The patella is the largest bone in the human body, triangular in shape, with the bottom edge on the top and the tip on the bottom, the back is covered with cartilage and in contact with the patellar surface of the femur, the quadriceps tendon connects the upper part of the patella and moves down along its front to form the patellar ligament, which ends at the tibial tuberosity, with the parapatellar tendon membrane on both sides, which is an important support belt of the knee joint. The patella is in front of the knee and is the main fulcrum of the knee extension of the quadriceps muscle, which protects the knee joint and enhances the strength of the quadriceps muscle.
Etiology and classification
Patellar fractures can be caused by direct or indirect violence, with indirect violence being the most common. In direct violence, the fracture is caused by direct blow to the patella or direct impact of the patella on the ground during the fall, and the fracture is mostly comminuted or stellate fracture with little displacement. Indirect violence is caused by a fall and damage to the knee mechanism, which can affect knee extension if not treated properly.
Patellar fractures can be divided into transverse fractures and comminuted fractures according to the fracture site and the direction of the fracture line.
Clinical manifestations and diagnosis
After the injury, the anterior part of the knee joint is swollen and protrudes, there is a large amount of blood in the joint, the anterior patella is bruised and battered under the skin, and even localized blisters occur, the knee joint function is lost, and the affected limb cannot be straightened and lifted on its own. The pain is severe and the pressure pain is obvious. In the case of transverse fractures, fracture fractures can be felt, and in the case of nondisplaced fractures, bone rubs can sometimes be palpated. Positive and lateral x-rays of the knee can clarify the type of fracture and displacement.
Treatment
1, conservative treatment.
2.Manual repositioning patellar graspers fixation method.
3.Wire percutaneous suturing method.
(1) wire percutaneous wrap-around suture method.
(2) Tension band suture of steel wire through the skin.
Complications
1, quadriceps atrophy or hypotonia.
2, bone discontinuity.
3.Traumatic arthritis.
Rehabilitation functional exercise (for surgical patients)
1.Early stage
(1) Ankle flexion and extension activities to promote blood circulation, subside swelling and prevent deep vein thrombosis.
(2) Isometric contraction exercises for quadriceps and N cord muscles.
2.2 days after surgery
(1) Active contraction training of the quadriceps muscle can be started. The patient lies flat on the bed and does isometric contraction of the thigh muscles with active static force, 100-500 times/d.
(2) The patient can walk on the floor with the help of crutches, but only for necessary activities such as going to the bathroom.
(3) Start side leg raising exercises.
(4) Back leg raising exercises.
(5) Use the apparatus, use the lower limb CPM, operate under the guidance of a professional rehabilitation doctor, start slowly with no or minimal pain angle, and apply ice for 10-15 minutes immediately after the exercise.
(6) Sitting on the side of the bed and hanging the leg, under the guidance of a professional rehabilitation doctor, the angle of movement is appropriate in a gradual manner.
The above exercises should be performed in sequence, with a slight improvement in the angle each time. Generally, the passive flexion angle of the knee joint should be exactly the same as that of the healthy leg 3 months after surgery. Too rapid a progression will affect the healing growth of the fracture. Pain during flexion exercises is normal and must be overcome. Fear of pain without progress in the first 2 weeks may result in joint adhesions. Therefore, it is necessary to gradually increase the flexion angle.
3.6 weeks-3 months after surgery
(1) With the increase of flexion angle, start to sit or lying knee hold practice flexion sitting leg hold.
(2) 4-6 weeks after surgery, start straight leg raising exercises (can also be practiced earlier). Slight pain at the patella is normal and should be tolerated.
(3) Leg hook exercises.
(4) Forward and backward, lateral straddle exercises.
(5) Heel lifting exercises.
(6) Balance trainer training to strengthen the recovery of proprioception.
(7) Strengthening training of the quadriceps.
4.After 3 months postoperative
Depending on the fracture healing situation, the training mode and intensity can be decided.
(1) Prone stretching.
(2) Full squat under protection.
(3) static squatting exercises, gradually increase the angle of squatting with the increase of strength.
(4) Single leg squat on the affected side.
(5) step down exercises.
(6) If available, you can start fixed bicycle exercises, no load to light load.
(7) Manipulative treatment by a professional rehabilitation doctor.