I- INTRODUCTION :
Ruptures of the & rsquo; Knee device are defined by the & rsquo; & rsquo existence; continuity solution on the chain tendino- musculo- bone that provides the & rsquo; knee extension.
Fractures of the patella is the most common cause of this break in continuity of & rsquo; extensor other component elements are the quadriceps muscle, the quadriceps tendon and the patellar tendon.
ANATOMICAL RECALL :
L & rsquo; AEG COMPRISES 4 ELEMENTS :
– The quadriceps muscle compound 4 muscles : the earlier right, le muscle crural, the vastus lateralis and vastus
– The tendon quadricipital
– The kneecap
– The patellar tendon Ensures & rsquo; active extension of the leg on the thigh.
FRACTURE OF THE BALL :
They represent 1% fractures.
Are seen as a result of trauma iatrogenic cause is more and more common C & rsquo; is the most often used joint fractures hand fractures developed Diagnosis is easy guided by clinical confirmed by radiology
The treatment for orthopedic surgical undisplaced fractures for other fractures complemented by rehabilitation
Anatomy Descriptive :
Sesamoid the larger body included in the & rsquo; extensor knee subcutaneous its location makes it particularly vulnerable anteriorly is higher qua posteriorly its thickness is 1,3 cm, while its width is 4,7 cm Ball is well vascularized placed at the proximal third
SYSTEM & rsquo; AMMARRAGE THE BALL :
Back capsular sleeve that s & rsquo; inserts on the periphery of the ball just before coming in s & rsquo; insert share is d & rsquo; other ;
As in the & rsquo; s fin internal patellar that & rsquo; inserts on both internal third of the patella Outside the & rsquo; s fin external patellar that & rsquo; inserts on the upper half
Vascularisation ; femoral popliteal arteries dependent on, peroneal and tibial an anastomotic system
ROLE OF Rotui :
Transmits the forces generated by the quadriceps muscle to the patella tendon It increases the lever arm extender system it the center & rsquo; extensor
It ensures the transmission and distribution of stresses in contact with the trochlea
II- ANA-PATH :
1- mechanism of injury :
The most common mechanism is a direct mechanism by shock on the front side of the knee arrow
subcutaneous position of the ball makes it particularly vulnerable
The indirect mechanism to route e upset when contraction of knee extensor apparatus
2- Classification : many
Type I : single transverse line most often at the junction 2 upper third 1 inferior
Type II : type I or communisions combines a compaction distal the proximal fragment remains intact
Type III : fracture star
III- DIAGNOSTIC :
1- Examination : research :
The mechanism of injury, degrees of flexion at the time of trauma, the patient's land and history.
2- Physical examination :
O & rsquo; interest to find a mostly complete continuity solution of & rsquo; extensor, a big knee swells if the patient is seen late, existence & rsquo; a wound, a d & rsquo; Abrasion, Agrtignure, skin opening, palpation found a depression on the front side open ball jacks inter fragmentary
LESION S ASSOCIEES :
Must imperatively be sought: skin lesions, fractures associates including snacks edge spreadsheet syndrome ;femur cotyle cheville ….ligament injury or cartilage.
IV- IMAGING :
Radiology is to confirm
Baseline Budget radio and lateral knee with a side impact 45 ° knee flexion to assess the & rsquo; state patellar aileron.
Axial impacts CT or MRI may be required in case of doubt or suspicion lesions cartilage or tendons Differential Diagnosis :
Patella bipartitta trait overcome- external irregular interest of a snapshot on the contralateral knee -latérale
V- TREATMENT : IT IS OR ORTHOPEDIC SURGICAL
most anatomical reduction.
1- ORTHOPEDIC :
For non-displaced fractures preceded by a prior puncture d & rsquo; hemarthrosis
Strict immobilization by a splint or plaster for circular 4 a 6 weeks in flexion 20 degrees radiological monitoring is necessary to watch for a secondary displacement
2- SURGICAL TREATMENT :
Under AG or ALR
Route of & rsquo; first usually median anterior anatomical reduction and visually strong and stable contention.
Means & rsquo; multiple osteosynthesis
hoops, screwing, dynamic guying assembly supported on two parallel pins transforms compressive force distraction forces.
TREATMENT OF INJURIES ASSOCIATED
RE-EDUCATION : quickly recover range of motion.
WE- COMPLICATION :
Secondary displacement Pseudarthrosis Low Ball
secondary necrosis above the proximal third.
BREAK OTHER elements of L & rsquo; STENT UNIT :
The breaking of the other element of the & rsquo; extensor tendon namely quadriceps, or patellar tendon avulsion of the anterior tibial tuberosity place d & rsquo; insertion of the patellar tendon are rare lesions whose treatment is usually surgical.
Course Dr S. Kःanici – Faculty of Constantine