A fracture is a condition in which there is a 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 the 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 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 skiing.
Diagnosis is made through your medical history, a 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 the 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.
• Intramedullary nailing: In this procedure, a specially designed metal rod is placed into the 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.
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 cases, 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.