Knee Fractures (Strategies in Fracture Treatments)

✍ Scribed by Marc Hanschen (editor), Peter Biberthaler (editor), James P. Waddell (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 293
• Category: Library

✦ Synopsis

This book provides a complete overview of the various types of fractures around the knee. Each chapter addresses anatomical key features, surgical procedures, postoperative regimes and complication strategies. International knee experts discuss how to improve osteosynthesis techniques as well as pearls and pitfalls for each type of knee fracture. Current clinical outcomes are included throughout and the authors recommend their preferred therapeutic approach and salvage measures if required.

Knee Fractures isan essential, go-to resource for orthopaedic surgeons dealing with the total spectrum of simple and complex knee fractures in daily clinical practice.

✦ Table of Contents

Contents
List of Editors
List of Authors
1: Anatomy of the Knee
1.1 Anatomy of the Distal Femur
1.2 Anatomy of the Proximal Tibia
1.3 Anatomy of the Patella
1.4 Cartilage, Ligaments, Meniscus and Capsule of the Knee
1.4.1 Cartilage
1.4.2 Ligaments
1.4.2.1 Collateral Ligaments
1.4.2.2 Cruciate Ligaments
1.4.3 Meniscus
1.4.4 Capsule
1.5 Muscles, Nerves and Vessels of the Knee
1.5.1 Muscles
1.5.2 Vessels
1.5.3 Nerves
1.6 Functional Anatomy of the Knee
References
2: Imaging Following Knee Injury
2.1 Plain Imaging
2.1.1 Introduction
2.1.2 Technique
2.1.2.1 Standard Views
Knee Anteroposterior (AP) View
Knee Lateral
2.1.2.2 Additionals
Patella Axial View
Tunnel View
Oblique (Internal or External Rotation)
2.1.3 Examples and Catches to Avoid
2.2 Special Imaging
2.2.1 Introduction
2.2.2 Imaging Modalities
2.2.2.1 Computed Tomography (CT)
2.2.2.2 Magnetic Resonance Imaging (MRI)
2.2.2.3 Ultrasound
2.2.2.4 Arthrography
2.2.3 Summary
References
3: Epidemiology and Classification of Distal Femur Fractures
3.1 Epidemiology of Distal Femur Fractures
3.1.1 Distal Femur Fractures in the Elderly and Super-Elderly
3.1.2 Distal Femur Fractures in the Younger Adult Population
3.1.3 Pediatric Distal Femur Fractures
3.2 Classification
3.2.1 Classification of Fracture Pattern
3.2.1.1 Neer Classification
3.2.1.2 Seinsheimer Classification
3.2.1.3 AO/OTA Classification of Distal Femur Fractures
3.2.2 Classification of Soft Tissue Damage
3.2.2.1 Tscherne and Oestern Classification
3.2.2.2 Gustilo and Anderson Classification
3.2.3 Classification of Periprosthetic Fractures
3.2.3.1 Rorabeck Classification
3.2.3.2 Unified Classification System
3.2.4 Classification of Pediatric Fractures
3.2.4.1 Salter-Harris Classification for Distal Femoral Epiphyseal Fractures
3.2.4.2 AO Pediatric Comprehensive Classification of Long-Bone Fractures
3.3 Concomitant Injuries in High-Energy Trauma
3.3.1 Ipsilateral Injuries
3.3.2 Injuries in Other Body Regions
References
4: Preoperative Planning in Distal Femur Fractures
4.1 Conservative Versus Surgical Treatment
4.1.1 Periprosthetic Fractures of the Distal Femur
4.2 Timing of Surgical Treatment
4.3 Preoperative Planning
4.3.1 Planning for Intramedullary Nailing of Distal Femoral Fractures
4.3.2 Planning for Intramedullary Nailing of Periprosthetic Distal Femoral Fractures
4.3.3 Planning for Internal Fixation of Distal Femoral Fractures
4.3.4 Planning for Internal Fixation of Periprosthetic Distal Femoral Fractures
4.3.5 Planning for Revision Arthroplasty of Periprosthetic Distal Femoral Fractures
References
5: External Fixation of Distal Femur Fractures
5.1 Indications
5.2 Surgical Approach
5.2.1 Site of Placement of Schanz Screws
5.2.2 Angle of Placement
5.2.3 Plane of Placement
5.3 Case ‘External Fixation of Distal Femur Fractures’
References
6: Nail Osteosynthesis of Distal Femur Fractures
6.1 Introduction
6.2 Indications
6.3 Antegrade vs Retrograde Nailing
6.4 Retrograde Nailing Versus Locked Plating of Distal Femur Fractures
6.5 Surgical Approaches and Reduction Techniques
6.5.1 Reduction and Nail Insertion (Extra-articular Fractures)
6.5.2 Reduction and Nail Insertion (Intra-articular Fractures)
6.6 Postoperative Treatment
6.7 Conclusions
References
7: Plate and Screw Osteosynthesis of Distal Femur Fractures
7.1 Indications for Plate and Screw Fixation of Distal Femur Fractures
7.2 Choice of Implants for the Plate and Screw Fixation of Distal Femur Fractures
7.2.1 Conventional Plate Fixation
7.2.2 Fixed-Angle Plate Fixation
7.2.3 Locked Plate Fixation
7.3 Surgical Approaches to the Distal Femur for Plate and Screw Fixation
7.3.1 Lateral Approach
7.3.2 Medial Approach
7.3.3 Posterior Approach
7.4 Postoperative Course and Follow-Up After Plate and Screw Fixation of Distal Femur Fractures
7.5 Clinical Case: Plate and Screw Fixation of a Distal Femur Fracture
References
8: Epidemiology and Classification of Proximal Tibia Fractures
8.1 Introduction
8.2 Epidemiology of Proximal Tibia Fractures
8.3 Patterns and Classification of Proximal Tibia Fractures
8.3.1 Schatzker Classification [Ref. 9 and Fig. 8.1]
8.3.2 AO/OTA Classification [Ref. 10 and Fig. 8.2]
8.3.3 The Three-Column Classification [Ref. 11, 12 and Fig. 8.3]
8.4 Concomitant Injuries and Classification of Open Fractures of the Proximal Tibia
8.4.1 Concomitant Injuries
8.4.2 Classification of Open Fractures of the Proximal Tibia
8.4.2.1 Take-Home Message
References
9: Preoperative Planning in Proximal Tibia Fractures
9.1 Conservative Versus Surgical Treatment
9.2 Timing of Surgical Treatment
9.3 Pre- and Perioperative Procedure
References
10: External Fixation of Proximal Tibia Fractures
10.1 Indications
10.2 Surgical Approach
10.2.1 Fixateur Externe
10.2.2 Hybrid Fixator
10.2.3 Motion Fixator
10.2.4 Ring Fixator
10.3 Case: External Fixation of Proximal Tibia Fractures
References
11: Nail Osteosynthesis of Proximal Tibia Fractures
11.1 Indications
11.2 Surgical Approach
11.2.1 Preoperative Planning, Equipment, and Patient Positioning
11.2.2 Approach and Nail Entry Point
11.2.3 Fracture Reduction
11.2.4 Reaming Process
11.2.5 Additional Fixation Tools
11.3 Subsequent Treatment and Follow-Up
11.4 Case: Reamed Intramedullary Nailing of Proximal Tibia Fractures (Figs. 11.1, 11.2 and 11.3)
References
12: Plate and Screw Osteosynthesis of Proximal Tibia Fractures
12.1 Principal Considerations
12.2 Therapeutic Plan
12.3 Approaches
12.4 Placement
12.5 Reduction
12.6 Conclusion
References
13: Epidemiology and Classification of Patella Fractures
13.1 Anatomy and Biomechanics
13.2 Etiology and Epidemiology of Patella Fractures
13.3 Fracture Patterns and Classification of Patella Fractures
13.4 Concomitant Injuries and Open Fractures of the Patella
References
14: Preoperative Planning in Patella Fractures
14.1 Conservative Versus Surgical Treatment
14.2 Timing of Surgical Treatment
14.3 Preoperative Planning
References
15: Wire, Screw and Plate Osteosynthesis of Patella Fractures
15.1 Introduction
15.2 Surgical Approach
15.3 Osteosynthesis Procedures
15.3.1 K-Wires and Tension Wiring
15.3.2 Screw Osteosynthesis
15.3.3 Plate Osteosynthesis
15.4 Augmentation Techniques
15.4.1 Alternative Materials for Cerclages and Tension Wiring
15.5 Partial Patellectomy and Total Patellectomy
15.6 Therapeutic Algorithm
15.7 Aftercare
15.8 Case Reports
15.8.1 Case 1
15.8.2 Case 2
References
16: Periprosthetic Fractures Around the Knee
16.1 Epidemiology
16.2 Clinical Work-Up Following Periprosthetic Fractures Around the Knee
16.3 Classification of Periprosthetic Fractures Around the Knee
16.4 Therapy of Periprosthetic Fractures of the Distal Femur
16.5 Therapy of Periprosthetic Fractures of the Proximal Tibia
16.6 Therapy of Periprosthetic Fractures of the Patella
16.7 Risk Factors for Failure of Osteosynthesis Following Periprosthetic Fractures Around the Knee
16.8 Case Report
References
17: Floating Knee
17.1 Introduction
17.2 Epidemiology
17.3 Classification
17.4 Outcome Measures
17.5 Emergency Management
17.6 Definitive Surgical Management
17.7 Fraser Type 1: Ipsilateral Femoral and Tibial Shaft Fractures
17.8 Fraser Type II (a-c): Intra-articular Fracture Patterns
17.9 Associated Intra-articular Soft Tissue Injuries
17.10 Predictors of Outcome
17.11 Case Study 1
17.12 Case Study 2
17.13 Conclusion
References
18: Infected Nonunions Around the Knee
18.1 Evaluation of the Problem
18.1.1 Introduction
18.1.2 Risk Factors and Epidemiology of Infected Nonunion
18.1.3 Patient Factors
18.1.4 Pathophysiology of Fracture-Related Infection
18.1.5 Duration of Infection
18.2 Preoperative Planning
18.2.1 Diagnosis
18.2.2 Clinical Presentation
18.2.3 Laboratory Tests
18.2.4 Imaging
18.2.4.1 Plain Radiographs
18.2.4.2 Ultrasonography
18.2.4.3 Computer Tomography
18.2.4.4 Magnetic Resonance Imaging
18.2.4.5 Nuclear Imaging
18.2.5 Microbiological and Histological Diagnosis
18.2.6 Classification of Infected Nonunion
18.3 Infection and Reconstruction Management
18.3.1 General Principles of Management
18.3.2 Particular Challenges Faced in Infected Nonunion Around the Knee
18.3.3 Timing of Surgery in Established Infected Nonunion
18.3.4 Principles of Surgical Management of Infected Nonunion
18.3.4.1 Microbiological Sampling
18.3.4.2 Debridement
18.3.4.3 Dead Space Management
18.3.4.4 Stability
External Fixation
Internal Fixation
18.3.4.5 Soft-Tissue Cover
18.3.4.6 Systemic Antibiotic Therapy
18.3.5 Specific Surgical Techniques for Managing Bone Defects in Infected Nonunion
18.3.5.1 Ilizarov Reconstruction
18.3.5.2 Free Vascularised Fibula Transfer
18.3.5.3 The Induced Membrane Technique
18.3.5.4 The Papineau Technique
18.3.6 When to Consider Endoprosthetic Replacement
18.3.7 Knee Arthrodesis vs. Above Knee Amputation
18.3.8 Conclusion
References
19: Non-infected Nonunions and Malunions Around the Knee
19.1 Evaluation of the Problem (Posttraumatic Axis Deviation)
19.1.1 History
19.1.2 Clinical Evaluation
19.1.3 Radiological Evaluation
19.2 Preoperative Planning
19.2.1 Deformity Analysis
19.3 Surgical Approaches and Osteotomies
19.3.1 Nonunion
19.3.2 Malunion
19.3.3 Osteotomy
19.3.4 Correction and Fixation
19.4 Case Example
References
20: Posttraumatic Bone Defects Around the Knee
20.1 Introduction
20.2 Bone Grafts
20.2.1 Autologous Bone Grafts
20.2.2 Allogeneic Bone Grafts
20.2.3 Xenografts
20.2.4 Synthetic Bone Grafts
20.3 Indications for Use of Bone Grafts
References
21: Management of Ligament Injuries Following Fractures Around the Knee
21.1 Epidemiology of Ligament Injuries Following Fractures Around the Knee
21.1.1 Peri-articular Fractures and Soft Tissue Injury
21.2 Clinical Assessment and Imaging
21.3 Meniscal Injury
21.4 Collateral Ligament Injury
21.5 Fibular Head Avulsion
21.6 Cruciate Ligament Injury
21.7 Anteromedial Plateau Fractures
21.8 Oblique Split Depression Fractures
References
22: Management of Chondral Injuries Following Fractures Around the Knee
22.1 Management of Osteochondral Fractures
22.2 Management of Chondral Lesions
22.2.1 Microfracturing
22.2.2 OAT
22.2.3 ACT (Autologous Chondrocyte Transplantation)
22.2.4 Treatment Recommendation for Cartilage Defects
22.3 Case Report Management of Chondral Injuries Following Fractures Around the Knee
References
23: Challenges in Geriatric Patients with Fractures Around the Knee
23.1 Identification of Seniors at Risk
23.2 Challenges in Orthogeriatric Patients
23.3 Treatment Pathways and Goal Setting
23.4 Pre-/Perioperative Medical Management and Anaesthetic Assessment
23.5 Surgical Decision-Making and Treatment Strategies
23.5.1 Fractures of the Distal Femur
23.5.2 Proximal Tibial Fractures
23.5.3 Postoperative Management and Rehabilitation
23.6 Secondary Fracture Prevention
References
24: Juvenile Fractures Around the Knee
24.1 Distal Femoral Physeal/Epiphyseal Fractures
24.1.1 Epidemiology
24.1.2 Classification, Associated Injuries and Workup
24.1.2.1 Classification
24.1.2.2 Associated Injury
24.1.2.3 Signs and Symptoms
24.1.2.4 Imaging
24.1.3 Treatment
24.1.4 Effect on Growth
24.2 Proximal Tibia Epiphyseal/Physeal Fractures
24.2.1 Epidemiology
24.2.2 Classification, Associated Injuries and Workup
24.2.2.1 Classification
24.2.2.2 Associated Injuries
24.2.2.3 Signs and Symptoms
24.2.2.4 Imaging
24.2.3 Treatment
24.2.4 Effect on Growth
24.3 Tibial Tubercle Fractures
24.3.1 Epidemiology
24.3.2 Classification, Associated Injuries and Workup
24.3.2.1 Classification
24.3.2.2 Associated Injuries
24.3.2.3 Imaging
24.3.3 Treatment
24.3.4 Effect on Growth
24.4 Tibial Spine/Eminence Fractures
24.4.1 Epidemiology
24.4.2 Classification, Associated Injuries and Workup
24.4.2.1 Classification
24.4.2.2 Associated Injuries
24.4.2.3 Signs and Symptoms
24.4.2.4 Imaging
24.4.3 Treatment
24.4.4 Effect on Growth
24.5 Patellar and Patellar Sleeve Fractures
24.5.1 Epidemiology
24.5.2 Classification, Associated Injuries and Workup
24.5.2.1 Classification
24.5.2.2 Associated Injuries
24.5.2.3 Signs and Symptoms
24.5.2.4 Imaging
24.5.3 Treatment
24.5.4 Effect of Growth
24.6 Osteochondral Fractures
24.6.1 Epidemiology
24.6.2 Classification, Associated Injuries and Workup
24.6.2.1 Classification
24.6.2.2 Associated Injuries
24.6.2.3 Signs and Symptoms
24.6.2.4 Imaging
24.6.3 Treatment
24.6.4 Effect on Growth
References
25: Management of Nerve Injury in Knee Trauma
25.1 Introduction
25.2 Neuroanatomy
25.3 Diagnostics
25.3.1 Clinical Examination
25.3.2 Electrophysiology
25.3.3 Imaging
25.3.4 Classification
25.4 Type of Nerve Injuries
25.4.1 Peroneal Nerve
25.4.2 Tibial Nerve
25.5 Management of Nerve Injury in Knee Trauma
25.6 Case
25.7 Conclusion
References
26: Management of Vascular Injury in Knee Trauma
26.1 Introduction
26.2 Anatomical Considerations
26.3 Pathology of Popliteal Vessels
26.4 Diagnostic
26.5 Clinical Picture
26.6 Management of Popliteal Vessel Injuries
References
27: Postoperative rehabilitation following fractures around the knee
27.1 Basic Principles of Rehabilitation
27.2 Functionality of the Knee Joint and Its Role in Rehabilitation
27.3 Recording of Findings and Documentation
27.3.1 Inspection
27.3.2 Assessment of the Range of Motion
27.3.2.1 Neutral Zero Method
27.3.3 Palpation
27.3.4 Assessment of Instabilities
27.3.5 Muscle Function Test
27.3.5.1 Assessment of Muscle Strength
27.3.5.2 Functional Testing
27.3.6 Neurological Status
27.3.6.1 Femoral Nerve
27.3.6.2 Sciatic Nerve
27.4 Therapeutic Regimens Overview
27.5 General Therapeutic Measures
27.5.1 Positioning and Orthosis
27.5.2 Analgesia
27.5.3 Cooling Applications
27.5.4 Heat Applications
27.5.5 Massages
27.5.5.1 Manual Lymphatic Drainage
27.5.5.2 Scar Massage
27.5.5.3 Traditional Massage
27.5.6 Electrotherapy
27.5.6.1 TENS
27.5.6.2 EMS
27.5.6.3 Iontophoresis
27.5.6.4 Ultrasound
27.6 Structure of Joint Mobilization
27.7 Acute and Early Stage
27.7.1 Motorized Exercise Splint
27.8 Early Mobilization
27.8.1 Transition to Active Movement
27.8.2 Exercise with the Body Weight and PNF
27.8.3 Orthopedic Manipulative Therapy (OMT)
27.9 Building Phase and Return Activities of Daily Living
27.9.1 Medical Training Therapy/Physiotherapy with Devices
27.10 Load Stability with Return to Work and Sportive Activities
27.10.1 Homework for Patients
27.10.1.1 Examples for Exercises in the Acute Phase
27.10.1.2 Examples for the Phase of Load Stability
27.10.1.3 Examples for Building Stability
27.10.1.4 Important Questions and Issues for Everyday Life
References