Mechanisms Of Injury Assignment Question
Mechanisms of injury
There are two-part mechanisms that can lead to this condition of which are ought to be of significant energy. One of the mechanisms can be attributed to a case whereby an axial load happens to be applied with either a concurrent varus or even valgus force applied at the knee. There are also the lateral plateau fractures that usually happen to be the most common fractures on medial plateau being around 10-23% while the bicondylar features representing 10-30%. Another thing that must be closely watched cautiously is the joint distraction force that tends to occur on the opposite condyle (Rytter et al. 2009). This at times shows up as soft tissue injury. It is also good to note that high energy injuries tend to mostly occur to young patients while the elderly happen to mostly occur just as shown in figure (2) (A-B).
Just as shown in the above figure, (figure 3), a horizontal beam lateral knee is used to demonstrate this condition known as lipohaemarthrosis. What makes this image even more useful especially when it comes to the subtle lipohaemarthrosis is a simple fact that there are no superimposed quadriceps tendons. On the other hand, the image seems to have some limitations to its use due to the fact that there is a great possibility of the patient with this fracture not being able to move (Hall, 1975). This condition is usually or rather commonly referred to as the snow globe effect. Basically, a snow globe is a toy that is usually shaken with the aim of producing an effect like that of falling snow. The same phenomenon witnessed here can also be observed during the presentation of this condition. When it comes to some patients, a very indistinct fat-blood interface might be witnessed during the initial plain film image of the lipohaemarthrosis of the knee. Some conclusion was made that this demonstration could be as a result of the mixing of both the blood and fat that is mostly associated with the movements made by the patient when moving to the X-ray table or even those of the stretcher as the patient is being transported in the scan department (Hall, 1975). The movement can be associated with the shaking of the snow globe which as a result mixes the fluid inside the globe and hence producing the snowing effect. The very patient will also happen to show a fat-blood interface that will definitely be sharply defined several minutes later after the test has been concluded. These representations are clearly shown on figure 4 and 5 respectively.
Basically, fat floats on water, the same case applies in this situation whereby the marrow that is usually fatty is separated from water that is usually based in the blood. When it comes to the pain radiograph, since the beam happens to be tangential to the blood fat interface, then this makes it possible to see the fat fluid level on any horizontal beam radiograph. As for the knee, the best view can only be achieved through the utilization of the cross-table horizontal lateral view. However, this fat should not be confused at all with the suprapatellar fat pad that happens to lie posterior to the quadriceps tendons as well as anterior to the pouch. The two can be distinguished through the massaging of the suprapatellar which will in turn cause the fat-fluid level to disappear due to the mixing figure (6).
Effects, treatment and complications
In this condition, the patient happens to experience a lot of pain from the knee region. There is also usually the swelling of the knee mostly due to the accumulation of the fluid. The management of the conditions is through surgery by an orthopedic surgeon (Campbell, 2012, pp. 6). These procedures will depend on many factors such as the fracture pattern, joint displacement, extend of soft tissue injury and also the comorbidities and the functional demands of that patient. The indication for the operative management is not absolute but has been suggested for fractures with the articular step of 3mm or more, a valgus tilt of over 50 or condylar widening of over 5mm (Campbell, 2012, pp. 6). Complications that may arise include the proximity of veins to both the bone and the soft tissues are disrupted. There are also common long term complications such as secondary osteoarthritis that might result from the damage of the chondral during the time of injury, residual articular discontinuity or the disruption of the mechanical axis postoperatively.