Iliotibial Band Syndrome

Iliotibial Band Syndrome or 'Ilitibial Band Friction Syndrome' is a common sports injury generally associated with running. This syndrome is bound to cause lateral knee pain in runners. This injury can also be caused by biking, hiking and weight lifting. This Iliotibial band is a thick fibrous tissue that runs from the outside of the pelvis, over the hip, knee and below the knee joint. The band stabilizes the knee during movements like running. The band coordinates with several other thigh muscles and moves from behind the femur in the thigh to the front during the gait cycle. The Iliotibial Band Syndrome refers to the superficial thickening of the tissue that is on the outside of the thigh. Continuous rubbing and flexing of the band causes irritation usually over the outside of the knee joint.

Common causes of the Iliotibial Band Syndrome among runners

• Iliotibial Band Syndrome occurs when the level of activity increases especially among runners who tend to increase their mileage. Increasing distance too quickly or excessive downhill running is a common cause among runners.
  
• Poor training habits in runners can cause this syndrome. While running on an indoor track, the leg bends slightly inwards and this causes extreme stretching of the Iliotibial band and the resultant injury.
  
• Inadequate warm up and cool down sessions among sports persons can cause this syndrome.
  
• While cycling, having the feet 'toed in' at an extreme and excessive angle can cause the Iliotibial band injury.

Individuals with anatomical abnormalities of the leg such as bow legs, high or low arches, overpronation of the foot and uneven leg length are prone to this condition. Muscle imbalance such as weak hip abductor muscles can lead to iliotibial band syndrome.

Symptoms of this syndrome include pain in the knee joint that worsens with continued movement and resolves on rest. There is persistent pain below the knees or stinging sensation just above the knee joint. Often swelling or thickening is noticed at the point of knee joint where the band moves over the femur. Persons suffering these symptoms must avoid running downhill or squatting, playing tennis or basketball and indulging in martial arts.

Treatment for Iliotibial Band Syndrome normally begins with applying ice the area of injury, selection of proper footwear and stretching routine. While icing, the injured part has to be kept elevated as this helps to reduce swelling. Anti-inflammatory medications and cortisone injections may be prescribed to reduce the inflammation. Surgery is rarely resorted to.

Femur fracture

The word 'femur' is taken from Latin meaning 'thigh'. The femur is the thigh bone and it is the largest and strongest bone in the human body. The femur bone extends from the hip to the knee joint. A femur fracture can be life threatening. Since the inside of the thigh is a place of major blood vessels, broken femur means break in the artery. Femur fracture is also called femoral shaft fracture, femur injury, femur stress fracture, fractured femur, femur trauma and femoral diaphyseal fracture. Femur is a tremendously strong bone. It usually requires a great deal of force to break the femur bone. The most common causes for femur fractures include:

• Falls from a great height
  
• Blows that are strong in force
  
• Car accidents and Collisions
  
• Severe twists
  
• Bones weakened by osteoporosis, tumor or infection leading to a condition called pathologic femur fracture.
  

Proximal femur fracture: This involves fracture in the uppermost portion of the thighbone adjacent to the hip joint. are further sub divided into different types.

Femoral shaft fracture: The femoral shaft fracture is a severe injury that occurs during high-speed motor vehicle collisions and significant falls. Injuries caused by femoral shaft fractures are usually severe. Treatment of femoral shaft fracture is always with surgery. The common procedure is to insert a metal rod bone, called 'intramedullary rod' down the center of the thigh. The two ends of the bone are connected by the rod. This intramedullary rod usually remains in the bone for the life of the patient but can be removed if it causes pain and other problems.

Supracondylar femur fracture: In this kind of fracture, the injury occurs just above the knee joint. Cartilage surface of the knee joint is usually involved in this fracture. Patients who sustain supracondylar femur fracture are at high risk of developing knee arthritis later. Supracondylar femur fracture is common in patients with severe osteoporosis. Patients who have undergone total knee replacement surgery also run the risk of this fracture. Treatment for supracondylar femur fracture is highly variable. A cast or brace, external fixator, plate, screws or intramedullary rod are used for treatment.

Symptoms of femur fracture include swelling, bruising and severe pain. There may be numbness or paralysis in the leg below the femur fracture. Femur fractures are apparent and visible in many cases. Apart from clinical examination by the orthopaedic, for non-apparent fractures, a bone scan is required. Treatment for fractures of femur depends upon various factors such as the patient's age, type of fracture, location of the break, bone stability in the injured, mechanism of injury, direction of the blow, factors of twisting, existence of internal bleeding and extent of soft tissue damage. Some of the methods of treatment are:

• Reduction or re-alignment
  
• Immobilization whereby the movement is restricted
  
• Insertion of an intramedullary fixation
  
• A cast
  
• External fixation such as a frame on the outside of the leg anchored into the bone using pins.
  

• Pain or arthritis
  
• Rotational deformity due to misalignment
  
• Infections in open fractures
  
• Uneven leg length
  
• Injury of blood vessels
  
• Nerve damage
  
• Compartment syndrome
  
• Amputation
  
• Failure to heal - 'non-union' is also a possibility
  

Intra articular sepsis, arthritis and knee stiffness are some of the permanent complications that can occur among persons who have undergone femur fracture and treatment. Sometimes femur fracture is bound to cause permanent disability in injured persons. This is due to the thigh muscle pull and incorrect reunion of fragments when they overlap. Femur fracture patients should be careful not to put weight on the leg as this can delay the healing process.

Patella Fracture

A break in the kneecap is known as a fracture of the patella. A fall from a height, a direct blow to the knee and indirect stress are some of the frequent causes of patella fractures. Severe pain, swelling, tenderness and difficulty in straightening the knee are some of the common symptoms associated with patella fracture. Fracture of the patella is also known as kneecap fracture, broken knee, knee fracture and broken patella.

Causes of a Patella Fracture

• Direct force on the patella can result in fracturing the patella.
  
• A fall from a height or a hit to the knee which is very common in contact sports.
  
• During an automobile accident, when a knee that is bent hits against the dashboard and can lead to a patella fracture.
  
• Indirect stress is one reason that can cause patella fracture.
  
• Twisting of the leg.
  
• Muscle contraction that is violent.
  
• Calcium deficiency due to poor nutrition.
  
• Persons who are obese are more prone to this kind of fracture if they suffer a fall.
  
• Joint diseases such as osteoporosis or bone diseases increase the risk of fracture of this kind.

Severe pain and swelling at the area of the fracture is noticed when a person fractures his patella. It will be difficult to move the leg either forward or backward or extend it. There may be swelling and tenderness around the kneecap along with catching or locking of the knee. If bone fragments split enough to bend or twist normal knee contours, deformity of the knee will be apparent. The patient may experience numbness and chill that extends beyond the site of the fracture, if the blood supply at the site gets affected. In a compound fracture or open fracture, the skin is broken by the bone in extreme cases. Immediate attention should be given to this open fracture to avoid infection. The fracture of the patella is classified into three different types.

• As a result of a direct blow an undisplaced fracture of the patella may occur
  
• A direct blow to the front of the knee or a fall can cause a stellate or comminuted fracture. Compromised anterior skin and subcutaneous tissue may be associated with this type of fracture which may be the result of a direct trauma.
  
• The third type is a transverse fracture where there is a gap between the fragments. There is possibility for this fracture when there is a forced, passive flexion of the knee joint is associated with a contraction of the knee joint extenders or the quadriceps muscles.
  

There should not be any delay in realigning the broken bones to reduce the shock. To determine if the patient has suffered a fracture the physician will request for x-rays and stress films after he examines the knee. To immobilize the fracture site, the physician may realign the broken bones and place the knee in a cast or splint only if the fragments of bones are lined up well. Surgery is the other option to remove broken pieces of the knee. A person who has suffered a patella fracture is more prone to knee problems in the future.