Trauma around the knee joint can involve the top of the shin bone (proximal tibia), the bottom part of the thigh bone (distal femur) or the knee cap (patella). Where someone has a knee replacement, fractures around the replacement joint (called peri-prosthetic fractures) are also common.
The severity of the fracture depends on the mode of injury with high energy trauma (e.g. a car accident) resulting in more severe injury than that caused by low energy trauma (e.g. a fall or slip when standing or walking), although age of the patient also determines when a bone may fracture, with older patients more prone to fractures from low energy trauma. This is often an insufficiency fracture as a result of osteoporosis.
Fractures of the distal femur or proximal tibia can be broadly divided into extra-articular (not involving the knee joint) or intra-articular (fracture extending into the knee joint).
High energy fractures are often severe injuries with long lasting consequences.
Most of these fractures require surgical fixation with plates and screws or intra-medullary nails – to regain limb alignment and length; restore the joint surface and enable early movement, exercises and weight bearing.
If the fracture is associated with severe swelling (very common with proximal tibial fractures or tibial plateau fractures), compartment syndrome or open wounds – a two stage procedure is often required. The first stage involves an external fixator and wound management. The second stage involves definitive fixation after swelling has settled and wounds have been managed.
These injuries often involve a period of protected weight-bearing and long period of physiotherapy. Return to work and activities depends on the severity of injury and individual recovery/healing.
Severe variants of these fractures need multi-disciplinary care involving the Orthopaedic surgeon, Plastic surgeon, physiotherapist, occupational therapist and wound-care nurse practitioner.
Dr Sunil P Reddy is an experienced Orthopaedic trauma surgeon who manages many of these injuries at the Lyell McEwin hospital. He treats trauma patients with private insurance cover at the Calvary Central Districts hospital and Ashford Hospital where appropriate.
Learn more about fractures around the knee – visit American academy of Orthopaedic Surgeons website.
GPs can call Dr Reddy at his Rooms on 08 8232 8899 or his mobile to discuss and refer trauma emergencies.