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In transverse fracture of the patella the treatment is a)Excision of a small fragment b)Wire fixation c)Plaster cylinder d)Patellectomy
Transverse Patellar Fracture Introduction Transverse fractures of the patella are the result of an indirect force, usually with the knee in flexion. Fracture may be caused by sudden voluntary contraction of the quadriceps muscle or sudden forced flexion of the leg with the quadriceps contracted. The level of fracture is commonly in the middle. Associated tearing of the patellar retinacula depends upon the force of the initiating injury. The activity of the quadriceps muscle causes upward displacement of the proximal fragment, the magnitude of which depends on the extent of the retinacular tear.
Clinical Findings Swelling of the anterior knee region is caused by hemarthrosis and hemorrhage into the soft tissues overlying the joint. If displacement is present, the defect in the patella can be palpated, and active extension of the knee is lost. A straight leg raise may be preserved if the retinacula is intact. Treatment Nondisplaced fractures can be treated with a walking cylinder cast or brace for 6-8 weeks followed by knee rehabilitation. Open reduction is indicated if the fragments are displaced > 3 mm or if articular step-off is > 2 mm. The fragments must be accurately repositioned to prevent early posttraumatic arthritis of the patellofemoral joint. If the minor fragment is small (no more than 1 cm in length) or severely comminuted, it may be excised and the quadriceps or patellar tendon (depending upon which pole of the patella is involved) sutured directly to the major fragment. Whenever possible, internal fixation of anatomically reduced fragments should be done, allowing early
2. Most often. Recurrent dislocation of patella is most often associated witha)Abnormally high patella b)Abnormally low patella c)Bow leg d)Quadriceps contracture . Note:-Satisfactory results have been reported with use of the tension band wire and its modification in treating comminuted and displaced patellar fractures although most authors recommend patellectomy when less than half of the articular surface of the patella remains intact 2. but on rare occasions excision of the patella and repair of the defect by imbrication of the quadriceps expansion is the only viable alternative. No matter what the treatment. This is best achieved by figure-of-eight tension banding over two longitudinal parallel K-wires. pain in the knee.motion of the knee joint. If comminution is not severe and displacement is insignificant. and general restriction of activity. Severe injury may cause extensive destruction of the articular surface of both the patella and the opposing femur. Severe comminution can often be treated with ORIF with addition of a cerclage wire. Accurate reduction of the articular surface must be confirmed by lateral radiographs taken intraoperatively. high-energy injuries are frequently complicated by chondromalacia patella and patellofemoral arthritis. little or no separation of the fragments occurs because the quadriceps retinaculum is not extensively torn. Excision of the patella can result in decreased strength. Comminuted Patellar Fracture Comminuted fractures of the patella are usually caused by a direct force. immobilization for 8 weeks in a cylinder extending from the groin to the supramalleolar region is sufficient. Communited fracture of patella is treated byA)Tension wire bandage b)Surgery and immobilisation c)Conservative d)Patellectomy 3.
4. the tibial tubercle will usually have to be moved also. an isolated lateral release will not be sufficient.Clergymen¶s knee is due to involvement ofa)Prepatellar Bursa c)Suprapatellar b) Intrapatellar bursa d) Infrapatellar bursa 5.10) is a tight lateral retinaculum that is producing the patient¶s symptoms.The Patella is high-lying in the shallower part of intercondylar groove. allowing early . and a patella alta(high) PATELLA ALTA:. don¶t release it. a vastus medialis obliquus (VMO) deficiency. ARTHROSCOPIC LATERAL RELEASE The indication for arthroscopic lateral release (Fig. which have not responded to appropriate nonoperative treatment. The fragments must be accurately repositioned to prevent early posttraumatic arthritis of the patellofemoral joint. These abnormalities are preexisting and developmental. If the patient has a large Q angle as well. Open reduction is indicated if the fragments are displaced > 3 mm or if articular step-off is > 2 mm. If it is not tight. it may be excised and the quadriceps or patellar tendon (depending upon which pole of the patella is involved) sutured directly to the major fragment. Whenever possible.The majority of patients with complaints of patellar pain and instability will have objective abnormalities of the extensor mechanism and patellofemoral joint. an increased quadriceps angle (Q-angle). Major examples include a shallow trochlea. 87.Treatment of displaced transverse fracture of patella ± a) POP b) Tension band wiring c) Screw d) Patellectomy Ans given in guides is a b and d but its wrong as # is displaced Nondisplaced fractures can be treated with a walking cylinder cast or brace for 6-8 weeks followed by knee rehabilitation. If the minor fragment is small (no more than 1 cm in length) or severely comminuted. internal fixation of anatomically reduced fragments should be done.
and MCL LCL and PLC IIIL ACL.Injury to the major nerve trunks behind the knee (all of these are especially vulnerable when the tibia is displaced backwards) Also know Nerve trunks in posterior relation to the knee joint . the medial and lateral ligaments and the joint capsule) and ii) Protective control of powerful Quadriceps muscle.Anatomic classification of knee dislocations Type Injury Intact Structures I Single cruciate and collateral Single cruciate and collateral II ACL and PCL Collaterals IIIM ACL.e.motion of the knee joint.Common peroneal nerve (posterolaterally) TABLE :. PCL. MCL..Injury to the popliteal artery . This is best achieved by figure-of-eight tension banding over two longitudinal parallel K-wires 6 Which one of the following structures is at least risk of damage in knee dislocation? (UPSC 02) a)Cruciate ligaments b)Common peroneal nerve c)Patella d)Popliteal artery Ans. LCL. and PCL None V Fracture dislocation Variable C Arterial injury Variable . Dislocation usually occurs in the posterolateral or anteromedical direction Complications of knee dislocation Most feared complication of knee dislocation are ± . is µc¶ i. 713. . 237] Normally the knee is held stable by I) Its strong ligaments (the two cruciate ligaments. MCL. and PLC MCL IV ACL. Adam's outline of fracture p. Dislocation is possible only if some or all of the ligaments are ruptured. Patella [Ref : Apley's 8e p.Tibial nerve (at the middle) . PCL. PCL.
33%) including intimal tears rather than complete disruptions. 7. internal fixation of anatomically reduced fragments should be done.24 year old young male is ± a)Patellectomy if undisplaced b)No treatment required c)Internal fixation if communited fracture d)POP in full extension 9. The tibial nerve may be involved and can be assessed with FHL and gastrocnemius/soleus strength along with sensation over the lateral border and planter surface of the foot. Type III injuries are most common.Treatment of fracture patella in. transverse fracture of patella is best treated by ± a)Patellectomy b)Application of cylindrical POP cast c)Strict bed rest with quandriceps exercises d)Tension band wiring following by POP cast ans given is C in guides but i think its wrong. including EHL and tibial anterior strength and sensation to the EHL and tibialis anterior strength. . with type IIIL having a poor outcome when compared to type IIIM. There is a 14% to 35% incidence of injury. There is a high incidence of arterial injury (on average.N Nerve injury Variable The anatomic system takes into account the soft tissue and is seen in Table . Neurologic Examination. Neurologic examination includes a thorough evaluation of the peroneal nerve.In a young patient. allowing early motion of the knee joint. Whenever possible. What is the treatment of choice? a) Tension band wiring b) Cylinder cast c) Patellectomy d) Conservative 8. the most common occurrence is type III L (varus) as a result of traction.Transverse fracture of patella in a young adult.
Clinical feature .Usual site of TB bursitis ± a) Prepatellar b) Subacromial c) Subdeltoid d) Subpatellar e) Trochanteric . 469-470] The plica syndrome . 11. . .These three cavities are separated from each other by membranous septa. thickened and eventually fibrosed.The plica is remnant of an embryonis synovial partition which persists into adult life. .The plica in itself is not pathological. It then acts as a light bowstring impinging on other structures in the joint and causing further synovial irritation.Usual site of Tubercular bursitis ± a) Prepatelar b) Subdeltoid c) Subpatellar d) Trochanteric e) None 12.During development of embryos the knee is divided into three cavities .Symptoms are aggravated on exercise or climbing stairs .The most characteristic feature is tenderness near upper pole of the patella.An adolescent or young adult complains of an ache in the front of the knee with intermittent episodes of clicking or `giving way¶ there may be history of trauma or markedly increased activity .The most common cause for anterior knee pain is a)Prepatellar bursitis b)Congenital discoid meniscus c)Plica syndrome d)Chondromalacia patellae Ref Apley p.10. But sometimes part of septum may persist as a synovial pleat or plica.a large Suprapatellar pouch and beneath this . But if acute trauma. Later these partitions disappear leaving a single cavity.This is seen in over 20% people. repetitive strain or some underlying disorder causes inflammation the plica may become oedematous.Medial and lateral comparments.
Housemaids knee is inflammation of bursa a) Subpatellar b) Suprapatellar c) Infrapatellar d) Pre patellar 14.Patella B.Tibia C. this finding is considered pathognomonic for the syndrome. and patellae (kneecaps). Arthrodysplasia of the elbows is reported in approximately 90% of patients.Medial malleolus D. the knees may be unstable.P. Bones and joints Patellar involvement is present in approximately 90% of patients. limited pronation. patellar aplasia occurs in only 20%. however. supination. extension). Patellar tendon bearing P.O. Exostoses arising from the posterior aspect of the iliac bones are present in as many as 80% of patients.13. toenails.Nail patella syndrome is characterised by a) Iliac horn b) Sacral horn c) Absent patella d) Knee deformity e) Dislocation of patella The hallmark features of this syndrome are poorly developed fingernails. Subluxation of the radial head may occur. In instances in which the patellae are smaller or luxated. 16. cast is indicated in the following fracture : A. General hyperextension of the joints can be present. The elbows may have limited motion (eg.Patella is at a higher level in ± a)Recurrent dislocation b)Nail-patella syndrome c)Rheumatoid arthritis d)Plica syndrome 15.Femur .
Non dynamic splint is ± a) Banjo b) Opponons c) Cock-up d) Brand Cock-up:- .Ans is B Orthopaedics MCQs Q1.
A simple palmar cock-up splint may increase the grip strength 3 to 5 times . A patient requiring greater excursion of the fingers may prefer a dynamic splint with extension assists for the wrist and metacarpophalangeal joints.Commonest fractures in childhood is ± a) Femur b) Distal humerus c) Clavicle d) Radius .Principles of treatment Ref:.Chapman Ortho Radial Nerve Palsy:The importance of maintaining supple joints free of deformity cannot be overemphasized. Use splints and physical therapy while awaiting nerve recovery and before considering tendon transfers. Splinting must be individualized. Most patients are well served by such a splint. 2.
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