KNEE INJURIES The knee is inherently an unstable

KNEE INJURIES. The knee is inherently an unstable joint. Basically formed by almost flat tibial plat eaus and semicircular femoral condyles. The stability is maintained by soft tissues ; extraand intracapsular ligaments. • It is no surprise that they are so often injured or dislocated. • Injuries can be soft tissue , bony or the combination. • • 1

BONY INJURIES OR #’S. • Supracondylar fractures ; already covered. • Fracture-separation of the distal femoral epiphysis ; caused by severe trauma. S-H II of the distal femur. Childhood and adolescent injury. May cause vascular injury. Late complication; growth disturbances / deformity. 2

Bony injuries……. . • May be caused by direct fall / fall from a height. • May involve one or both condyles. • Exclude nerve and/ vascular injury. • TREATMENT; depends on the displacement. Minimally displaced #’s can be managed conservatively. If displaced ; ORIF. 3

¥TIBIAL PLATEAU #’S. • Caused by valgus/varus force combined with axial force. • One of both plateaus can be fractured. • The # can be a split , depression or both. • Any fracture around the knee has a potential for neuro-vascular injuries. • The aim of treatment follows the principle of intra-articular fractures. • Complications ; early; C/S. Late ; joint stiffness, deformity and Osteo-Arthritis. 4

FACTURED TIBIAL SPINE. • Caused by severe varus/valgus s 5 tress or twisting injuries. • May damage knee ligaments as well. • Commonly affects young adults or children • Treatment depends on the extend of displacement. • C/R OR ORIF. 5

Fracture-separation of the proximal tibial epiphysis. ü Uncommon injury. ü Caused by a severe hyperextension and valgus strain. ü Commonly S-H II INJRY. ü Treatment : C/R OR ORIF. ü Complications : growth disturbance and/or angular deformity. 6

Fracture of the patella. o May be caused by indirect or direct force. o The fracture can be undisplaced or displaced. o It can be a simple transverse fracture or very communited (stellate). o Treatment : The key to the management of patellar # is the state of the extensor mechanism. 7

Ligamentous injuries. The ligaments are injured when the knee is flexed, the capsule relaxed and permitting rotation. The important point is that a dislocation can easily occur. The dislocation is commonly missed because it might have reduced spontaneously. Always exclude knee dislocation. The dislocation can be anterior , posterior , medial or lateral. It may also be a combination ; postero-lateral dislocation. Treatment ; operative or conservative. 8