Le fratture articolari ed extra-articolari del ginocchio
Abstract
ARTICULAR AND EXTRA-ARTICULAR KNEE FRACTURES
Joint fractures of the knee include epiphyseal detachments of the distal femur and proximal tibia (types 3 and 4
according to Salter-Harris). Extra-articular fractures include: avulsion of the tibial spines, detachment of the anterior
tuberosity and patellar fractures. Fractures involving the distal femoral and proximal tibial epiphysis are relatively
infrequent but may lead to long-term complications owing to the formation of post-traumatic bone bridges. Unless
the fracture is composed, surgical treatment is always indicated. Avulsion fractures of the tibial spines occur as a result
of a chondro-epiphyseal detachment of the insertion of the cruciate ligaments (predominantly the anterior one). They
are infrequent injuries (3 per 100,000 cases per year, 2% of all knee injuries). Accurate diagnosis and appropriate
treatment prevent unfortunate outcomes. Adolescent tibial tubercle fractures are uncommon, high-energy injuries
sometimes combined with patellar tendon rupture; they represent a frequently missed diagnosis. Open
reduction/internal fixation is generally required. Patellar fractures are caused by direct trauma (primary osseous
fractures) or by an eccentric load during extension of the knee (sleeve and avulsion fractures). Most fractures require
open reduction/internal fixation. The complication rate is low but late reconstruction of missed injuries may result in
an extensor deficit.
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© Società Italiana Ortopedici Traumatologi Ospedalieri d’Italia 2018 , 2018
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