Treatment of Knee Fracture & Dislocation

Knee Fracture

A fracture is a condition in which there is break in the continuity of the bone.  In younger individuals, these fractures are caused from high energy injuries, as from a motor vehicle accident. In older people the most common cause is weak and fragile bone.

Fractures of the knee can include the following:

  • Distal femur fracture: The distal femur is part of the femur bone that flares out like the mouth of the funnel. A distal femur (top part of knee joint) fracture is a break in thighbone that occurs just above your knee joint.
  • Femoral shaft fracture: A femoral shaft fracture is a break that occurs anywhere along the femoral shaft, long, straight part of the femur.
  • Fractures of proximal tibia: A proximal tibial fracture is a break in the upper part of the shin bone or tibia. Proximal tibial fractures may or may not involve the knee joint. Fractures that enter the knee joint may cause joint imperfections, irregular joint surfaces, and improper alignment in the legs.  This can lead to as joint instability, arthritis, and loss of motion. These fractures are caused by stress or trauma or in a bone already compromised by disease, such as cancer or infection. Proximal tibia fractures can result in injury to the surrounding soft tissues including skin, muscle, nerves, blood vessels, and ligaments.
  • Tibial shaft fractures: A tibial shaft fracture is a break that occurs along the length of the tibia or shin bone (larger bone of the lower leg) between the knee and ankle joints. These fractures can occur while playing sports such as soccer and

Diagnosis is made through your medical history, physical examination, and other diagnostic imaging tests. X-rays are taken to know whether the bone is intact or broken. X-rays are also helpful to know the type and location of fracture. Your doctor may also recommend a computerized tomography (CT) scan to know the severity of fracture.

Treatment options include non-surgical and surgical. Non-surgical treatment involves skeletal traction and use of casts and braces. Skeletal traction involves placement of pin into the bone in order to realign broken bones. Surgery involves internal fixation and external fixation.

Internal fixation

  • Intramedullary nailing: In this procedure, a specially designed metal rod is placed into the marrow canal of the femur. Then the nail is passed on to reach the fracture site and keep it in place. The rod is secured in place with screws at both ends.
  • Plates and Screws fixation: In this procedure, your surgeon will reposition the broken bone ends into normal position and then uses special screws or metal plates on the outer surface of the bone to hold the bone fragments in place.

External fixation

During the procedure, metal pins or screws are inserted into the middle of the femur and tibia and are attached to a device outside the skin to hold bone fragments in place to allow alignment and healing. If your bone is fractured in many pieces, a plate or rod is fixed at both ends of the fracture to maintain the overall shape and length of the bone in place while it heals. In elder patients where fracture healing delays, a bone graft taken from the patient or tissue bank may be used to form callous. In severe case, the bone fragments are removed and the bone is replaced with a knee replacement implant.

The most common complications of surgery include infection, knee stiffness, delayed bone healing, and knee arthritis.

Patellar Dislocation

Patella (knee cap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. Patella attaches with the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

Dislocation of the patella occurs when the patella moves out of the patellofemoral groove, (called as trochlea) onto a bony head of the femur. If the knee cap partially comes out of the groove, it is called as subluxation and if the kneecap completely comes out, it is called as dislocation (luxation). Patella dislocation is commonly observed in young athletes between 15 and 20 years and commonly affects women because of the wider pelvis creates lateral pull on the patella.

Some of the causes for patellar dislocation include direct blow or trauma, twisting of the knee while changing the direction, muscle contraction, and congenital defects. It also occurs when the MPFL is torn. The common symptoms include pain, tenderness, swelling around the knee joint, restricted movement of the knee, numbness below the knee, and discoloration of the area where the injury has occurred.

Your doctor will examine your knee and suggests diagnostic tests such as X-ray, CT scan, and MRI scan to confirm condition and provide treatment. There are non-surgical and surgical ways of treating patellofemoral dislocation.

Non-surgical or conservative treatment includes:

  • PRICE (protection, rest, ice, compression, and elevation)
  • Nonsteroidal anti-inflammatory drugs and analgesics to treat pain and swelling
  • Braces or casts which will immobilize the knee and allows the MPF ligament to heal
  • Footwear to control gait while walking or running and also decreases the pressure on the kneecap.
  • Physical therapy is recommended which helps to control pain and swelling, prevent formation of scar of soft tissue, and also helps in collagen formation. Physiotherapist will extend your knee and applies direct lateral to medial pressure to the knee which helps in relocation. It includes straightening and strengthening exercises of the hip muscles and other exercises which will improve range of motion.

Surgical treatment is recommended for those individuals who have recurrent patella dislocation. Some of the surgical options include:

  • Lateral-release- ­It is done to loosen or release the tight lateral ligaments that pull the kneecap from its groove which increases pressure on the cartilage and causes dislocation. In this procedure, the ligaments that tightly hold the kneecap are cut using an arthroscope.
  • Medial patellofemoral ligament reconstruction - In this procedure, the torn MPF ligament is removed and reconstructed using grafting technique. Grafts are usually harvested from the hamstring tendons, located at the back of the knee and are fixed to the patella tendon using screws. The grafts are either taken from the same individuals (autograft) or from a donor (allograft). This procedure is also performed using an arthroscope.
  • Tibia tubercle realignment or transfer - Tibia tubercle is a bony attachment below the patella tendon which sits on the tibia. In this procedure, the tibia tubercle is moved towards the center which is then held by two screws. The screws hold the bone in place and allow faster healing and prevent the patella to slide out of the groove. This procedure is also performed using an arthroscope.

After the surgery, your doctor will suggest you to use crutches for few weeks, prescribe medications to control pain and swelling, and recommend physical therapy which will help you to return to your sports activities at the earliest.

Click on the topics below to find out more from the orthopaedic connection website of American Academy of Orthopaedic Surgeons.