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What is a Knee Fracture?

A knee fracture is a break in the continuity of bone within the knee. This can involve the tibia (shinbone), kneecap (patella), or femur (thigh bone).

What does ORIF mean?

ORIF refers to open reduction and internal fixation. It is a surgical procedure employed for the treatment of a fracture not amenable to non-surgical conservative treatment.

Anatomy of the Knee

The knee joint is formed by 3 bones; the thighbone (femur), shinbone (tibia), and kneecap (patella). Tendons and ligaments function as strong ropes that hold the bones together and aid in knee movements. In addition, the shape of the bone ends help in keeping the knee properly aligned. The knee is regarded as the biggest weight-bearing joint of the body. 

Causes of a Knee Fracture

Knee fractures can be caused by many ways such as:

  • Direct hit to the knee
  • Motor vehicle accidents (MVA)
  • Falling
  • Sporting accidents
  • Repeated stress (excessive activity)
  • Cancer or infection
  • Poor bone quality due to old age
  • Muscle contractions (rare instances)

Symptoms of a Knee Fracture

Some of the common symptoms of knee fractures include:

  • Extreme pain
  • Swelling
  • Bruising
  • Tenderness
  • Unable to bend or straighten the knee
  • Muscle spasms
  • Crackling or popping sound on movement
  • Inability to walk
  • Deformity of the knee

Diagnosis of a Knee Fracture

To make an accurate diagnosis and recommend suitable treatment, your doctor will undertake measures, such as:

  • Review of signs and symptoms, medical history, and how the injury was sustained
  • Physical examination to assess the range of motion, amount of swelling, disfigurement, and severity of pain
  • Ordering certain diagnostic tests, such as:
    • X-rays to confirm the presence, type, and location of the fracture
    • CT scan for detailed information about the severity of the fracture
    • MRI scan to identify injuries to ligaments, tendons, and other soft tissues surrounding the knee

Treatment for a Knee Fracture

Non-Surgical Treatment

Non-surgical treatment options would include use of casts and braces to hold the fractured knee in position, restricting movement and weight bearing. During the recovery process, your doctor would most likely order X-rays to monitor how well the bones are healing while in the cast.

Surgical Treatment

Severely displaced, open, or complex fractures may require open reduction and internal fixation (ORIF). The procedure will be done under general or local anesthesia. 

  • Your surgeon will make a cut over the kneecap to look at the fractured bone and assess how well the fractured bones can be put together. 
  • If fragments of bone are too small to be put back into place, your surgeon may remove them. 
  • Your surgeon will reassemble the pieces of the patella and join them together with the use of metal wires, pins, or screws. 
  • These are generally made of medical grade stainless steel that permanently remain in the body and aid in keeping the bones in place while the bones heal and grow back together. 
  • After the bones have been joined, the opening is closed with staples or stitches and covered with sterile dressings. 
  • The knee is placed in a cast or other device to make it immobile while it heals.

Postoperative Care and Instructions

The average hospital stay for open reduction and internal fixation of the knee would be 1 to several days and some of the measures you should follow post ORIF would include:

  • Elevating the affected knee above chest position to reduce swelling
  • Use of assistive devices such as crutches or wheelchair 
  • Getting up out of bed and walking at least 2 to 3 times a day
  • Physical therapy to regain range of motion and muscle strength
  • Specific instructions on the care of the surgical site
  • Specific instructions on the use of medications and analgesics

Complications of Open Reduction and Internal Fixation of the Knee

As with any surgery, some of the potential complications of an ORIF procedure may include:

  • Bleeding
  • Infection
  • Anesthetic reactions such as fever, nausea, or allergic reaction
  • Blood clots or deep venous thrombosis
  • Damage to nerves and blood vessels
  • Stiffness or arthritis
  • Fat embolism
  • Failure to heal properly and the need for repeat surgery

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