Fracture of Patella
Characteristics and Treatment
Need to asses extensor mechanism if treated conservative
- Intra-articular
- Needs internal fixation and early mobilization (why?)
- Wires/Screws and Tension band
Tibial Shaft Fracture
Mechanism and Risks
- High mechanism of energy
- Prone to major injuries
- Crush injuries
- High risk of open fractures
- Bone immediately under skin
- High risk of compartment syndrome
- Tight compartments
Classification
-
Spiral fracture
- Twisting injury – indirect force
- Good soft tissue
- Good healing
-
Transverse fracture
- Direct trauma
- More soft tissues injury
Assessment of energy of injury
Can be judged from type of fracture pattern
Treatment
- Open versus closed
- Both conservative & Surgical
- Surgical is the best
Conservative Treatment
- If minimally displaced
- Patient’s choice
- Long leg cast
- (5 degrees of flexion) for 4-6 weeks
- Patella-bearing cast
- (Sarmiento) or fracture brace
- The average union time is 16±4 weeks
Operative Treatment
- Intramedullary (IM) Nailing
- The treatment of choice for mid shaft tibia fracture
- Interlocking
- Provides relative stability
- Applied without disturbing blood supply of fracture
- Allows early Weight-bearing
External Fixation and Plate Fixation
- External fixation
- Open fracture with severe soft tissue injury
- Plate fixation
- Successful
- Complication:
- Infection,
- Wound breakdown,
- Nonunion
- Increased with higher-energy injury patterns
AO Principles of Fracture Management
Tibial Plateau Fractures
Mechanism and Complications
- Occurs from axial loading with valgus or varus forces, such as in a fall from a height
- More in lateral tibial plateau
- May be associated with collateral ligament or meniscus injuries
- May lead to early OA in the knee joint
Imaging and Treatment
-
May need special images / CT to assess injury
-
Usually surgical treatment is required to restore anatomy and function of knee joint
