Supracondylar fractures Supracondylar fractures of the femurof the femur

Usually affect:Usually affect:

1.1. Young adults from high energy trauma.Young adults from high energy trauma.

2.2.Elderly osteoporotic persons.Elderly osteoporotic persons.

Mechanism of injury:Mechanism of injury:Direct violence, the fracture line Direct violence, the fracture line

above the condyles and may extend above the condyles and may extend between them or may be severely between them or may be severely comminuted.comminuted.

The distal fragment displaced The distal fragment displaced posteriorly by the gastrocnemius posteriorly by the gastrocnemius endangering the Popliteal artery.endangering the Popliteal artery.

Clinical FeaturesClinical FeaturesThe knee is deformed and swollen, The knee is deformed and swollen,

movements are impossible, don’t movements are impossible, don’t forget to examine the distal pulses.forget to examine the distal pulses.

X-ray:X-ray: the line above the condyles the line above the condyles and may extend between them with and may extend between them with comminution; displacement and comminution; displacement and tilting are posterior.tilting are posterior.

TreatmentTreatment1.1. Non operativeNon operative:: if slightly if slightly

displaced and extra articular; use displaced and extra articular; use skeletal traction on a skeletal traction on a BOHLER BOHLER FRAMEFRAME for 6weeks followed by for 6weeks followed by partial weight bearing.partial weight bearing.

2.2. Operative:Operative: provide early mobilization provide early mobilization and regain of knee flexion:and regain of knee flexion:

Retrograde intramedullary nail. (Retrograde intramedullary nail. (if no if no intraarticular extensionintraarticular extension))

90°angled blade plate (old not frequently used 90°angled blade plate (old not frequently used now).now).

Anatomical plate. Anatomical plate. Dynamic condylar screw. Dynamic condylar screw. Intraarticular Intraarticular

ExtensionExtension

followed by early partial weight followed by early partial weight bearing.bearing.

ComplicationsComplications 1.1. Arterial damage:Arterial damage: Popliteal artery in Popliteal artery in

danger even with minimal danger even with minimal displacement, if happen need displacement, if happen need exploration and repair.exploration and repair.

2.2. Joint stiffness:Joint stiffness: If intraarticular and If intraarticular and exercise is not performed well.exercise is not performed well.

3.3. Non union:Non union: rare if associated with rare if associated with knee stiffness treatment is knee stiffness treatment is difficult( Fixation and bone grafting).difficult( Fixation and bone grafting).

Fracture Femoral CondylesFracture Femoral Condyles One or both condyles may break and One or both condyles may break and

may be associated with supracondylar may be associated with supracondylar fractures.fractures.

Clinical features:Clinical features: pain, swelling, pain, swelling, deformity, doughy feeling from deformity, doughy feeling from hemarthroses; examine the distal hemarthroses; examine the distal pulses.pulses.

X-ray:X-ray: one condyle may be fractured one condyle may be fractured

obliquely or both in T or Y pattern.obliquely or both in T or Y pattern. Treatment:Treatment: closed reduction and closed reduction and

internal fixation:internal fixation: Canulated screws if one condyle.Canulated screws if one condyle. Dynamic condylar screw or anatomical plate if Dynamic condylar screw or anatomical plate if

bicondylar).bicondylar).

Dislocations Of The Knee Dislocations Of The Knee JointJoint

Usually caused by considerable violence, Usually caused by considerable violence, causing rupture of cruciate and causing rupture of cruciate and collateral ligaments.collateral ligaments.

Clinical features:Clinical features: severe bruises, severe bruises, swelling, gross deformity, exclude swelling, gross deformity, exclude neurovascular injury.neurovascular injury.

X-ray:X-ray: shows the dislocation and shows the dislocation and possible fracture of the tibial spine possible fracture of the tibial spine (cruciate ligament avulsion).(cruciate ligament avulsion).

Treatment: Treatment: urgent reduction under urgent reduction under GAGA, splintage by , splintage by

back slab in 15°flexion, close back slab in 15°flexion, close observation of the circulation for the observation of the circulation for the next week.next week.

When swelling subside POP cast applied When swelling subside POP cast applied for 12 weeks followed by extensive for 12 weeks followed by extensive physiotherapy.physiotherapy.

Open reduction:Open reduction: is indicated if closed is indicated if closed one fail due to interposition of injured one fail due to interposition of injured ligaments; capsule and ligaments are ligaments; capsule and ligaments are sutured.sutured.

ComplicationsComplications

1.1. Popliteal artery damagePopliteal artery damage is very is very common and need immediate repair.common and need immediate repair.

2.2. Common peroneal N.Common peroneal N. may be injured may be injured but usually neuropraxia.but usually neuropraxia.

3.3. Joint instabilityJoint instability: due to ligament : due to ligament injury, usually muscle strengthening injury, usually muscle strengthening control the joint.control the joint.

4.4. Stiffness:Stiffness: due to prolonged due to prolonged immobilization.immobilization.

Fracture PatellaFracture PatellaThe largest sesamoid bone; function to The largest sesamoid bone; function to

increase the efficacy of the quadriceps increase the efficacy of the quadriceps muscles, protection of the knee.muscles, protection of the knee.

Its part of extensor mechanism Its part of extensor mechanism (quadriceps tendon, patella, patellar (quadriceps tendon, patella, patellar ligament, extensor retinaculum).ligament, extensor retinaculum).

Mechanism of injuryMechanism of injury::

1.1. Direct Force:Direct Force: fall onto the knee, fall onto the knee, blow against the dashboard of a car blow against the dashboard of a car causing undisplaced crack or causing undisplaced crack or comminuted fracture with minimal comminuted fracture with minimal injury to the extensor expansion.injury to the extensor expansion.

2.2. Indirect Force:Indirect Force: strong passive knee strong passive knee flexion while the quadriceps is flexion while the quadriceps is contracting, causing transverse contracting, causing transverse fracture with displacement.fracture with displacement.

Clinical featuresClinical featuresPain, swelling, abrasions in front of Pain, swelling, abrasions in front of

the knee, a gap may be felt the knee, a gap may be felt (transverse fracture).(transverse fracture).

Test active knee extension, if present Test active knee extension, if present extensor mechanism is intact.extensor mechanism is intact.

Aspiration of the knee shows Aspiration of the knee shows hemarthroses with fat droplets.hemarthroses with fat droplets.

X-ray: (AP and lateral view)X-ray: (AP and lateral view)1.1. Transverse fracture with displacement.Transverse fracture with displacement.

2.2. Comminuted fracture (stellate).Comminuted fracture (stellate).

Treatment:Treatment: Undisplaced and minimally Undisplaced and minimally

displaced:displaced:

Aspirate the hemarthroses and Aspirate the hemarthroses and immobilization in a POP cylinder for 3-immobilization in a POP cylinder for 3-4 weeks.4 weeks.

Comminuted displaced fractures:Comminuted displaced fractures:

Patellectomy otherwise it ends with Patellectomy otherwise it ends with Osteoarthrits.Osteoarthrits.

Displaced transverse fracture:Displaced transverse fracture:

Open reduction and internal fixation by Open reduction and internal fixation by tension band method (two K- wires tension band method (two K- wires and figure of 8 flexible wire).and figure of 8 flexible wire).

Complications:Complications:1.1. Knee stiffness.Knee stiffness.

2.2. Patello femoral osteoarthrits.Patello femoral osteoarthrits.