distal femur, patellar and proximal tibial fractures Flashcards
where in the distal femur can fractures occur?
- supracondylar
- condylar - unicondylar or bicondylar
what is a tibial plateau fracture?
the break of the upper part of the tibia
what can cause a supracondylar fracture?
- forced flex and hyperextension injury
what is recommended with a supracondylar fracture?
ORIF is usually recommended
what causes a condylar fracture?
- high energy trauma eg fall from height or RTA
- older people - lower energy trauma eg osteoporosis
what types of fractures can be seen with a condylar fracture?
- open
- minimally displaced
- displaced
how is an** undisplaced **condylar fracture managed/treated?
undisplaced - bone is broken but not out of alignment
- hinged knee brace
- NWB for 6 weeks
- joint aspiration
how is a displaced condylar fracture managed?
- ORIF with plates and screws
- continous passive motion CPM machine to prevent stiffness
- NWB gait
how is an open condylar fracture treated?
- external fixation
- NWB
what are complications with distal femoral fracture?
- shock
- fat emolus
- non union
- mal union
- limb shortening- eg if it heals in a shortened position
- muscle weakness eg quad lag
- loss of ROM - eg limited knee flexion
- infection
what MOI’s could cause a patella fracture?
- direct impact injury
- indirect eccentric contraction/ indirect lengthening of muscle (injury caused by internal force in body)
Describe the management of a non displaced patellar fracture
- aspirate the joint - suck out synovial fluid - if there is excess swelling or bleeding
- apply long leg cast for 4-6 weeks - knee is in extension
- NWB or PWB
what is a transverse fracture of the patella?
- this occurs when the patella fractures into 2 parts in the transverse plane , dividing the bone into an upper and lower portion
what is a big risk with transverse patella fractures?
- there is a risk of further separation of the fracture
- we dont want the quadricep to contract too much as it might pull the quadricep tendon apart further and make the fracture worse
how is a transverse patella fracture treated?
- ORIF
- long leg cylinder cast for 6 weeks
- NWB / PWB on gait
- NO ISOMETRIC QUAD exercises as it may destabilise the fracture site
what is a comminuted fracture of the patella?
a comminuted fracture of the patella is when it shatters into 3 or more pieces
what is the MOI for a comminuted patella fracture?
- a blow to flexed knee - eg fall or RTA
describe the management of a comminuted fracture of the patella
- ORIF - to reassemble the fragments
- patellectomy - reserved for severe and excessive comminution (surgical removal of knee cap)
- full cast for 6 weeks with knee in extension
what is the MOI of a tibial plateau fracture?
- caused by a strong force on the lower leg with the leg in valgus or varus position
- falls, RTAS and sports - only 5-10%
what other conditions / injuries may be seen with a tibial plateau fracture?
- injury to ACL
- injury to MCL
- injury to the menisci of the knee
what system classifies tibial plateau fractures?
- the schatzker system - classifies these fractures into 6 types
- 1-3 = lower energy trauma and 4-6 = higher energy trauma
what does the conservative management of a tibial plateau fracture involve?
- hinged brace
- NWB for 8-12 weeks
- early ROM especially knee flexion
what does the surgical management of a tibial plateau fracture involve?
- ORIF
- may or may not need bone grafting - replacing damaged bone
- early ROM - esp knee flexion
- may or may not have - continous passive movement machine
what are the complications of a tibial plateau fracture?
- knee joint instability, especially if there is also ligament damage
- long term risk of post traumatic OA
