Knee Fracture

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

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 fracture is a break in the thighbone that occurs just above your knee joint.
• Fractures of proximal tibia: A proximal tibial fracture is a break in the upper part of the shinbone 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 tibial fractures can result in injury to the surrounding soft tissues including skin, muscle, nerves, blood vessels and ligaments.

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

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

Internal fixation

Internal fixation may involve:

• Intramedullary nailing: In this procedure, a specially designed metal rod is placed into the marrow canal of the femur. Then, the nail is passed to reach the fracture site and is kept in place. The rod is secured in place with screws at both ends.
• Plates and screw fixation: In this procedure, your surgeon will reposition the broken bone ends into normal position, and then use 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 the bone fragments in place, and 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 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 callus. 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.