How to effectively treat knee fracture

A fractured kneecap may be caused by accidental injury due to carelessness in life. In terms of treatment, attention should be paid to fixation to prevent the occurrence of traumatic arthritis. In the recovery period, care should be taken not to do strenuous exercise.

(1) Plaster splint or tube fixation: This method is suitable for non-displaced patellar fractures (like yours). No manual reduction is required. The blood accumulated in the joint is drained, bandaged, and the affected limb is fixed in an extended position with a long-leg plaster splint or tube for 3 to 4 weeks. Practice quadriceps contraction during the cast period, and practice knee flexion and extension after the cast is removed.

(ii) Open reduction and fixation There are many methods for internal fixation of patellar fractures, which can be divided into two categories. One type still requires external fixation for a certain period of time after internal fixation; the other type of internal fixation is relatively strong and does not require external fixation.

1. Improved tension band wire internal fixation (1) Indications a. Transverse patellar fracture; b. Comminuted patellar fracture that can be reduced. (2) Surgical method: Make a transverse arc incision in front of the patella to expose the fracture line. From the fracture surface at the distal end, two Kirschner wires with a diameter of 1.5 mm are inserted retrogradely to fix the fracture ends. The hand is inserted into the joint cavity. After the patellar articular surface is felt to be flat, a steel wire is wrapped around the Kirschner wire to fix it. Secure the other needle in the same way. (3) No external fixation is required for postoperative treatment. Quadriceps contraction exercises are performed on the second day after surgery. Most fracture patients can flex their knees 90° and walk 2 weeks after surgery.

2. Resection of the upper or lower part of the patella and reattachment of the quadriceps tendon (1) Resection of smaller bone fragments or comminuted fractures, reattachment of the patellar ligament to the upper part of the patella, or reattachment of the quadriceps tendon to the lower part of the patella. (2) Postoperative treatment: Use a large amount of dressing and fix the long leg in a straightened position with plaster for 3 weeks. After removing the plaster, practice joint movement without weight bearing. After 6 weeks, the patient gradually began to walk with the help of crutches and to increase joint range of motion and quadriceps muscle strength training. This method can preserve the function of the patella, heal quickly, and restore the function of the quadriceps femoris without problems such as fracture healing and uneven joint surface.

3. Total patellar resection is suitable for severe comminuted fractures that cannot be reduced or partially removed. When removing comminuted fracture fragments, the periosteum and quadriceps aponeurosis should be protected as much as possible. After resection, the torn expanded part and joint capsule are sutured to restore them to normal tightness. Then, the quadriceps tendon is pulled down and sutured to the patellar tendon. If direct suture is not possible, the quadriceps tendon can be flipped and repaired. Make a "V"-shaped incision on the quadriceps tendon, turn the cut tendon flap downward, and repair the newly formed defect after the patella is removed. The tendon flap of the vastus lateralis and the lateral part of the quadriceps tendon can also be turned downward to repair the defect at the site of patella resection. The patient was fixed with a plaster splint for 4 weeks after surgery and the knee flexion and extension were practiced.