Patellar Fracture

　　Both direct and indirect violence can cause patellar fractures, among which indirect external force is more common. When falling forward, the knee joint suddenly flexes, and the quadriceps muscle has a strong reflexive contraction, causing the patella to be tensely pulled and fractured. The fractures caused by this kind of indirect external force are mostly transverse fractures, more common in the middle and lower part of the patella. Not only is the patellar anterior tenotomy completely torn, but the joint capsule on both sides of the fracture line is also torn to varying degrees; at the same time, due to the contraction of the quadriceps muscle, the two ends of the fracture are separated by a relatively long distance.

　　Direct violence is often caused by direct impact on the patella. The fracture is often comminuted or star-shaped. The patellar anterior tendon and joint capsule remain intact, so the fracture is often without displacement, and has little effect on the extension and flexion of the knee joint.

　　In addition, during the injury process, the muscles contract strongly, causing the patella to fracture. After falling, it is directly撞击 by external force, causing the fracture fragments to separate and resulting in mild comminuted fractures. This kind of injury is caused by the combined action of indirect and direct violence.

　　Patellar fractures are prone to limit the movement of the knee joint. In addition to the fracture itself, the adhesion and contraction of the surrounding soft tissues are also an important cause. Therefore, it is necessary to carry out Chinese medicine fumigation and washing, massage, and other local soft tissue treatments.

　　The patella is an important part of the knee joint and the largest sesamoid bone in the human body. Its role is more prominent in the extension of the knee. If the patellar fracture is not treated properly, it will seriously affect the movement of the knee joint and even cause lifelong disability. Patellar fractures often have complications. What are the complications of patellar fractures? The following introduces the complications of patellar fractures.

　　I. Early complications of patellar fracture:

　　1. Traumatic shock:

　　Severe femoral shaft fractures can lead to internal bleeding of 500 to 1000 milliliters or even more. Post-traumatic pain stimulation may cause shock in the early stage. The principle of treatment is to fix early to reduce internal bleeding, expand blood volume and relieve pain, and actively treat shock.

　　2. Crush syndrome:

　　Severe crush injury leading to femoral shaft fracture requires attention to the occurrence of crush syndrome. The principle of treatment is to prevent acute renal failure and hyperkalemia, and to give early and rapid fluid replacement, alkalinization of urine, diuresis, and relaxation of renal vascular spasm, etc., even performing fasciotomy decompression.

　　3. Vascular and nerve injury:

　　Fracture of the lower segment of the femoral shaft, when the fracture fragment moves backward, can injure the popliteal vein and sciatic nerve. The principle of treatment is to properly fix the fracture and avoid repeated movement of the affected limb.

　　4. Fat embolism syndrome:

　　The medullary cavity of the femoral shaft contains a large amount of yellow marrow with a high fat content, which can cause fat embolism syndrome after injury. The principle of treatment is to strictly immobilize the patient and avoid moving arbitrarily.

　　Second, late complications of patella fracture:

　　1. Fracture malunion:

　　It is divided into angular deformity, shortening deformity, and rotational deformity. The principle of treatment is that mild shortening in children can be corrected spontaneously, and mild shortening in adults can be compensated by raising the heel, but shortening of more than 2.5 centimeters or rotational deformity all require surgical correction treatment.

　　2. Fracture nonunion:

　　The principle of treatment is to prevent infection, effectively fix and prevent premature activity.

　　3. Knee stiffness:

　　Long-term traction fixation of the knee joint or surgery and fracture trauma affecting the knee joint can cause knee joint contracture and stiffness. The principle of treatment is to carry out early knee flexion and extension activities, manual massage or surgical release, etc.

　　4. Delayed healing or non-union of patella fracture

　　The incidence of non-union of patella fracture is low, ranging from 2.4% to 4.8%. Treatment: For patients with no symptoms or mild symptoms, non-surgical treatment is adopted, although the fracture does not heal, the function of the affected knee is still good. For patients with obvious symptoms, surgical treatment is adopted, and the tension band wire fixation, partial resection of the patella, and total resection of the patella are performed according to specific conditions. Most patients have significant improvement in function after surgery.

　　5. Patella refraction

　　The incidence of patella refraction is 1% to 5%. Due to the incomplete recovery of the stabilizing effect of the quadriceps tendon on the knee joint in the short term after bone healing, in addition to the insufficient strength of the patella internal fixation, the insufficient time of knee movement, when the patient exercises or walks, under insufficient protection, the affected knee suddenly becomes weak, the quadriceps muscle contracts strongly, causing a refraction. If the bone fragments are separated greatly after the fracture, and the parapatellar fascia tissue is torn, it is still necessary to perform open reduction and internal fixation.

　　The above are the complications of patella fracture, which require active treatment to prevent the disease from worsening and threatening life.

　　The patella is the largest sesamoid bone in the human body and also a part of the knee joint. After the patella is removed, it can reduce the strength of the quadriceps muscle during extension of the knee, therefore, the patella can play a protective role for the knee joint, enhance the strength of the quadriceps muscle, and straighten the patellar groove. In treatment, it should be ensured that the posterior surface of the patella is a complete joint surface, and its lateral and medial sides are respectively formed into joint surfaces with the anterior surfaces of the femoral condyles, restoring flatness and reducing the occurrence of patellofemoral arthritis. The following introduces the symptoms of patella fracture:

　　There is a clear history of trauma, pain in the affected limb, and limited mobility. X-rays can determine the location and displacement of the fracture.

　　(One) Local swelling, pain, and inability to extend the knee joint autonomously are common symptoms, as well as subcutaneous ecchymosis and skin abrasions around the knee joint.

　　(ii) Local tenderness, when the fracture has separation and displacement, the concave fracture end can be felt, there may be bone rub sound or abnormal movement.

　　Expert tip:If there is a suspicion of injury to the medial side, then an internal rotation of 45 degrees can be taken. If there is a high clinical suspicion of patellar fracture and the X-ray films of all positions and the lateral position have not shown the fracture, then an additional patellar oblique X-ray film can be taken.

　　This disease is usually caused by trauma and car accidents, other causes such as kicking, falling injuries can directly cause the disease. Therefore, attention should be paid to living habits, high-risk workers such as construction workers and miners are prone to injury, and they should pay attention to protecting themselves during the work process. Be calm when facing things and avoid emotional excitement to avoid conflict leading to the disease. Secondly, early discovery, early diagnosis, and early treatment are also of great significance for the prevention of the disease.

　　The patella is the largest sesamoid bone in the human body and is also a part of the knee joint. After the patella is removed, it can reduce the strength of the quadriceps muscle during the extension of the knee joint, so the patella can play a role in protecting the knee joint, enhancing the strength of the quadriceps muscle, and straightening the patellar groove. In the treatment, it is best to keep the posterior surface of the patella a complete articular surface, and its lateral and medial sides are respectively formed into articular surfaces with the front surfaces of the femoral condyles to restore flatness, reducing the occurrence of patellofemoral arthritis. The following introduces what kind of examinations are needed for patellar fracture.

　　Patellar fracture requires X-ray examination for diagnosis. When taking X-rays, the lateral and oblique positions of the knee joint should be used instead of the anteroposterior position. The lateral position is most useful for determining transverse fractures and fragment separation, but it cannot determine whether there is a longitudinal fracture or a comminuted fracture. The oblique position can usually be taken in an external rotation of 45 degrees to avoid overlapping with the femoral condyle; it can show the full view and is more conducive to diagnosing the longitudinal fractures on the lateral side. If there is a suspicion of injury to the medial side, then an internal rotation of 45 degrees can be taken. If there is a high clinical suspicion of patellar fracture and the X-ray films of all positions and the lateral position have not shown the fracture, then an additional patellar oblique X-ray film can be taken.

　　The patella is an important part of the knee joint. If the patella fracture is not handled properly after the injury, it will seriously affect the activity of the knee joint and even cause lifelong disability. Scientific diet during treatment is very helpful for the recovery of the disease. The following introduces the dietary注意事项 for patellar fracture.

　　1. Early stage of patellar fracture (1-2 weeks):

　　The injured area is ecchymotic and swollen, the meridians and collaterals are blocked, and the Qi and blood are stagnant. During this period, the treatment focuses on promoting blood circulation and removing blood stasis, and promoting Qi and dissipating stagnation. According to traditional Chinese medicine, 'If the blood stasis is not removed, the bone cannot grow' and 'when the blood stasis is removed, new bone will grow'. It can be seen that reducing swelling and removing blood stasis is the primary goal for fracture healing. The principle of diet coordination is to maintain a light diet, such as vegetables, eggs, dairy products, fruits, fish soup, lean meat, etc.

　　2. Middle stage of patellar fracture (2-4 weeks):

　　Most of the ecchymosis has been absorbed. During this period, the treatment focuses on nourishing the body, relieving pain, removing blood stasis, and promoting the growth of new tissue. Diet should shift from light to moderate high-nutrition supplementation to meet the needs of callus growth. One can add bone soup, Cordyceps chicken stew, animal liver, and other foods to the initial diet to provide more vitamin A, D, calcium, and protein.

　　3. Late stage of patellar fracture (more than 5 weeks):

　　After 5 weeks of injury, the ecchymosis at the fracture site is basically absorbed, and there has been the growth of callus, which is the late stage of a fracture. Treatment should focus on tonifying, by tonifying the liver and kidney, and Qi and blood to promote the formation of a more solid callus, and to relax tendons and activate collaterals, so that the adjacent joints of the fracture site can move freely and flexibly, restoring their previous function. Diet-wise, restrictions can be lifted, and the diet can be supplemented with old hen soup, pork bone soup, sheep bone soup, deer tendons soup, and braised fish, among others. Those who can drink can choose Du Zhong Guisui wine, Jixueteng wine, and Hu Gu Mu Gua wine, etc.

　　4. Foods to avoid in the early stage of patellar fracture:

　　Avoid eating sour and spicy, dry and hot, and greasy foods. Especially, it is not advisable to consume rich and nourishing foods such as bone soup, fatty chicken, and braised fish too early, otherwise, blood stasis will accumulate and be difficult to disperse, leading to delayed course of the disease. This will result in slow growth of callus and affect the recovery of joint function in the future.

　　5. Patients with patellar fracture should avoid eating too many meat bones:

　　Some people believe that eating more meat bones after a fracture can promote early healing. In fact, this is not the case. Modern medicine has proven through multiple practices that eating more meat bones by fracture patients not only cannot promote early healing but may also delay the healing time of the fracture. The reason for this is that bone regeneration after injury mainly relies on the functions of the periosteum and bone marrow. The periosteum and bone marrow can only better exert their functions under the condition of increased collagen. The main components of meat bones are phosphorus and calcium. If a large amount is consumed after a fracture, it will promote an increase in inorganic components within the bone, leading to a disorderly proportion of organic components within the bone. Therefore, it will hinder the early healing of the fracture. However, fresh meat bone soup has a delicious taste and can stimulate appetite, so eating a small amount is harmless.

　　6. Patients with patellar fracture should avoid dietary bias:

　　Patients with patellar fracture often have local edema, congestion, hemorrhage, and muscle tissue damage. The body itself has resistance and repair capabilities for these conditions. The repair of tissue, the growth of long bones, callus formation, and the material for resolving blood stasis and reducing swelling rely on various nutrients. Therefore, it can be known that the key to the smooth healing of a fracture is nutrition.

　　7. Patients with patellar fracture should avoid excessive intake of sugar:

　　After excessive intake of sugar, a rapid metabolism of glucose occurs, resulting in intermediate metabolic substances such as pyruvate and lactic acid, causing the body to be in an acidic poisoning state. At this time, alkaline calcium, magnesium, and sodium ions will be immediately mobilized to participate in neutralization to prevent the blood from becoming acidic. Such a large consumption of calcium is detrimental to the recovery of fracture patients. At the same time, excessive sugar intake will also reduce the content of vitamin B1 in the body, as vitamin B1 is an essential substance for the conversion of sugar into energy in the body. Deficiency of vitamin B1 greatly reduces the activity of nerves and muscles, and also affects the recovery of function. Therefore, fracture patients should avoid consuming excessive amounts of sugar.

　　8. Patients with patellar fracture should avoid long-term use of Sanqi tablets:

　　In the early stage of a fracture, there is internal hemorrhage locally, with blood stasis leading to swelling and pain. At this time, taking Sanqi tablets can constrict local blood vessels, shorten the clotting time, and increase thrombin, which is very appropriate. However, after one week of fracture reduction, bleeding has stopped, and the damaged tissue begins to repair. Repair requires a large amount of blood supply. If Sanqi tablets are continued to be taken, the local blood vessels remain in a contracted state, leading to poor blood circulation and being detrimental to the healing of the fracture.

　　The above are the dietary precautions for patellar fracture, and scientific and reasonable diet is conducive to the recovery of the disease. Patellar fracture patients need to actively seek scientific treatment to recover as soon as possible.

　　The patella is an important part of the knee joint, and its role is more significant in the extension of the knee. If the patella fracture is not properly treated, it will seriously affect the movement of the knee joint and even cause lifelong disability. There is no effective medication for the treatment of patellar fractures. The treatment of fresh patellar fractures should aim to restore the smoothness of the joint surface to the maximum extent, provide a firm internal fixation for early knee joint activity, and prevent the occurrence of traumatic arthritis. The following introduces the treatment methods for patellar fractures.

　　1. Cast brace or tube fixation:

　　This method is suitable for non-displaced patellar fractures, which do not require manual reduction. Remove the accumulated blood inside the joint, bandage, and fix the affected limb in an extended position for 3 to 4 weeks using a long leg cast brace or tube. During the period of cast fixation, practice the contraction of the quadriceps muscle. After removing the cast brace, practice knee extension and flexion exercises.

　　2. Open Reduction and Internal Fixation:

　　There are many internal fixation methods for patellar fractures, which can be divided into two categories: one category requires a certain period of external fixation after internal fixation, and the other category has a strong internal fixation and does not require external fixation.

　　3. The dialectical treatment of patellar fracture:

　　Non-displaced fractures can be fixed with a splint alone, while displaced fractures must have a good reduction and maintain the integrity and smoothness of the joint surface to restore the function of the extensor mechanism of the knee and prevent the occurrence of traumatic arthritis.

　　4. The method of reduction for patellar fracture:

　　Firstly, under sterile operation, remove the accumulated blood inside the joint thoroughly to make the fracture easier to align. The patient lies on their back with the knee straightened, and the operator uses the thumbs, index fingers, and middle fingers of both hands to hold the proximal and distal ends of the fracture and push them towards each other. Then, with one hand, the thumb and index finger press on the upper and lower ends, while the other hand touches the patella to determine if the joint surface is flat. If there is still residual anterior and posterior displacement, the other hand's thumb and index finger fix the sunken end, and the other hand's thumb and index finger push and press on the other end that protrudes forward to realign it.

　　The above is the treatment method for patellar fracture, which is very helpful for everyone to understand patellar fracture. Treatment is very important. Pay attention to treatment and try to prevent the occurrence of sequelae.