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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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Our favorite friend and neighborhood adopted "gramma" fell and broke her knee. I guess the fracture is just above the knee but the bone broke into tiny bits. What are her chances for recovery?

Prognosis for recovery may depend on several factors related to your friend -- her age, the condition of her bones (weak or brittle versus dense and strong), and any other compounding health problems like high blood pressure, diabetes, or obesity. The type of fracture can make a significant difference, too. Let's start by taking a quick look at the classification scheme used to describe these fractures. In your mind's eye, imagine one of three fracture locations: 1) at the bottom of the femur (long bone in the thigh) but just above the knee joint, 2) through one of the femoral condyles (round bony knobs at the bottom of the femur), and 3) through both condyles and through the joint. The second type (through the condyle) is termed unicondylar because it only goes through one of the two condyles. The unicondylar femoral fracture also affects part of the joint, so it's also referred to as a partial articular unicondylar fracture. If the fracture goes through both condyles, then it is classified as a complete articular/bicondylar femoral fracture and is part of the third group listed. Any of the fractures can be simple (a single fracture line that is undisplaced -- meaning it doesn't separate or move) or comminuted. Comminuted fractures have tiny fragments of bone because there are so many fracture lines. It sounds like your neighbor Gramma friend has a comminuted fracture but the details of how much of the bone and joint are affected are unknown. Today's fixation devices are new and improved. Some are specifically designed to be used in patients who have thin, brittle bones. Locking plates offer improved management in that they can provide a rigid hold on the many tiny (comminuted) pieces of bone. The newer, updated fixation devices are stronger, accept more load, and resist pulling out of the bone. Not only that, but many of the improved fixation devices are designed so that the surgeon doesn't have to cut through so many important soft tissue structures on the way to the bone. The metal plates are even shaped like the natural bone to allow for a closer fit. The plate can be slipped under the skin and muscle and placed against the bone using just a small incision. As with any surgery, even with new and improved techniques and devices, problems and complications can occur. There can be infections. The fixation devices can come loose. Even with the holding power of these nails, plates, screws, and wires, the bone may fail to close. The result is a nonunion fracture. Older adults with bone loss, arthritis, or who have a long history of using steroids (antiinflammatory drugs) are at risk of additional bone fractures around the fixation devices. Malalignment of any healing fracture can present significant problems later with loss of motion, instability, and deformity. But for those patients who get past all that to the end result, the outcomes can be very good (even excellent!). In fact, a recent study comparing two different ways to surgically treat this problem (a nail down through the bone versus a plate screwed in place), 87.5 per cent of the patients reported excellent results. More studies are needed to compare different types of fixation devices for each type of fracture. The information gained from studies like this would help guide surgeons in choosing the best treatment approach for each patient.


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