Overview
Broken bones, also called fractures, are among the most common orthopedic injuries. Fracture treatment is often with a cast, but sometimes treatment of broken bones requires surgery. Read on for more fracture information...
Broken bones are most commonly caused by an accident, such as a car crash or a fall. Osteoporosis, a disease that weakens bone, often leads to a fracture.
Your knee joint is made up of three major bones: your thighbone, shinbone, and kneecap. Breaks can occur in several places along these bones. All can result in knee pain or problems.
A fracture, or break, in the bone of the upper part of the lower leg (tibia, or shin bone) may result from a low-energy injury, such as a fall from a height, or from a high-energy injury, such as a motor vehicle accident. Proper identification and management of these injuries will help to restore limb function (strength, motion, and stability) and lessen the risk of arthritis.
The soft tissues (skin, muscle, nerves, blood vessels, and ligaments) also may be injured at the time of the fracture. Because of this, the orthopaedic surgeon will also look for any signs of soft-tissue damage and include this in plans for managing the fracture.
Anatomy
When compressive forces depress the boney surface a defect remains. This may result in arthritis and instability if not corrected by elevating the depressed fragments.
Reproduced with permission from Koval KJ, Helfet DL: Tibial Plateau Fractures: Evaluation and Treatment.
The knee joint is the largest weightbearing joint of the body. Although it is likened to a hinge joint, its motions are more complex. Movement of the knee occurs in several planes, for example, back and forth and, to a lesser degree, side to side. The stability of the joint is therefore dependent not only on soft tissues (muscles and ligaments) but also on the way in which the joint surfaces oppose each other to keep the bones of the knee properly aligned.
Cause
Fractures that involve the upper fourth of the lower leg, or tibia, may or may not involve the knee joint. Fractures that enter the knee joint may render the joint imperfect and the joint surface irregular. Additionally, these fractures may result in improper limb alignment. Either of these factors may contribute to excessive joint wear (arthritis), instability, and loss of motion.
A fracture of the upper tibia can occur from stress (minor breaks from unusual excessive activity) or from already compromised bone (as in cancer or infection). Most, however, are the result of trauma (injury).
Young people experience these fractures often as a result of a high-energy injury, such as a fall from considerable height, sports-related trauma, and motor vehicle accidents.
Older persons with poorer quality bone often require only low-energy injury (fall from a standing position) to create these fractures.
Many older persons may also have medical concerns, such as heart or lung problems, diabetes, or other diseases which must be considered and addressed.
Symptoms
A fracture of the upper tibia (shin bone) may result in injury to both the bone and the soft tissues of the knee region.
Pain on bearing weight
Typically, the injured individual is most aware of a painful inability to put weight on the affected extremity.
Tenseness around the knee; limited bending
The knee may feel and appear tense, owing to bleeding within the joint. This also limits motion (bending) of the joint.
Deformity around the knee
The leg may or may not appear deformed.
Pale, cool foot
A pale appearance or cool feeling to the foot may suggest that the blood supply is in some way impaired.
Numbness around the foot
Numbness, or "pins and needles," within the region of the foot raises concern about nerve injury or excessive swelling within the leg.
If these symptoms are present after a fracture, you should have an assessment done in the emergency room.
Diagnosis
The diagnosis of an upper tibia fracture of the knee joint is based both on clinical examination and imaging studies.
During the clinical examination, the physician will ask for details about the circumstances resulting in the injury (the history). Any symptoms described above, if present, should be offered in the history. In addition to the knee joint, the physician will ask about previous medical history and will identify any additional concerns to other parts of the body.
The physician will examine the soft tissue surrounding the knee joint. He or she will check for bruising, swelling, and open wounds, and will assess the nerve and blood supply to the injured leg and foot.
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