A 54 year old male comes to the ER after RTA, on the day of injury. He has pain & swelling over the right leg. Co-morbidity- Renal stone.

Here are the pre-op & post op X-rays.

 

Let’s discuss the case here:

Q. What are the issues with this fixation? Which factors led to these issues during the fixation?

A. Fracture reduction is inadequate, Anatomical Articular fragment reduction is not achieved as advised in AO principles of fracture fixation. The incongruence of the knee joint in this patient will predispose it to early degenerative changes and early Osteoarthritis knee.

Adequate exposure and visualization of the articular surface is of prime importance in fixation of such fractures.

These fractures require pre-surgical planning in terms of approach required for accessing each fracture with adequate visualization of articular surface.

Some Surgeons advocate use of arthroscopy to visualize the articular continuity/reduction whereas other group prefer submeniscal arthrotomy for direct visualization of fracture reduction.

Selection of the implant is also important in case of Internal fixation is considered as wide variety of Proximal Tibial plates are available such as L shaped plates, L plates with curved Short limb, T shaped plates or anatomical plates.

These injuries are sometimes best treated with Illizarov Fixation system that allows Early mobilization, early restoration of functioning of the limb with minimal soft tissue damage.

Pre-plan the surgery in-terms of fixation system- Internal fixation/ external fixation. (read implant manual for ideal site of placement of plates)

Plan the necessary approach.

Plan for bone grafting if articular depression is not corrected/ Maintained after lifting the articular margin.

Always temporarily fix the reduction with K wires/ screw to prevent sagging of articular fragment and Visualize the articular congruity.

After confirming the fracture reduction the implant used for this scenario should be L plate instead of Anatomical Proximal tibial plate.

Lateral plate needs to be positioned slightly proximal and posterior in position to hold the posterior fragment.

Medial plate needs to be more posterior and slightly proximal or the fracture should have been adequately reduced and fixed with lag screw and posteromedial plate to be fixed in neutralization mode.

Knee Pain Relief : Non-Surgical Treatment

Knee is a largest and complex joint made of bone, cartilage and ligaments in the body. The function of cartilage is to keep the bones in the joint from rubbing together and it acts as a cushion and gliding surface in the knee. Causes of cartilage break down are injuries, aging and degenerative conditions in which the joints of bones make contact and cause pain. Symptoms of knee pain are redness, warmth, tenderness, swelling and pain. You should avoid high-impact exercises like running or playing tennis if you feel pain and swelling at your knee. Smoking is also harmful as it slows healing because it decreases blood supply and delays tissue repair. Compression or wrapping the injured or sore area with an elastic bandage also helps you in reducing knee pain.

Some Non-Surgical Treatments Which Helps You To Get Rid of Your Knee Pain:

1. Use of walking aids/assistive devices:

There are varieties of assistive devices that can help in managing knee pain; with the help of these devices you can perform certain function easily. With the help of cane or other walking aid you can protect your knee by putting excess stress on them.    Wheelchair is recommended when both knees are affected from arthritis. These walking aids should be recommended by your doctor. Doctors are happy to refer their patients about the assistive devices of GPC Medical Ltd. as it is the best name in India and world-wide which is ISO, WHO-GMP Certified with quality product and reasonable price.

2. By controlling weight with the help of exercise or physiotherapy:

With the help of exercise you can recover from the injury and decrease the pain you are experiencing. Regular and useful exercise can strengthen muscles in your knee, improve stability and flexibility and reduce pressure on the joint.

3. Knee bracing:

Knee braces are very helpful in controlling knee pain because it provides different level of support and fix to the knee in number of ways. Arthritis braces reduces the forces going through the arthritis part of the knee and it support, improve stability, and reduce pain of your knee and it also delays the need for surgery. These are also available at GPC Medical Limited you can order online.

4. Rest:

Rest plays an important role than medicine in knee or any type of orthopaedic pain. So it is good to take a break from any activity that is causing you pain or soreness. Try to keep the knee straight or in positions that limit bending and you can place a small pillow under your knee while resting.

5. Cold and heat therapy:

Cryotherapy and thermotherapy are rational, cheap self-treatment options with minimal risks for centuries. These are used today as standard medical treatment all over the world which works by stimulating your body’s own healing force. One should know the correct use of these therapies otherwise they cause problem rather than be helpful. You should avoid using hot packs, hot showers or alcoholic beverage for the first 48 hours of the injury as it might increase swelling. Once if swelling is gone after 48 to 72 hours, apply heat and start gentle exercise which help restore and maintain flexibility.

6. Use of medication and injection:

Aspirin, ibuprofen and naproxen are traditional pain relievers which provide temporary relief of arthritis pain. Analgesics like rubs and ointments can provide quick pain relief for people with arthritis. Cortisone injections helps in temporary relief but these must be used only by the recommendation of a physician as overdose may be harmful. These injections offer quick, effective pain relief but the more use of these injections results in weaken bone and cartilage.