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[Basic information] Male, 52 years old
[Disease type] Left patella fracture
[Treatment hospital] Chaohu Hospital Affiliated to Anhui Medical University (Third Class A)
[Treatment Treatment plan] Surgical treatment, anti-infective drug treatment
[Treatment cycle] Hospitalization for 17 days, follow-up for half a year
[Treatment effect] After treatment, the patient was able to walk with the help of walker
1. First introduction to the patient
The patient is a worker who works at construction sites on weekdays and often does heavy physical labor. He is relatively healthy. In his spare time, the patient likes to climb mountains with his family. This morning, the patient was carrying goods at the construction site and was accidentally hit by a cart coming from the left. At that time, the patient felt pain in his left knee joint, which was rapidly swelling and bleeding. His knee joint could not move, his activities were limited, and he could not walk immediately. The person in charge of the construction site immediately called an ambulance and was admitted to our hospital emergency department . After asking about the patient's basic information, the patient was previously in good health with no underlying diseases and no history of infectious diseases. An X-ray showed a comminuted fracture of the left patella, so he was admitted to the hospital in the emergency department with a "fracture of the left patella."
2. Treatment process
After the patient was admitted to the hospital, based on the consideration of "left patella fracture", CT examination, MRI examination, electrocardiogram examination, blood routine, blood routine, complete set of blood coagulation tests, blood type testing, liver function and kidney function and other related tests were further improved. These examinations are used to prepare patients for surgical treatment. The examination results showed that the patient had a comminuted fracture of the left patella, medial femoral condyle edema, joint effusion, soft tissue damage around the knee joint, posterior horn and body damage to the medial meniscus; sinus rhythm within the normal range; increased neutrophil percentage, hemagglutination D dimer, 0.93 micrograms per liter, total bilirubin, and direct bilirubin.
Based on the above examination results, considering the patient's left patella fracture, combined with the patient's specific disease conditions, it can be clinically diagnosed as a left patella fracture, and the patient was given surgical treatment, including open reduction and internal fixation of the left patella fracture, which lasted 2 to 3 hours. After surgery, cephalosporin anti-inflammatory drugs and clarithromycin were given for anti-inflammatory and sterilization to avoid post-operative infection. Iodophor was used to disinfect the damaged skin areas and keep the damaged skin areas clean and dry. After the operation, the patient was given rehydration and treatment to maintain body homeostasis and maintain physical weakness after the operation.
After treatment, the patient's wound healed, his body gradually recovered, and his left knee could be moved while losing weight. The patient and his family asked him to be discharged from the hospital and asked him to avoid bearing weight on his lower limbs after discharge and to be able to move his lower limb joints. He returned to the orthopedic department for a review one month after the operation and actively carried out life management.
3. Precautions for patients during treatment
1. On the first day after surgery, raise the affected limb. You can do muscle contraction exercises of the affected limb and plantar flexion of the metatarsophalangeal joints and interphalangeal joints, and dorsiflexion, but dorsiflexion of the affected foot is strictly prohibited.
2. Patients should pay attention to a light diet after surgery and eat more calcium-containing foods, such as milk and soy products. Try to avoid drinking alcohol, smoking, and spicy food.
3. To score the patient's pain at the fracture site on time, you can use the VAS pain rating scale.
4. Patients’ family members can help patients perform distal joint activities to avoid deep vein thrombosis.
4. The patient's therapeutic effect
After being hospitalized for more than half a month, the patient's left knee wound healed well, the left knee joint can move slightly, the toes can feel and move well, and the peripheral blood supply is normal. The review X-ray showed that the patella was healing well and the broken end was well restored. The routine blood test showed that the patella had returned to normal. The patient's activities of daily living were assessed and it was found that the patient could take care of most of his daily life activities and was discharged.
5. Precautions for patients in daily life
1. Pay attention to diet, choose some high-protein and high-calcium foods, eat more fresh vegetables and fruits, and supplement vitamins and minerals, which can help the healing and recovery of fractures.
2. Under the supervision of family members, walking aids can be used for standing training, appropriate joint activities and walking exercises to avoid overexertion and pay attention to prevent patients from falling.
3. Actively participate in health education, understand disease knowledge, improve treatment compliance, and avoid adjusting treatment plans on your own.
6. Doctor’s Insights
Patella fracture is a relatively common injury. It is a fracture caused by an accidental fall or external impact, resulting in local swelling and pain of the patella, limited voluntary flexion and extension of the knee joint, subcutaneous ecchymosis, and skin abrasions.
The current treatment methods for patella fractures include traditional Chinese medicine knee-hugging ring fixation, patellar graspers, patella holders and other external fixators that combine traditional Chinese and Western medicine, as well as improved tension band wire fixation and pressure riding suture nail fixation designed based on modern biomechanics principles. Each method has its own certain adaptability. We can choose different methods according to different types of patellar fractures to continuously improve the efficacy. In the past, patients often had to stay in bed for 1-2 months after patella fractures were reduced and fixed. Now, after treatment and fixation, patients can immediately practice knee joint flexion and extension and joint range of motion training. However, the current rehabilitation of patients with patellar fractures is not widespread enough. Postoperative rehabilitation and home rehabilitation after discharge should be introduced to patients in detail so that patients have a certain understanding of it. Patients should be regularly evaluated on their knee joints and the rehabilitation plan should be changed in a timely manner. This can enable the patient to recover as soon as possible and improve the patient's ability to live.
After patients are discharged from the hospital, in addition to paying attention to a balanced diet, strengthening nutrition, quitting smoking and drinking, and maintaining a happy mood, they should also continue functional training of the affected limb under the guidance of their family members, so that the patient can return to normal life as soon as possible.
Name: Dai Ru
Unit: Chaohu Hospital Affiliated to Anhui Medical University
Department: Orthopedics
Professional title: Attending physician
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