RESEARCH ARTICLE


Periarticular Fractures of the Knee in Polytrauma Patients



M.L. Bertrand*, P. Andrés-Cano, F.J. Pascual-López
Department of Orthopaedic Surgery and Traumatology. Hospital Costa del Sol. University of Malaga, Spain


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© Bertrand et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Málaga, 29603 Marbella, Malaga, Spain; Tel: +0034 617 444 939; E-mail: mlbertrand@yahoo.es


Abstract

Periarticular fractures around the knee are a challenge for the orthopaedic surgeon. When these fractures are presented in the context of a multiple trauma patient, they are even more difficult to manage because the treatment approach depends not only on the fracture itself, but also on the patient’s general condition. These fractures, caused by high-energy trauma, present complex fracture patterns with severe comminution and major loss of articular congruity, and are often associated with vascular and nerve complications, particularly in the proximal tibia, due to its anatomical features with poor myocutaneous coverage. They are almost always accompanied by soft tissue injury.

The management of polytrauma patients requires a multidisciplinary team and accurate systemic stabilization of the patient before undertaking orthopaedic treatment. These fractures are usually addressed sequentially, either according to the general condition of the patient or to the local characteristics of the lesions. In recent decades, various fixation methods have been proposed, but there is still no consensus as to the ideal method for stabilizing these fractures. In this paper, we describe the general characteristics of these fractures, the stabilization methods traditionally used and those that have been developed in recent years, and discuss the treatment sequences proposed as most suitable for the management of these injuries.

Keywords: Damage control, distal femur, external fixator, knee injuries, locking plates, polytrauma, proximal tibia.