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Types and treatment of fractured patella

Fracture of the patella occurs in approximately 1.5 % of all bone fractures. Because the patella is a bone special education, signs of injury and methods of treatment are largely different from those for standard fractures.

problema pereloma nadkolennika

What is the patella

The patella is a small bone-shaped: the upper edge is rounded, and the bottom slightly pointed. Often the patella also called the kneecap, as it is part of the knee joint and is situated at the front part. This bone is woven into the thickness of the tendon of the quadriceps femoris, the function of which is the extension of the lower leg.

Laterally patella support cords extending from this tendon, and the bottom he fixed his own bunch, which is attached to the femur. When the leg straightened at the knee, this bone is easily detectable and shifts up, down, left and right, and when bent the limb it is placed in a special recess in the femoral head.

Despite its relatively small size, the patella is an important part of the skeleton, and performs several tasks:

  • protects the knee joint from injuries and damages;
  • stabilizes the knee, preventing lateral displacement of the articular surfaces of the femur and tibia;
  • working as a unit, increasing the lever arm and the force of traction of the quadriceps muscle.

On this basis, it can be argued that this bone suffers quite often, and the consequences of damaging it are very unpleasant.

Causes and symptoms of patella fractures

 vidy perelomov nadkolennikaMost often, this injury occurs when the direct impact, that is, when falling on a flexed knee or a blow to him. Also, there are times when the patella is literally exploding with a sharp strain of the quadriceps muscle.

When the patella fracture usually experience the following symptoms:

  • knee pain;
  • limitation of function of the knee joint: flexion is difficult, it becomes impossible to extend the knee while lifting the leg (straight leg raise does not work);
  • the result of the accumulation of exudate in the joint cavity observed its increase in size and smoothed contours;
  • some time after the injury in the knee joint you get a bruise, which sometimes, gradually moves down.

If you suspect a fracture of the patella the doctor produces not only inspection, but palpation, which allows to detect the presence of free fluid in the joint, the indents between thefragments during their displacement, pathological mobility of fragments of the patella.

Dangerous signs is a permanent swelling in the knee region and the violation of the sensitivity in the injured leg.

Depending on the nature of the fracture there are several types:

lechenie perelomov kolennoj chashechki

  1. Because of the peculiarities of attachment of the ligaments of the patella, the most common are fractures of the horizontal type in which the fault line runs directly across the bone, forming two fragment.
  2. Several less common separation of the lower edge of the patella.
  3. Possible multisplintered fracture, where the kneecap is crushed more than 2 of a fragment.
  4. When the fault line runs along the bone, diagnosed a vertical fracture.
  5. Finally, in some cases, there osteochondral fracture. It is characterized by separation of a small fragment of the articular surface of the patella.

If atomtime is formed between the free space, then we can talk about their differences. Most often, the divergence of bone fragments in fractures is observed with a horizontally running line fault, and very rarely they diverge in the vertical fractures.

To confirm or refute the presumptive diagnosis, the doctor will be taking x-rays of the knee joint in frontal and lateral projections. This method helps to visualize the fracture of the patella with displacement or without it. It is important to note that some people have such an innate feature as naselenie nuclei of ossification. In the case of such pathology patella itself consists of 2-3 fragments.

How to treat fractures of the patella

rentgenovskij snimok pereloma nadkolennikaImmediately after the injury, you should provide complete rest of the limb, to attach to the knee ice wrapped in a towel or a clean cloth, and immediately seek medical attention. After the surgeon will conduct research and establish the type of fracture, he will choose tactics of treatment. In the home can only be treated patellar fracture without displacement. Injury, accompanied by the divergence of bone fragments, usually treated only in a hospital.

Conservative treatment is carried out in cases where fragments do not differ by more than 3 mm. the task of the doctor is to eliminate hemarthrosis - blood removal from the knee joint. The procedure is performed in the following way:

  • the skin in the knee region treated with antiseptic;
  • through a thin needle injected anesthetic;
  • as soon as the anesthetic kicks in, the doctorintroduces a thick needle into the joint cavity and with a syringe sucking the blood out of it, after entering a small amount thinning medications;
  • after the puncture to the area of the patellar tendon applied a special bandage in the form of "bagel" so that his hole was above the knee cap;
  • the extremity is fixed plaster bandage on the whole foot, keeping the small angles of flexion in the knee and ankle joints.

3-4 days after these manipulations, you can start physiotherapy treatment with UHF. Therapeutic exercise during this period is only for the toes, and a week later you can start to exercise a static type for the muscles of the thigh. After 3-4 weeks, the doctor usually allowed to walk, slightly leaning on the injured limb, using crutches. Usually the plaster is removed at the end of the month, then you need to continue the physiotherapy and therapeutic gymnastics.

https://www.youtube.com/watch?v=YaIY38t0ZwQ

Surgical therapies

If the doctor diagnose the divergence of bone fragments more than 3 mm require surgical intervention. The surgeon makes the skin incision exposes the patella, removes from the glenoid cavity blood, brings the fragments, and then secures them with a special sutures or screws. The surgeon then sutured ligaments that support the patella, as in trauma, they are often broken and not so good function of fixing.

After surgery the limb is immobilized using a plaster bandage is exactly the same as in the course of conservative treatment, but the plaster should be worn a bit longer, for 6 weeks. After removal of the dressing with the aim of normalization of the limb is also necessary physiotherapy treatment, hydrotherapy, and special exercises.

Thus, after surgery, work capacity is fully restored only at the end of 8-10 weeks, and if the treatment was conservative, it will happen in 6 weeks.

It should be noted that the timing of fracture healing could increase, especially in the elderly and in women over the age of 50 years. This is due to osteoporosis - lack of calcium in the bones, which becomes the cause of their slow regeneration. Therefore, treatment of such injuries sometimes includes a specialized diet rich in foods high in calcium, and of calcium supplementation (strictly on prescription).

https://www.youtube.com/watch?v=0AymA0z5dEY

All therapeutic manipulation, including puncture of the knee joint, should be performed exclusively by a doctor. If time does not seek medical help and do not resolve properly the fracture of the patella, severely affected knee joint. The resultconcentrations in this exudate will develop an inflammation - arthritis. In addition, trauma to the kneecap will cause destabilization of the knee because of a violation of fixation of the articular surfaces of the tibia and the femur, what would be the result of deep arthropathy in gross violation of the functions of the limb.