Bone fractures tend to heal themselves in a process that I will explain later, and in most cases, your physician will simply let nature take its course. However, there are times when surgical intervention is necessary. Surgery is almost always required in the case of a displaced fracture when a bone breaks in such a way that even if it mends on its own, its normal strength and shape cannot be restored. If the fractured bone is an integral part of a joint—such as the knee—it can become the weak link in the joint, eventually destroying the anatomy and balance of the joint. For example, many older people fall and fracture their knee in an area called the tibia plateau, the location where the articular cartilage sits on the bone. If the injury displaces the tibia plateau by more than a few millimeters, it can throw off the entire alignment of the knee joint and cause severe arthritic changes. Therefore, this kind of injury requires surgical correction to restore the joint.
Physical Examination. A fracture about the knee is quite painful and the patient will not move the knee very much, if at all. There will usually be immediate swelling and tenderness at the site of fracture. Within a few hours, the area will be black and blue.
An X-ray. Complete bone fractures can be diagnosed by X ray, which will show the location of the fracture and the type of break.
Computerized Axial Tomographic Scanning (CAT Scan). A CAT scan is a regular X ray that transects the bone into serial sections, either from front to back or from the side. It is sometimes used to help assess the depth of a subtle fracture.
If the fracture is stable, that is, if the broken bones can firmly reattach, surgery is not required. The more surface area involved in the break, the more likely the fracture is stable. For example, a long spiral fracture is usually more stable than a transverse fracture that neatly splits the bone in two and has very little surface area. If the fracture is stable, the leg is casted until it mends—a so-called closed reduction procedure. Closed reduction, which requires no incision, is often performed under general anesthesia. In this procedure, the bones are put back in their normal position and held in place by a cast. When the fracture is healed, the cast is removed. An experienced knee surgeon can usually predict whether a closed reduction will be successful prior to surgery.
If, however, the fracture is unstable, that is, if the bones cannot reattach without becoming wobbly—as in the case of a transverse fracture—a surgical procedure called open reduction and internal fixation may be required. If an open reduction is necessary, it will require an appropriate incision and internal fixation of the fracture fragment with hardware, plates, screws, and, possibly, rods. The recovery time from the surgery depends on the injury and individual. The principle of rehabilitation is to allow knee joint motion as early as possible while protecting the fracture from excessive weight-bearing stress. The rehabilitation program varies depending on the type of injury.
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