Knee Injury

Knee by the Unit, tibia and patella, a fibula, the structure is complicated, prone to sports injuries is the key. The primary function of the knee flexion and extension movement in the semi-flexor flexor 90 ° or a slight rotational movement. And the muscles around the knee tendon, and lateral collateral ligament, the former, and the posterior cruciate ligament and lateral meniscus, and to maintain the stability of the knee.

A knee injury reasons for the different structures and principles are different, specific below:

Medial collateral ligament: knee flexion (about 130 ~ 150 °), the calf suddenly outreach external rotation, or foot and leg fixed, or thigh sudden internal rotation, will keep the medial collateral ligament injury. Reverse of the size and extent of closely related injury

Lateral collateral ligament: knee-buckling, in a sudden resumption of leg spin, or thigh suddenly outreach swing, the lateral collateral ligament injury occurred, the less damage to the ligament.

Cruciate ligament: a total of two in the joint capsule, the main function is to limit excessive anterior tibial or after the shift. Knee flexion-rotation suddenly and completed within finish outreach movement is an important injury mechanism.

Meniscus: knee-buckling of leg spin, or outreach to the internal rotation, two meniscus sliding disharmony, it will meniscus caught in the femoral condyles and the tibial plateau between by the rapid grinding, Nianzhuai and tear.

Second, the knee injury main clinical manifestations include the following five areas:

① knee pain. Mild ligament sprain, knee pain suddenly somewhere often, but often immediate alleviation, and will continue its adherence to the competition, such as knee injuries have Pala sound, accompanied by limitations like tearing pain, limb not Chichong, not walking, suggesting that may be completely torn ligament in the knee joint or injury.

② knee swelling. Knee sprains, swelling lighter, confined to a particular, if fully ligament rupture, local swelling larger, and subcutaneous plaque deposition, floating patella test positive.

③ knee tenderness. Sprain will arise in different parts tenderness, as in the tender point palpable defect to the local organization of depression, to do more to complete ligament rupture performance.

④ knee activities obstacles. After the knee injury muscle spasm around, a mild knee flexion position, but patients can take the initiative to be slowly knee flexion or extension to the normal range.

⑤ knee locked. Joint interlocking seen some meniscus tear cruciate ligament and medial collateral ligament rupture; stump medial collateral ligament in the joint space between incarcerated caused.

Three knee injuries screening method includes the following three tests:

① knee lateral exercise test. Used to check collateral ligament. This test checks to both sides, preferably at the time of the injury immediately, so as to avoid false positives.

② drawer test. Is to check whether cruciate ligament after relaxation method.

③ McNamara test. Knee meniscus injury is to check the method.

Knee injuries how do? Yao injured - from the knee injury and treatment of orthopedic Network

On December 23, 2006, the Chinese NBA star Yao Ming of concern in the Department of the NBA game right knee injury accidents. At that time, Yao Department were strongly impact right knee, pain keen on the floor for five minutes long can not stand up. It is reported that Yao right knee Department of a “fracture” or at least needed a break six weeks to restore competition.

Yao injured We are concerned about the same time, need to understand what is fracture? Knee injuries can be caused those injuries? How injured joints should be done?

Fracture is the fracture, from X-chip fracture line can be seen, but they do not shift. Such fractures often occur in the joints cancellous bone parts such as the wrist, hip and knee. These parts of fracture healing ability, and generally 4 after functional training can gradually resume.

In sports or everyday injured knee is the most easily one of the site. No muscles around the knee protection relies entirely on the joint capsule, ligaments and a half months板起protecting and stabilizing role. Therefore, the knee injury can cause fractures, ligament and meniscus injury.

Then, after knee injuries should be how do? If serious injury, severe pain, swelling or a joint rapid blood stasis, or activities should be avoided as far as possible to stand trial, so as not to add to injury. If there is a fracture, standing, walking will add fracture displacement. After the wound bleeding injuries to use clean towels, paper towels or other items to protect the wound. Two legs and has to be homogeneous, used clothing or towels tied together, can be avoided on the way to hospital and cause further damage and can reduce pain. Or should call the ambulance stretcher to the hospital for an examination as soon as possible, confirmed. A medical examination only if gypsum fracture can be fixed. If the fracture is displaced fracture or ligament, meniscus injury generally require surgical treatment.

Lateral collateral ligament knee injury treatment

1. Fresh collateral ligament injury

(1) of the knee fracture will be placed in 150 ~ 160 ° flexion, with the long legs of cast immobilization (not including foot and ankle), a week after walking with gypsum Shimoji, 4 to 6 weeks after the removal of fixed knee flexion and extension exercises, training attention quadriceps.

If the merger with cruciate ligament injury, should first repair cruciate ligament, and then repair collateral ligament; If the merger meniscus injury, should first resection meniscus injury, and then repair the ligament damage.

2. Old lateral collateral ligament rupture

Quadriceps Exercise should be strengthened, so as to enhance the stability of the knee, such as the knee is unstable and can be used for the adjacent site tendon ligament reconstruction. Recently there have been reports carbon fiber used as collateral ligament reconstruction materials, achieved satisfactory results.

3. Anterior cruciate ligament injury: Where dissatisfied with the two weeks of anterior cruciate ligament surgery for fracture should be sutured. Arthroscopic currently stands suture of doing ligament.

4. Posterior cruciate ligament injury: current views biased in favor early in arthroscopic repair.

C-type femoral condylar fracture treatment

According to the Department of comminuted fracture of femoral condyle AO classified as C-type, often non-surgical treatment of malunion, ankylosis, surgical treatment for severe crush fractures, bone defects and more difficult. In our hospital since 1993, 38 cases of femoral condylar fracture type C treatment efficacy satisfied with the report are as follows:

1 clinical data

General information on the group 1.1 male 35 cases, three cases of women, aged 19 to 66 years old, with an average age of 42.5. Right 12 cases, 26 cases left. Injury reasons: traffic accident injury 20 cases, 14 cases of falling injuries, weights injured four cases. Fracture Classification and Mergers injury: All of fresh fractures, open fractures six cases, 32 cases closed fracture. C1 fracture of 18 cases, 12 cases of fracture of the C2, C3 fracture eight cases. Six cases of patellar fracture merger, the cruciate ligament injury two cases, one case of meniscus injury.

1.2 fixation methods (1) “L” plate + cancellous bone screws; (2) cancellous bone screw or bolt + rectangular nail; (3) cancellous bone screws + wire. Surgery points, with the exception of open fractures emergency surgery, while experts have surgery in a week: ① anterolateral incision general use should be fully exposed and outside the femur distal femoral condyle and to reset under direct vision and restore the integrity of anatomy. ② should cartilage defect repair. ③ should first restoration femoral condylar fracture block. ④ choice of the “L” - shaped plate fixed before, and by the distal femoral condyle cortical shape, the “L” plate for molding, following in the lateral femoral condyle from the articular surface of the 1.5 to 2 cm diameter of 4 mm by bit. Knee axis parallel to the drill 2-4 hole. Then bone knife cutting groove, into the “L” plate. To prevent separation between the hammer at the condyle, ahead of the plate before cancellous bone screw fixation condylar fracture block. ⑤ if firms rectangular nail, the first two with cancellous bone screw fixation femoral condyle and outside, and then inside and outside the femoral condyles were good blow to the pre-selected rectangular nails. Under open reduction and good after-fracture fixation, double-nail at the same time slowly upward into, filling nail blow to the nearly pack-marrow, such as marrow, less firmly fixed, the same road again with the original nails into a rectangular nails. ⑥ For more smash-fracture, that is unable to use the “L” plate, they can not use rectangular nails, then reset good, with several cancellous bone screws, wire, plaster after entrusted fixed. ⑦ postoperative adhesions in order to prevent quadriceps and knee infection, we conventional suction drainage device implantation, after 24 to 72 hours for removal.

2 Results

Early postoperative X-ray showed fractures reach nearly anatomic reduction or anatomical reduction to 34 cases, 4 cases of pre-curved plate in the femoral condyle, and the junction of radians enough, resulting in the femoral condyles and the relative bias. Follow-up of 10 to 62 months, with an average 22 months without a wound infection and osteomyelitis, all bone healing, functional recovery reference Neer [1] score standards, gifted 15 cases, good in 19 cases, three cases, one case of poor, the excellent and good rate 89.5%.

3 discussion

3.1 prevention or mitigation we believe that the incidence of complications in dealing with such fractures, to the following points, can play in preventing or slowing arthritis and osteoarthritis of the knee joint dysfunction: (1) Static restoration of the knee and dynamic stability in the handling of femoral condylar fracture, due the possibility of resuming femoral condyle physiological anatomy of integrity, and completed all the knee ligament injury repair. (2) should be the articular surface repair cartilage damage and fracture reduction and good is as important as the status of some of the rupture did not completely free set off the articular cartilage, be restored formation, after the fracture fixation, these new cartilage surface coverage, and to give fixed. (3) The importance of early functional exercise.

3.2 selecting suitable fixation because of femoral condylar fractures are unstable, often three-dimensional nature of intra-articular fractures, coronal, sagittal, axial have fracture, internal fixation difficult and the knee muscle groups through the powerful, multi-forward displacement fracture proximal, distal backward shift . Therefore shall first consider the implant of choice to obtain and maintain anatomical reduction for early functional exercise. C-type femoral condylar fracture treatment should be the first choice “L” plate because it is a piece of the overall materials, its fixed-strong, three-dimensional planar maintain reduction in general without external fixation, and early activities to meet the needs of the knee, there are 34 cases in this group use the “L” plate + cancellous bone screws . But for serious C crush fractures, “L” plate can not be firmly fixed condylar, clinical application, we cancellous bone screws 1 ~ 3 condylar fixed internal and external, will be complex condylar fracture into a condylar fracture, but also can be used more nail root rectangular cross-fixed, the group has three cases. As for femoral shaft oblique, spiral-shaped fracture of the elderly patients, we just wire tied, cancellous bone screw fixation, one case of this group, of the 65-year-old patients, postoperative care for gypsum fixed. For serious bone defects caused by the crushing impact of the bone healing patients, we give autologous iliac bone grafting, with a view to a healing fracture, a serious crush on the case, while shortening supracondylar area, but not more than 2 cm principle. Fragments of bone were filled to the healing.

Treatment of femoral condylar fracture

No transfer or mildly displaced femoral condylar fractures, intra-articular plot extract blood pressure bandaging. Entrusted with traction or gypsum fixed 4 to 6 weeks after knee activities.

Along with internal fixation devices continue to improve, so that more complex femoral condylar fractures, can also be more reliable internal fixation, the current treatment in the general trend, tend to surgery.

In addition to general surgery indications of intra-articular, bone fractures adjacent to the total, are in this position the following situations.

Merger ligament or meniscus injury, severe vascular nerve injury, and fractures of free blocks, bad blood supply.

Internal fixation methods are as follows:

(1) Steel plate angle was 95 ° angle, the fracture site can guarantee stability.

(B) including specialized plate screws for femoral condyle fracture plate screws and artificial bending it after the femoral condyle and in line ordinary plate. Characterized by a strong adaptability, easy to use simple. But in the plate and screws connecting parts easy to loosen, or even fracture, fracture is difficult to guarantee the stability of the site, with plaster frequently fixed at the same time. To overcome these shortcomings, it has designed a new type of plate screws. In addition to “AO” T-plate, such distal plate width, and a number of Screw Hole so that the screws from the front or rear hole into bone, fixed femoral condyle.

(C) The screw, bolt, screw.

(4) Needle Steinmann pin fixation in the bone mass can be no serious cases smash application. Eiffel Tower needle can be used for femoral condylar fracture with supracondylar fracture cases.