displacement, then the doctor will confine to conservative therapy: gypsum is applied, and the leg is thus fixed for a month or one and a half.
At regular intervals, X-rays are taken to clarify the quality of bone healing. When the callus becomes visible in the picture (herald of a quick recovery), the plaster cast is removed for further development of the knee.
Trauma to the femoral and tibial bones
This type of fracture is divided into intra-articular (when the femoral condyles are damaged) and extra-articular (the condyles remain intact).
Falling on the side or a sharp turn of the knee - these are the main reasons for such damage. The trauma is accompanied by pallor of the skin and paresthesia in the lower limb: numbness, tingling and goosebumps.
If there was no displacement, treatment is limited to skeletal traction through the heel, the duration of rehabilitation is less than a month. In the case of displacement of fragments, traction may be delayed up to 6 - 8 weeks.
When the condyles are damaged, but without displacing the bones, the diseased leg is immobilized and a plaster splice is applied, otherwise skeletal traction is done. If the damage is too great and the fragments cannot be collected in a conservative way, an operation is performed: bone tissue pieces are held together with a screw or graft.
This is the most common damage among all fractures in the joint. Meniscus rupture occurs when a knee hits a sharp object or after landing from a great height. If the leg does not unbend after the injury and is in a half-bent position, you can suspect this type of injury.
Therapy begins with pumping blood from the articular sac. The patient is anesthetized to the desired area of the leg with novocaine or another drug, after which the meniscus is returned to its physiological position. At the same time, bending the legs in the joint at a right angle and pulling the tibia in a healthy direction.
After this manipulation, a plaster cast is applied to the entire leg, from the buttock to the fingertips. After the disappearance of signs of hemarthrosis (blood in the joint) plaster is allowed to remove.
To quickly restore the limb after the removal of the gypsum, the patient may be prescribed the following procedures:
- Physiotherapy. Fractures of the bones successfully heal under the influence of various physiotherapeutic methods: UHF, magnetic therapy and electrophoresis.
- Proper nutrition with the inclusion in the diet of foods containing calcium, magnesium and vitamins of group B. This may be nuts, cereals, dairy products, savory vegetables, fish and eggs.
- Acceptance of a multivitamin recommended by your doctor will significantly speed up the recovery of bone tissue.
- Therapeutic physical culture. Some patients will need physical therapy exercises to develop a joint.
No need to do exercises without discussing them with your doctor. Wrong actions, too much diligence can sometimes harm the wound even more than inaction. For permission to study at home, ask a specialist.
Forecast and conclusions
The prognosis for a fracture of the knee when rehabilitation measures are started on time is favorable, however, ignoring the doctor’s prescriptions and excessive loads after removing the gypsum can lead to disability.
You need to take care of your health, undergo a prophylactic medical examination in a timely manner, and drink vitamins in the spring and autumn. This will help avoid accidental damage to the musculoskeletal system and improve health.
Fracture of the knee joint is considered to be a difficult injury, as it can cause damage to the tibia, condyle of the thigh, patella. Fracture of the knee joint doctors refer to intra-articular. They lead to displacement of the surfaces of the joints.
As a result of such an injury with an incorrect fusion of bone structures, deforming arthrosis may occur. It leads to the destruction of the joint, which leads to the loss of the patient's ability to move. With timely access to doctors, an accurate diagnosis and the correct choice of patient treatment strategies - all this will make it possible to prevent destruction.
What is the knee joint?
This structure is considered to be complex, as it consists of 4 bones: the tibia, femur, patella, and fibula bone. Any of them can break, and this can lead to partial or complete fractures of the knee. A condyle is located on the tibia and femur. This is the bone protrusion on which the muscle structures are attached.
Therefore, with a sharp and strong muscle contraction, the condyles can get a fracture.
Along with the above parts, there are other joints on the knee joints:
- Bundles that fasten all parts from the outside and inside.
- Lateral and medial menisci. They allow you to soften the friction of the stones relative to each other.
- The articular surfaces are covered with cartilage tissue.
- Outside, all this is fixed by muscles and tendons.
Different types of fractures in the lap
What are the injuries on the knee joints? Doctors subdivide them into these types:
- Fracture of the femur.
- Trauma to the tibia.
- Fracture of the fibular structure.
- Fractures of the calyx or patella.
- Meniscus injury.
According to the classification can be distinguished extraarticular and intraarticular fracture. In the second case, the bag with synovial fluid, which is located outside the joint, is necessarily damaged. With a fracture of extra-articular nature, the main lesion is in the bones.
In trauma, the fact that in some cases parts of the knee structures are displaced relative to each other plays a major role. Such displaced fractures lead to difficulties in the treatment of the affected person.
Symptoms of damage to the knee joints
How to identify the main signs of injury? In case of fractures on this part of the leg, they may have common and specific symptoms, which mainly depends on the location of the injury itself. Common signs in such cases are:
- Acute pain syndrome, which increases when you try to feel the joint, or make any movement with it.
- Edema gradually develops in the affected area.
- After injury, bruising may occur.
- The functioning of the joint is impaired, and the injured person cannot bend and flex the leg. He can not rely on a limb.
Together with the signs of damage listed above, there is also a symptom characteristic only for each specific fracture. It is so diverse that it sometimes makes it difficult to make an accurate diagnosis.
In case of damage to the patella, cups or meniscus pain syndrome is always present. Swelling occurs. Deformation is possible. After injury, a bruise may form in her place, which can then descend down the leg for several days.
Diagnosis of lesions of the knee joints
At first, the patient is examined visually and his complaints are recorded. It turns out the cause of the fracture, the force of impact on the knee. Then the person is sent for radiographic examination. The resulting radiograph determines the main line along which the fracture occurred. The presence of a displaced fragment or a whole bone is also determined.
Fracture of cartilage on the knee joints does not give such clear marks. With it, the pain syndrome is less pronounced, although it is aggravated when the patient tries to make a movement, and at rest the pain is almost absent. Radiographic examination in such cases does not show any changes.
To clarify the diagnosis, doctors can send a patient to the procedure of arthroscopy. This is a method of visualization of the soil in the joints, which is produced using special endoscopic equipment. With this method, doctors can see cracks in the tissues of cartilage structures, which are considered to be the main factor in the disruption of the knee joint.
The meniscus is examined by methods that are used to study cartilage. Fractures on it can be diagnosed using arthroscopy. After all the data have been collected, doctors plan a strategy to eliminate the disease.
Knee fracture treatment and rehabilitation
How can a damaged knee joint be treated? The patient should be put in a specialized clinic with the appropriate equipment and specialists. Treatment is based on the phased care of the affected person. This means that immediately after making an accurate diagnosis, medical care to the patient begins to be provided in the amount that depends on the resources available to the doctors.
At the first stage, primary assistance is provided, which consists in providing the at-hand means of immobility of the injured knee joint. This is an immobilization procedure that does not allow the knee to get even more damage. To relieve pain, you can put ice on the damaged area. At this stage, doctors administer analgesics to the patient to relieve pain shock. After that, proceed to the next step of help to the affected person. To do this, a surgical operation is performed, during which all the bones and debris that have moved, are fixed in the correct position. This can be done in two ways - open and closed.
They are then fixed with needles or with the use of metal plates with clamping screws. A plaster cast is applied to the damaged area, a bandage from which helps to fix the immobility of the joint in the position that the doctors need.
In the event of damage to the cartilage tissue of the patient, doctors prescribe chondroprotectors, which help the restoration of cartilage structures.
When the patella fracture often after surgery, various complications arise. In this case, the patient begins to develop arthrosis.
If necessary, anti-inflammatory drugs can be used. Especially often this occurs in fractures of the condyles of the knee joints. This is necessary because such damage can have complications such as autoimmune phenomena that can be suppressed with the use of anti-inflammatory drugs.
At the last stage of the treatment process, the rehabilitation process of the entire knee joint after the fracture is performed. This is a mandatory period to restore normal functioning of the limbs.
In this case, the patient is prescribed a set of exercises, which allows you to raise the muscle tone. Used methods of physiotherapy, massage, various water treatments. These measures do not allow the development of complications in the form of arthrosis.
Doctors may recommend using calcium-containing medications to speed up the healing of injuries and fully restore broken bones.
The full course of recovery usually lasts from 3 months to 1.5 years.
It depends on the severity of the damage and the individual characteristics of the patient.
Fractures on the knee joint affect almost any anatomical structures that are directly involved in the formation of this structure. Diagnosing them is possible only after obtaining all the necessary data obtained using X-ray and other equipment. The treatment process is recommended to begin immediately after the examination of the patient and the provision of first aid. Cure patients with fractures of the knee joint is made in specialized clinics. Usually, surgery is required in such cases.
The rehabilitation process requires a lot of restraint and strength from the patient. If he fulfills all the recommendations of the doctors, then all the functions of the joint are restored. Virtually no lameness. If the patient does not listen to doctors, there is a danger that he will become disabled.
Every day, the knee joint is subjected to huge loads, so getting injured or breaking it can be quite simple. A fracture will limit mobility for at least a few weeks, because such damage has been restored for quite some time.
The knee joint is considered one of the largest joints in the human body, but, despite its size, it is quite fragile. In medicine, it is fractures of this kind that occur most often. For the treatment of an injured limb, a knee splint is prescribed, which prevents the leg from moving.
Possible causes of fracture
Fracture of the knee joint most often occurs due to the force applied to it or with excessive pressure. Very often such an injury occurs:
- After falling on his knee in a bent state.
- With a direct blow to the patella, as often happens during accidents or sports games.
- In some cases, a fracture of the knee can occur without direct force. Damage can cause excessive tendon cravings, which both damage the surrounding muscles and the knee bones. This pathology in most cases becomes the cause of the complete separation of the lower part of the patella.
Fracture can be of two types:
- open, when soft tissues and skin are damaged,
- closed, in which the skin and muscles remain intact.
In most cases, damage to the knee joint occurs during physical activity, when there is a direct impact on the knee joint:
- Falling from height.
- Direct hit to the joint area.
Fracture development mechanism
Almost always the rule applies: the more complex the mechanism, the easier it is to break it, and with the knee joint. Even a gentle blow with a bent limb is sufficient to damage it, and the rupture of the anterior ligament of the knee is guaranteed.
Often there is an injury called the Turner triad, which damage:
- internal ligaments,
- cruciate ligament.
Such damage is often found in professional athletes.
Severe cases of fracture are characterized by damage to two cruciate ligaments, the joint itself and all lateral ligaments. Symptoms can be traced in this order:
- There is a sharp pain.
- There is an increase in the size of the joint.
- Filling the cavity of the joint with blood.
With such damage, the knee ceases to perform its functions, so a person will not be able to fully walk until full recovery. Sometimes damage to the knee joint is not accompanied by any symptoms, and the injury does not interfere with movement. A person may feel only a little laxity in the knee area.
The most common fractures of such parts:
- lower thigh bone
- knee cap,
- the upper part of the tibia.
There are two types of damage:
- Intra-articular, in which the synovial sacs and ligaments are damaged.
- Extra-articular, in which the joint itself is practically not damaged, and the cartilage and ligaments are not affected.
It is possible to diagnose a fracture only by radiography. After conducting such a study, it turns out to determine correctly:
- fracture line
- joint displacement
- damage complexity.
If the cartilage is damaged, the clinical manifestations are not so prominent. A characteristic feature of this damage is increased pain during movement, and in a state of rest no unpleasant manifestations arise.
Quite often, arthroscopy is used to diagnose a fracture of the knee joint. Such a study allows visualization of the joint area with special equipment, which makes it possible to reliably make out the damaged area and establish the main cause of the malfunction of the knee.
The choice of treatment method depends on the degree of damage and the complexity of the fracture. If the fracture has passed without displacement, then the doctor simply applies plaster, immobilizing the injured limb. For effective recovery, radiography is performed, which allows you to control the healing process.
In severe cases, when the fracture occurred with displacement, surgery is required. Small particles of the patella can grow together incorrectly or not recover at all, so they are fixed manually during the operation.
Stable fractures respond to this type of treatment. For greater efficiency, it is carried out in several stages:
- Anesthesia of the damaged area with the help of anesthetics.
- If there is an accumulation of blood in the cavity, then it is removed by puncture.
- If there are no bones displacements, the limb is immobilized in a straightened position and plaster is applied. Gypsum is not applied to the knee itself, but from the ankles to the upper part of the thigh.
- The patient walks with plaster for 5-6 weeks, after which he is removed.
- During the entire period of wearing gypsum, the patient must undergo control radiographic examinations in order to monitor the smallest changes and prevent the wrong accretion in time.
- After removing the plaster, the patient recovers over several weeks, increasing physical strength of the muscles.
Conservative treatment is based on the long-term immobilization of the injured limb to achieve complete healing of the injured knee joint. To fully restore the functioning of the joint after such treatment is quite difficult and requires a lot of time and effort. This method carries with it the danger of an abnormal accretion of the patella, which can lead to deformation of the knee joint, and provoke osteoarthritis or gonarthrosis.
If a patient has a marked displacement of the patella debris by more than 2 mm in the x-ray image, then an operation is necessary to restore it. Stages of surgery:
- Naked patella.
- Comparison of debris and their fixation with wire or a bolt-tie.
- In cases of comminuted debris, the surgeon stitches small parts of the joint with a special cord. Too small parts of the bones are removed, as they will not be able to fully grow together.
- The surgeon completely restores the damaged surface of the joint.
- After the operation, the patella is firmly fixed to prevent debris from moving again.
- A plaster cast is applied to the affected limb for 5-6 weeks.
- After removing the plaster, the patient needs to restore the mobility of the knee joint using therapeutic exercises.
Restoration of a damaged limb begins only with the permission of the attending physician. If you start developing your knee too soon, it can cause repeated damage and mixing of the bones.
The early period of rehabilitation includes mahanotherapy, which is carried out with the help of special devices.
A very important part of the recovery period is medical gymnastics and physical education. In order to fully regain the strength and mobility of the limb, it requires physical exertion that will help restore and strengthen the muscles and ligaments. In order for the patient to fully recover in the shortest flight, it is necessary to start the rehabilitation period in time.
It includes the following procedures:
- Exercise therapy,
- therapeutic exercises
- CPM therapy
- manual therapy
CPM therapy is a modern technique for restoring an injured knee joint. It is based on the implementation of passive exercises using a special apparatus that does not allow the patient to feel pain or fatigue. This method can be used almost immediately after the operation, because it can not harm.
A fracture of the knee joint is a dangerous injury that can lead to muscle atrophy and cause disability if you do not start effective recovery in time. The treatment is carried out by a conservative and surgical method, after which a mandatory course of rehabilitation and rehabilitation.