Patella fracture

Introduction to tibia fracture The tibia is an important part of the knee joint and the largest sesamoid in the human body. In the knee extension activity, the tibia can increase the strength of the quadriceps by about 30% by leveraging, especially when the last 10° to 15° of the knee joint is extended, the effect of the tibia is more important. Improper treatment after a fracture of the humerus will seriously affect the activity of the knee joint and even cause lifelong disability. Because the patella can cause permanent knee function limitation, the knee extension strength is weakened and the quadriceps atrophy can be caused. Therefore, the humerus should be preserved as much as possible after the fracture of the tibia. The tibiofemoral joint is formed in the anterior and posterior aspect of the tibia and femur. The fracture of the humerus should be restored as much as possible to reduce the occurrence of traumatic patellofemoral arthritis. basic knowledge The proportion of illness: 0.005% - 0.008% (more common in car accidents) Susceptible people: no specific people Mode of infection: non-infectious Complications: Traumatic shock, crush syndrome, fat embolism syndrome

Cause of humeral fracture

Violence factor (30%):

Because the position of the humerus is superficial and at the forefront of the knee joint, it is highly vulnerable to direct violence, such as impact injuries, kick injuries, etc., direct violent fractures of the tibia sometimes combined with ipsilateral hip dislocation, fracture Most of them are comminuted, less displacement, and the extensor support strip is rarely damaged. Therefore, the patient can actively straighten the knee joint.

Muscle strength factor (32%):

The quadriceps suddenly contracted violently. When the internal stress of the tibia exceeded the internal stress of the humerus, the tibia fracture was caused. The fracture was mostly transverse and the displacement was obvious, but it was rarely comminuted. The extensor support belt was severely damaged and could not actively stretch the knee. joint.

Prevention of tibia fracture

The fracture of the tibia is an intra-articular fracture. It should be dissected or near anatomical reduction. Otherwise, the joint surface will be uneven, which will lead to traumatic arthritis. Frequent pain affects life and work. Such fractures should not be underestimated. You should go to the hospital in time to ask the orthopedic doctor. Diagnosis and treatment.

Coma bone fracture complications Complications Traumatic shock crush syndrome Fat embolism syndrome

Common complications

Early complications:

1, traumatic shock: severe femoral shaft fractures can reach 500 ~ 1000 ml or more, painful stimulation after trauma, shock may occur in the early stage, the principle of treatment is early fixation to reduce internal bleeding, expand blood volume and pain, active anti-shock treatment.

2, crush syndrome: severe crush injury leading to femoral shaft fractures, need to pay attention to the occurrence of crush syndrome, the principle of treatment is to prevent acute renal failure and hyperkalemia, early rehydration as soon as possible, alkalized urine, diuretic, Relieve renal vasospasm and other fasciotomy and decompression.

3, vascular nerve injury: the lower part of the femoral shaft fracture, the displacement of the fracture block can be injured in the iliac vein and sciatic nerve, the principle of treatment to do a good fracture, avoid repeated activities of the affected limb.

4, fat embolism syndrome: a large number of yellow bone marrow in the femoral shaft of the femur, high fat content, can cause fat embolism syndrome after injury, the principle of treatment is that the patient is strictly braked, avoid random movement.

Late complications:

5, fracture deformity healing: divided into angular deformity, short deformity, rotational deformity, treatment principle, children can be corrected by slight shortening, adult mild shortening can be high heel compensation, shortening 2,5 cm or more Rotational deformities require surgical orthopedic treatment.

6, fractures are not connected: treatment principles to prevent infection, effective fixation and prevent premature activities.

7, knee joint stiffness: long-term traction fixed knee joint or surgery and fracture trauma and knee joint can cause knee joint contracture stiffness, treatment principles for early knee flexion and extension activities, manual massage or surgical release.

8. Delayed healing or non-union of the tibia fracture The incidence of nonunion of the tibia fracture is low, 2.4% to 4.8%. Treatment: non-surgical treatment for asymptomatic or mild symptoms, although the fracture does not heal, but the knee function is acceptable. Surgical treatment was performed in patients with obvious symptoms. According to the specific conditions, the incision and reduction tension band was fixed, the humerus was partially removed, and the humerus was completely removed. The function of most patients improved significantly after operation.

9, the incidence of humeral re-fracture 1% ~ 5%, because in the short-term after bone healing, quadriceps tendon control knee joint stability has not fully recovered, plus the internal fixation of the tibia is not strong enough, knee joint placement time is insufficient, when the patient When exercising or walking, in the case of inadequate protection, the knees suddenly soften the legs, the quadriceps muscles contract rapidly, causing re-fractures. If the bones are separated after the fracture, the tarsal tissue is torn apart, still need Open and reset the internal fixation.

Symptoms of humeral fractures Common symptoms Subcutaneous hematoma Bone pain Painful knee joint swelling Bloody knee pain Pain Q angle Abnormal skin abrasions Pushing resistance Anti-repression wrist Wound fracture

The age of humeral fractures is generally between 20 and 50 years old, and males are more than females, about 2:1.

After the fracture of the tibia, the knee joint is swollen and bloody. Skin abrasions and subcutaneous hematoma can be seen before the sputum. The tenderness is obvious. The displaced fracture can touch the fracture gap. The knee joint is severely painful during passive activities, and sometimes the bone rub is felt.

Tibial fractures are usually classified according to the location of the fracture, the shape of the fracture, and the extent of displacement.

1. Non-displaced humeral fracture

(1) Transverse fracture without displacement.

(2) Non-displaced comminuted fractures.

2. Displaced humeral fracture

(1) 1/3 transverse fracture of the humerus.

(2) A transverse fracture of the upper or lower tibia.

(3) A comminuted fracture with displacement.

(4) Longitudinal fractures.

(5) Osteochondral fractures.

Transverse fractures are the most common, accounting for 50% to 80% of all fractures of the tibia, mostly in the middle third or lower level; comminuted fractures account for 30% to 35%; longitudinal fractures and osteochondral fractures are the least, accounting for 12% 17%, longitudinal fractures are often caused by direct violence on one side of the humerus. Osteochondral fractures usually occur in adolescents and often occur in the case of traumatic patella dislocation or subluxation.

According to the clinical manifestations and X-ray findings, the diagnosis of tibiofibular fracture can be confirmed. After the fracture diagnosis is clear, the degree of injury of the extensor support band should be judged to facilitate the choice of treatment.

If the fracture displacement is greater than or equal to 5mm, it indicates that most of the extensor support band has been broken. If the fracture displacement is less than 5mm, and the knee joint can be fully extended, the knee extension device is not obviously damaged; if it cannot be fully extended Straightness indicates that there are different degrees of damage at the same time, and the local anesthetic is injected after the knee joint puncture and blood is taken, which is helpful for the implementation of the above examination.

Examination of the fracture of the tibia

X-ray films should be used in the lateral and oblique position of the knee joint, without the anterior-posterior position. Although the lateral position is most useful for the identification of transverse fractures and fracture separation, it is not possible to understand the presence or absence of longitudinal fractures and comminuted fractures. Routine 45o position can be routinely used to avoid overlap with the femoral condyle; it can show its overall appearance, and is more conducive to the diagnosis of lateral longitudinal fractures. If there is suspected damage inside, it can be taken 45o, if the clinical height is suspected When the humerus fracture and the X-ray films of the lateral and lateral positions are not displayed, the X-ray of the tibia can be taken again.

Diagnosis and diagnosis of tibia fracture

diagnosis

1. Some patients have a family history or a history of congenital foot deformity or trauma.

2. Pain or discomfort in the foot when standing or walking for a long time, flattening with the valgus foot, valgus of the forefoot, swelling and tenderness at the scaphoid nodule, rest can be alleviated or disappeared, and the lower part is squatting and rested for a long time. The symptoms are also difficult to improve.

3. Standing position X-ray foot positive lateral slice can be seen that the scaphoid nodule completely collapses, and the distance from the load-distance protrusion increases, from the bottom of the calcaneus nodule to the bottom of the first talus, and from the scaphoid nodule The line is a vertical line and its length is less than 1cm.

Through medical history, physical examination and X-ray examination, there is no difficulty in diagnosis, but attention should be paid to the following aspects:

1. Clinically suspected fractures of the tibia and X-ray films are also considered. The possibility of injury to the attachment of the tibia to the quadriceps or the patellar tendon should be considered. These two types of injuries may not have fractures, but local There should be significant tenderness and difficulty in stretching the knee.

2, in the differential diagnosis should pay attention to the exclusion of dichotomous sputum, it is mostly located in the upper tibia, the outer edge and the lower edge are rare, the gap between the tibia and the main tibia is relatively neat, clinically no tenderness, but if Stress fractures of the tibia are more difficult to distinguish from the humerus or its injury.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.