Patellar Condyle Fracture

　　Fractures of the upper femoral condyle are caused by direct and indirect violence. Fractures of the upper femoral condyle are divided into extension type and flexion type. Extension-type fractures are caused by injury at the extended position of the knee joint, with the fracture line obliquely from anterior and inferior to posterior and superior. When injured in the flexed position, a diagonal fracture from anterior and superior to posterior and inferior can be formed, or a transverse or comminuted fracture can occur under the action of direct violence. Currently, high-energy injuries caused by traffic accidents and agricultural and industrial trauma are common, often leading to comminuted upper condylar fractures or intercondylar comminuted fractures.

　　If the fracture of the upper femoral condyle is not treated correctly, it can cause complications such as non-union of the fracture and arterial injury.

　　First, extension-type fractures often cause injury to the posterior popliteal artery of the thigh.

　　Second, non-union of the femoral condyle fracture.

　　Reason:

　　1. Incorrect or insufficient fixation.

　　2. Unreasonable functional exercise of the affected limb.

　　3. Overtraction.

　　4. Infection

　　5. Soft tissue interposition between bone ends, once it occurs, it can be surgically removed, and strong internal fixation and bone grafting can be used.

　　Three, malalignment of the femoral condyle fracture

　　Malalignment of the joint surface of the femoral condyle is often accompanied by malalignment of the femoral condyle in the case of malalignment of the femoral condyle fracture.

　　Reason:

　　1. Poor reduction of the fracture ends, failure to achieve anatomical reduction or loosening of the internal fixation device, resulting in recurrence of displacement of the fracture ends due to poor fixation.

　　2. After the fracture of the femoral condyle, due to the compression of cancellous bone, there is often bone defect after reduction, and the bone grafting during surgery cannot be confirmed, and the side collapses again when healing.

　　3. Inappropriate weight-bearing, leading to healing of the fracture ends in a non-functional position, malalignment of the external condyle of the femur can cause external rotation of the knee joint, flexion and varus deformity; malalignment of the internal condyle of the femur can cause internal rotation, flexion, and varus deformity of the knee joint.

　　Four, loose internal fixation is not firm

　　Reason: Interc condylar fractures of the femur are often multi-directional displacement, and severe comminuted fractures account for more than 1/2, which brings many difficulties to surgical internal fixation and functional exercise, and internal fixation often has a loose phenomenon, the reason for which is:

　　1. Severe comminuted fracture of the femoral condyle.

　　2. Inappropriate selection and use of internal fixation devices, such as the tension screw used during surgery not exerting a compressive effect between the bone fragments.

　　3. Not using external fixation after surgery and unreasonable early functional exercise.

　　　　Fractures of the upper femoral condyle have two clinical manifestations: general symptoms and local symptoms.

　　　　1. General symptoms:Mostly lighter than that of the femoral shaft fracture, with an incidence of shock at 1/8 to 1/10 of the femoral shaft fracture.

　　　　Second, local symptoms

　　　　1. General symptoms of fracture:Mainly manifested as swelling, pain locally at the fracture site, and circumferential tenderness and conductive percussion tenderness above the femoral condyle.

　　　　2. Displacement:Manifested as lateral displacement of the fracture distal end and malformation of the knee joint flexion.

　　　　3. Functional impairment:The main manifestation is in the affected limb, especially the dysfunction of the knee joint.

　　　　4. Pay attention to complications:Mainly whether there are signs of injury to the popliteal artery or other vascular injuries.

　　Patella fracture of the femur is caused by direct violence or indirect violence. Currently, high-energy injuries caused by traffic accidents and agricultural and industrial外伤 are more common. Preventive work should start from daily life. In terms of diet, it is advisable to eat foods that promote blood circulation and remove blood stasis.

　　In diagnosing patella fracture of the femur, in addition to relying on its clinical manifestations, it is also necessary to rely on auxiliary examinations. Patella fracture of the femur can be examined by X-ray to show the fracture and type. For those with nerve and vascular injuries, MRI or angiography can be performed.

　　In terms of diet, eating foods that promote blood circulation and remove blood stasis is helpful. The following are dietary suggestions for patella fracture of the femur:

　　1. Food therapy for patella fracture of the femur

　　1. Early stage

　　10 grams of Sanqi, 10 grams of Angelica sinensis, 1 pigeon, stewed until soft, eat the soup and meat together, once a day, for 7-10 days.

　　2. Middle stage

　　10 grams of Angelica sinensis, 15 grams of bone-breaking, 10 grams of 续断, 250 grams of fresh pork rib or beef rib, stewed for more than 1 hour, eat the soup and meat together, take for 2 weeks.

　　3. Late stage

　　10 grams of Lycium barbarum, 15 grams of bone-breaking, 10 grams of续断, 50 grams of Job's tears. First decoct the bone-breaking and 续断 to remove the residue, then add the remaining two ingredients to cook porridge and eat.

　　4. Other food therapy recipes

　　(1) Appropriate amount of red bean, add a little red sugar, take it warm, this recipe is suitable for the stage of promoting blood circulation and removing blood stasis.

　　(2) 1000 grams of pork bone, 250 grams of soybeans, boiled with water over low heat until soft, seasoned with salt and ginger, and taken as food.

　　(3) One set of pork spine bone, cleaned, 120 grams of red dates, 90 grams of lotus seeds, 9 grams of Dingxiang, 9 grams of raw licorice, boiled with water over low heat until soft, seasoned with ginger and salt, and taken in multiple doses.

　　(4) 2 fresh lake crabs, take the meat (with yolk), when the glutinous rice porridge is cooked, add the crab meat, add appropriate amounts of ginger, vinegar and soy sauce, taken regularly.

　　(5) 1 male black chicken (about 500 grams), skin, feathers and internal organs removed, cleaned, 5 grams of 'Sanqi' sliced, placed in the chicken stomach, add a small amount of yellow wine, steamed separately over water, served with soy sauce after it is cooked, taken regularly.

　　(6) 30-60 grams of raw Astragalus membranaceus, concentrated decoction to obtain the juice, add 100 grams of glutinous rice, cook porridge, and take it in the morning and evening.

　　(7) 20 grams of Angelica sinensis, 100 grams of Astragalus membranaceus, 1 tender hen, boiled in water and eaten as soup.

　　(8) 50 grams of dried salvia miltiorrhiza, cleaned, boiled in water, taken the juice, and the juice with 1000 grams of pork long bone, 250 grams of soybeans, boiled until soft, add a small amount of cinnamon, salt and it is ready.

　　(9) Fresh crab 500 grams, pounded, served with 250 grams of hot yellow wine, the remaining residue applied to the affected area, about half a day 'each each' sound? Slander Sui? Fracture treatment.

　　What is the best to eat for patella fracture of the femur?

　　1. Early stage

　　The principle of diet coordination is to keep it light, such as vegetables, eggs, soy products, fruits, fish soup, lean meat, etc.

　　2. Middle stage

　　Bone soup, Panax notoginseng stewed chicken, animal liver.

　　3. Late stage

　　Old mother chicken soup, pork bone soup, sheep bone soup, deer tendon soup, stewed water fish, etc., those who can drink can choose Duzhong bone碎补酒, chicken blood vine wine, tiger bone papaya wine, etc.

　　Three, what should not be eaten for fractures of the upper femoral condyle?

　　Early avoidance of spicy, hot, and greasy foods, and especially not to apply fatty and nourishing tonics prematurely, such as bone soup, fatty chicken, braised fish, etc. In addition, fruit juice and sugar are also not suitable.

　　Fractures of the upper femoral condyle are primarily treated with non-surgical methods. For those with poor reduction, soft tissue entrapment, and vascular and nerve injuries, open reduction and internal fixation (or external fixation after reduction) is required.

　　1. Non-surgical treatment

　　Generally, bone traction and plaster cast fixation are used:

　　(1) Bone traction: Similar to the traction method for femoral shaft fractures, but the traction force line is lower to relax the gastrocnemius muscle and facilitate reduction. If the patellar tubercle traction does not reach the ideal alignment, switch to femoral condyle traction to make the force directly act on the fracture end. If surgery is possible, it is not advisable to perform condylar traction to prevent infection.

　　(2) Lower limb plaster cast fixation: After traction for 2-3 weeks, change to lower limb plaster cast fixation, with a knee flexion of 120°-150° as appropriate; change to functional position plaster cast after 2 weeks, strengthen knee joint function training after the plaster cast is removed, and can be supplemented with physical therapy.

　　2. Surgical treatment

　　(1) Indications for surgery: In the case of any of the following conditions, early surgery exploration and reduction should be considered.

　　① Alignment not meeting functional requirements.

　　② Soft tissue entrapment at the fracture ends.

　　③ Patients with symptoms of vascular and nerve stimulation, compression, and injury.

　　(2) Open reduction: Depending on the purpose of the surgery, the fracture ends can be visualized through lateral or other approaches, and the problems that need to be addressed and observed are resolved, including the treatment of vascular and nerve injuries, and the release of entrapped muscles, etc. After that, the fracture ends are aligned and internally fixed under direct vision. For those who are stable after reduction, it is generally not necessary to perform internal fixation surgery again.

　　(3) Fixation: For those who undergo simple reduction, continue to use the previous method for flexion position lower limb plaster cast fixation, and change to functional position plaster cast after 2-3 weeks. For those who require internal fixation, L-shaped steel plate screws, Ender nails, or other internal fixation devices can be selected according to circumstances, and then an external plaster splint is added for protection for 2-3 weeks.

　　In general, the prognosis is good, and a small number of patients may have bone nonunion and malunion due to unstable internal fixation.