fractures around the knee for connect physio newcastle
TRANSCRIPT
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Professor Deiary F Kader Department of Sport, Exercise, Northumbria University, Newcastle
www.oasir.co.uk
Knee Surgeon, Nuffield Hospital, Newcastle upon Tyne
FRACTURES AROUND THE KNEE – CLINICAL PATTERN RECOGNITION AND
APPROPRIATE ACTION PLANNING
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Prof Deiary Kader
Plan Knee Osteonecrosis Fracture around the Knee Advances in ACL Surgery Advances in PFJ instability PCL & PLC
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Prof Deiary Kader
Nuffield Hospital/NewcastleICRC 2015
QEH Gateshead 2005-2015
QEHGateshead Health
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Prof Deiary Kader
Knee Osteonecrosis (ON)
Spontaneous ON (SONK)
Secondary ON
Post-arthroscopic ON
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Prof Deiary Kader
Spontaneous Osteonecrosis of the Knee (SONK)
Osteonecrosis without an identified cause. Females Middle age or elderly. Epiphysis of medial FC Lateral FC, Tibial plateau Almost always unilateral. Associated with meniscal root tear May represent a subchondral insufficiency /
stress fracture
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Prof Deiary Kader
Clinical Presentation:
Sudden onset of severe knee pain (usually non-specific).
Can be focused over the medial femoral condyle
Decreased range of motion with no mechanical block
Effusion present in the acute stages Pain worse on activity
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Prof Deiary Kader
Treatment : Non-operative:
Activity modification
Rest and non or partial weight bearing
Analgesia including NSAIDs
Targeted physiotherapy focusing in range of motion and quadriceps strengthening
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Prof Deiary Kader
Treatment Operative
Only after conservative Rx -success is variable.
Retrograde drilling a trial with an off-loader brace is
recommended pre-operatively High tibial osteotomy (if mal-
alignment present) Arthroplasty (in larger lesions and
bone collapse)
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Prof Deiary Kader
Outcome of SONK
Small, isolated lesions often regress and heal
Medium-sized lesions may regress
Very large lesions, subchondral collapse will occur, regardless of treatment
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Prof Deiary Kader
Insufficiency Fractures of the MFC
Predominance in elderly women Osteoporotic bone Varus knee Obesity Trivial trauma Mechanical pain Increased radionuclide uptake. Rest and analgesics consistently
ensured a better outcome within three to four weeks
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Prof Deiary Kader
Secondary OsteonecrosisSubchonrdal AVN
Often involves both femoral condyles Multiple lesions epiphysis, metaphysis,
diaphysis ne. Typically younger than 45 years It is bilateral more than 80% Direct risk factors
Radiation Chemotherapy Corticosteroid Trauma. Sickle cell disease or other myeloproliferative
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Prof Deiary Kader
Treatment of secondary ON
Diagnosis at early stages Eliminate the causative factor if possible Nonsurgical treatment lead to poor
outcome Drill the lesions, may halt the
progression Supplement the drilling technique with
Bone morphogenetic protein Growth factors MSC
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Prof Deiary Kader
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Prof Deiary Kader
General causes of osteonecrosis include:
• TRAUMA
• CAISSON DISEASE
• HAEMOGLOBINOPATHIES SICKLE CELL DISEASE
• RADIOTHERAPY
• CONNECTIVE TISSUE DISORDERS
• RENAL TRANSPLANTAION
• CORTICOSTEROID EXCESS
• PANCREATITIS
• GOUT
• GAUCHER DISEASE
• ALCOHOL
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Prof Deiary Kader
Post-arthroscopic ON
Heat damage to the bone Trauma during surgery Lesions are typically only found in the
epiphysis. Patient age and sex is not a factor. Some of the associated risk factors include
meniscectomy, cartilage débridement, and ACL reconstruction.
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Prof Deiary Kader
Hoffa Fracture
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Prof Deiary Kader
Isolated femoral condylar fractures in the coronal plane
Direct anteroposterior force applied to a flexed knee in a high-energy accident
Hoffa described the injury in 1904 as generally involving the lateral femoral condyle
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Prof Deiary Kader
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Prof Deiary Kader
Sleeve Fracture Patella
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Prof Deiary Kader
Sleeve fracture occurs between the cartilage "sleeve" and main part of the ossific nucleus Age 8-12
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Prof Deiary Kader
Patella Tendon Rupture
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Prof Deiary Kader
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Prof Deiary Kader
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Prof Deiary Kader
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POSTGRAD ORTH Deiary Kader
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Sigond Fracturepathognomonic of ACL Rupture
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Tibial Eminence Fracture
Meyers and McKeever classification (1959)
Type I: non displaced
Type II: partially displaced or hinged
Type III: completely displaced (Type III)
Type IIIA (Zifko) involves the ACL insertion
Type IIIB (Zifko) includes the entire intercondylar eminence.
Type IV (Zaricznyj 1977): comminution of the fracture fragment.
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Treatment
• Casting in extension for type I
• Open reduction and internal fixation.
• Arthroscopic reduction and fixation
• Rarely ACL reconstruction is necessary
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Prof Deiary Kader
TP???????
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Prof Deiary Kader
TP
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Prof Deiary Kader
Tibial Plateau Fractures
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Prof Deiary Kader
Tibial Plateau Fractures
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Prof Deiary Kader
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Prof Deiary Kader
Metastatic cancer
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Prof Deiary Kader
Only bone cyst
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Prof Deiary Kader