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Abstract: Patellar fractures are mostly seen in middle-aged and middle-aged patients, among which transverse patellar fractures are more common. In this case, the patient accidentally tripped and fell during walking, and in order to prevent knee injury, the patient took the initiative to exert force, and the patellar fracture actually occurred accidentally before kneeling down, and the separation of the fracture end was obvious, which was confirmed by X-ray examination. After admission, surgical treatment + cold compress + rehabilitation therapy was used to reset the fracture end, and the knee pain was relieved and The fracture was repositioned and the knee pain was relieved and the range of motion was restored.
Basic information】Male, 48 years old
Type of disease】Patellar fracture
Hospital】Harbin First Hospital
Date of Consultation】October 2021
Treatment plan】Surgical treatment (incision and internal fixation) + cold compresses + rehabilitation (passive knee flexion and extension activities)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Results】Fracture repositioned and fixed, pain relieved, knee joint activity resumed
I. Initial consultation
The patient was 48-year-old Mr. Qian, who tripped and fell while walking. In order to prevent his knee from landing on the ground and causing injury, the patient took the initiative to force the quadriceps muscle before kneeling down, and the strong contraction of the quadriceps muscle caused a patellar fracture, so he came to the hospital. The X-ray revealed a transverse fracture and significant separation of the patella, and the patient was confirmed to have a patellar fracture by physical examination and imaging examination. In order to restore the integrity and continuity of the patella and to protect the function of the knee joint, after communication with the patient, he was admitted to the hospital for incision and internal fixation surgery to prevent traumatic arthritis and to ensure early rehabilitation of the knee joint to avoid complications such as stiffness of the knee joint. Before surgery, the patient was given a cold compress to reduce the swelling in time to minimize complications after the surgery and to facilitate the smooth operation.
II. Treatment history
During surgery, it was found that the fracture end of the patella was clearly separated and there was hematoma formation at the fracture end, and the fascial tissue in front of the patella was embedded in the fracture end. After clearing the soft tissue and hematoma of the fracture end, the patellar fracture end was repositioned, and the patella was looped around the patella with absorbable thread, and the patella was kept relatively stable after tightening the sutures. After the surgery, the knee was fixed with a local brace and treated with continuous cold compresses. When the swelling of the knee joint was relieved, passive knee flexion and extension activities were started to prevent knee adhesions and restore the range of motion of the knee joint.
III. Treatment effect
Through surgical treatment, the patellar fracture site was firmly fixed to ensure a normal patellofemoral joint gap and to restore the flatness of the patellofemoral joint surface, which facilitated the restoration of knee flexion and extension range of motion. After 7 days of hospitalization, the patient could complete passive knee flexion and extension activities with the help of the rehabilitation physician, and turning in bed did not induce painful symptoms, and no clinical manifestations such as knee stiffness occurred after surgery.
IV. Notes
However, the patient should be advised that after internal fixation of the patella fracture, it is necessary to ensure the continued stability of the fracture end and gradually increase the range of knee flexion and extension, so that fracture healing and knee function recovery can proceed simultaneously. After the patient is discharged from the hospital, the rehabilitation process should follow the principle of gradual progress, avoiding excessive intensity and violent rehabilitation, which can displace the fractured end of the patella and cause severe traumatic arthritis, affecting knee joint activities and knee joint weight bearing. Before the fracture is completely healed, the knee joint is prone to recurrent swelling and can be accompanied by intermittent pain, which can be completely relieved by taking cold ice packs and resting properly, but can still insist on continuing rehabilitation training.
V. Personal insight
The patellofemoral joint can be damaged after a patella fracture, and the function of the patellofemoral joint plays an extremely important role in human movement, therefore, after a patella fracture, the patient should be seen as soon as possible to restore the flatness of the patellofemoral joint in a timely manner. For the patient in this case, prompt medical consultation and fixation with a tension band after the fracture occurred can ensure the stability of the fracture end as well as facilitate postoperative rehabilitation training. In daily life, patients should avoid sudden quadriceps force, while they can exercise appropriately and get more sunlight to promote calcium absorption, which can strengthen the bone strength to some extent, avoid osteoporosis and prevent patellar fracture.