Knee Surgery & Rehab Flashcards
What are the indications for surgery for knee fractures?
- Critical size defect of shaft of tibia 12 +/- 1mm, 50% cortex
- Infection/open injury
- Complex case (older, other pathology etc)
- Need to reconstruct the joint
How is a spiral fracture fixed surgically?
Intramedullary nailing - rod goes along the shaft of the bone & is nailed in place
What are the 3 types of extra articular distal femur fractures (type A)?
Simple
Metaphyseal wedge
Metaphyseal complex (comminution)
What is considered for a extra articular distal femur simple fracture & what are the surgical options?
- Apophyseal or metaphyseal
- Oblique or spiral
- Sx: traction, external fixation or plate & screws
What are the surgical options for metaphyseal articular wedge & comminution fractures?
Traction
External fixation
Plate & screws
What are the 3 types of partial articular distal femur fractures (type B)?
Lateral sagittal
Medial sagittal
Frontal
What occurs during medial and lateral sagittal fractures and what are the surgical options?
- Simple
- Through notch/condylar load bearing surface
- Rx: Plate & screws, external fixation
What is the aim for partial articular distal femur fractures?
- Anatomical restoration of the articular surface
- Early active mobilisation of the joint
What are the 3 types of complete articular distal femur fractures (type C)?
Simple
Metaphyseal comminution
Multifragmentary
What occurs during a simple complete articular fracture?
No part of the articular surface is in continuity with the diaphysis
What occurs during a metaphyseal complete articular fracture?
No part of the articular surface is in continuity with the diaphysis
Comminution of metaphysis
What occurs during a multifragmentary complete articular fracture?
No part of the articular surface is in continuity with the diaphysis
Comminution of metaphysis
Comminution of articular surface
What is the phase 1 principle for knee fracture rehabilitation?
Protect & maintain
How is the knee maintained?
- Restrictions on joint ROM
- Restrictions on muscle contraction/weight bearing
- Management of oedema (compression, elevation)
- Consider other joints
- Educate patient
What is the mechanism of tibial plateau fractures?
- Direct fall (20%)
- Car vs pedestrian (50%)
- Axial compression & rotation force (30%)
What types of tibial plateau fractures are associated with axial compression & rotation force?
- Lateral plateau (abduction force)
- Medial plateau (adduction)
- Anterior (extended knee)
- Posterior (flexed knee)
What are the indications for surgery for tibial plateau fractures?
- Type of fracture
- Age of patient (younger = less likely)
- Degree of displacement/articular surface
- Compromised knee stability
What are the types of proximal tibial fractures?
Extra-articular:
- Avulsion
- Metaphyseal simple
- Metaphyseal multifragmentary
Partial articular:
- Pure split
- Pure depression
- Split-depression
Complete articular:
- Simple, metaphyseal simple
- Simple metaphyseal multifragmentary
- Multifragmentary
What is the mechanism of patella fracture?
- Direct trauma/fall on knee
- Big pull of quad muscles
- Displaced or non-displaced
What are the indications for surgery for patella fractures?
- Displacement >3-4mm
- Loss of active knee extension
What is the rehabilitation for patella fractures post surgery?
Protect - Weight bear as tolerated (in a splint) Maintain - ROM - Quads/hamstrings (wasting is rapid)
What does patella fracture surgery involve?
Reduction with K-wires & tension band
What needs to be considered during patella rehabilitation?
- Preoperative history/impairments
- Surgical procedure/tecnhique
- Surgeon’s assessment of the tissue status
What are the common restrictions associated with patella rehabilitation?
- Active/passive ROM
- ROM limits
- Weight bearing status
- OA, pre-existing problems
- Tendinopathy, bursitis, quads strength
