Multiple fractures of the bones of the knee joint
Traumatology / / May 10, 2016
to multiple intra-articular fractures of the knee bones can be attributed fractures each mating bone (distal femur, proximal tibia, patella), and various combinations thereof (femur and patella, femur and tibia, femur, patella and tibia; patella and tibia).In a separate group can be identified intra-articular fractures of the condyles of the femur and tibia fractures in conjunction with other departments of the same name, or conjugated bones.
most severe kind of intra-polifraktur are multiple fractures of the knee bones articulate.
Intra-articular fractures of the masked severe swelling and hemarthrosis.Careful evaluation difficult as sharp pain on palpation and movement, and the collateral damage (especially open) femur and tibia.Estimated diagnosis is based on signs of deformation of the joint region, an unusual rotation of the tibia in the medial or lateral side, a sharp pain in the joint on palpation, with a minimum of passive movements at effleurage on the heel.Diagnosis is much easier
Produce novocaine blockade by a puncture of the joint, thus partially removed blood and injected 60 mL of a 0.5% solution of novocaine.Firmly bandage the knee area.Transport immobilization is carried out by several bus Diterikhs or stair rails.
skeletal traction in the acute period of trauma applied to all patients.This functional method allows to achieve satisfactory reduction of bone fragments, promotes healing of wounds, the elimination of the inflammatory process, hemarthrosis and swelling of tissues, does not interfere with diagnostic and therapeutic manipulation.
Favorable results provide skeletal traction extremity of the tuberosity of the tibia, and the fragments of femoral condyle additional percutaneously fixed spokes.With skeletal traction reposition fragments carried out due to the tension tendon-muscular system joint, ligaments and joint capsule.A particularly important point is the expansion of the traction of the joint space, which significantly reduces the risk of developing post-traumatic contractures.Favored by the restoration of joint function affects the preservation of freedom of movement.Duration skeletal traction reaches 3-3.5 months, the total load on the axle is permitted to patients after 6-8 months.Development of deforming arthrosis observed in the future for all the victims and after skeletal traction, but its clinical manifestations are less pronounced, and the pain is easily stopped by conservative means.
When multiple fractures of the distal femur treatment begins with the imposition of skeletal traction behind the tuberosity of the tibia, then routinely performed osteosynthesis screws and bolts, ties, complex designs, Transosseous osteosynthesis by Ilizarov.
duration of immobilization plaster cast in the surgical treatment is 4-5 months, the total axial load on the limb is permitted no earlier than 6 months.Earlier axial load causes the development of arthritis, which is accompanied by swelling of the joint, effusion, pain intensity, forcing again resort to immobilize the limb to 1.5-2 months.Open reduction and internal fixation of bone fragments submersible designs always pose a risk of septic complications, and subsequent forced prolonged immobilization plaster cast negative impact on the recovery of joint function, as it contributes to a narrowing of the joint space and scar tissue.
to solve complex problems the treatment of intra-articular fractures of the Ilizarov method has been used successfully.The versatility of the Ilizarov apparatus makes it possible to collect for each patient the optimal design for reduction and fixation of bone fragments and the use of spokes with thrust pads ensures the necessary efforts in any desired direction for each fragment.However, when using external fixation chreskostnogo as there is a danger of purulent infection, especially during the spokes through the swollen tissue, hematoma, fracture focus, joint cavity.
In patients with open multiple intra-articular fractures of the femoral fixation of bone fragments by Ilizarov performed 2 weeks after wound healing, elimination of hemarthrosis, swelling of tissues.
With the apparatus for 6 weeks support the knee joint immobilization by applying two additional rings in the upper third of the leg with a mandatory extension of the joint space.After the restoration of motion in the knee joint femoral fixation of bone fragments continue up to 3-5 months.By that time, permitted axle load limbs.Employability is restored in 5-6 months.
When multiple intra-articular fractures of the proximal tibia are operational advantage treatments that allow you to completely restore the congruence of the articular surface and remove the damaged meniscus.With simultaneous fracture femoral condyle or tibial and other departments of the same name, or conjugated bones preferred combination therapies that include a simple distraction device (two half rings connected by two bars), fixation with two spokes knee in valgus or varus position (dependingfrom the fracture of the medial or lateral condyle), skeletal traction device directly behind the semicircle (fracture of the proximal femur) or heel bone (fracture of the distal tibia), circular plaster bandages.The total axial load is permitted not earlier than after 5-6 months.