Fractures around the knee for connect Physio Newcastle
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Fractures around the knee for connect Physio Newcastle
- 1. 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
- 2. Prof Deiary Kader Plan Knee Osteonecrosis Fracture around the Knee Advances in ACL Surgery Advances in PFJ instability PCL & PLC 2
- 3. Prof Deiary Kader Nuffield Hospital/Newcastle ICRC 2015 QEH Gateshead 2005-2015 3 QEH Gateshead Health
- 4. Prof Deiary Kader Knee Osteonecrosis (ON) Spontaneous ON (SONK) Secondary ON Post-arthroscopic ON 4
- 5. 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
- 6. 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
- 7. 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
- 8. 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)
- 9. 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
- 10. 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
- 11. Prof Deiary Kader Secondary Osteonecrosis Subchonrdal 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
- 12. 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
- 13. Prof Deiary Kader 13
- 14. 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 14
- 15. 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.
- 16. Prof Deiary Kader Hoffa Fracture
- 17. 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
- 19. Prof Deiary Kader Sleeve Fracture Patella
- 20. Prof Deiary Kader Sleeve fracture occurs between the cartilage "sleeve" and main part of the ossific nucleus Age 8-12 20
- 21. Prof Deiary Kader 21 Patella Tendon Rupture
- 22. Prof Deiary Kader 22 ???????
- 23. Prof Deiary Kader 23
- 24. Prof Deiary Kader 24
- 25. POSTGRAD ORTH Deiary Kader ???????
- 26. Sigond Fracture pathognomonic of ACL Rupture
- 28. ???????
- 29. 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.
- 31. Treatment Casting in extension for type I Open reduction and internal fixation. Arthroscopic reduction and fixation Rarely ACL reconstruction is necessary
- 34. Prof Deiary Kader 34 Tibial Plateau Fractures
- 35. Prof Deiary Kader Tibial Plateau Fractures
- 37. Prof Deiary Kader Metastatic cancer
- 38. Prof Deiary Kader Only bone cyst