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Author Topic: What causes a stellate fracture?  (Read 890 times)

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Offline miked1014

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What causes a stellate fracture?
« on: October 05, 2014, 03:07:48 AM »
Hi,

Been having problems with the knee (you can see my earlier long winded post for exhaustive details). I had an MRI performed mid August. My GP called me up the next day, telling me to go to emerg as it appears to be an infection of the joint.

To summarize the MRI,

Ligaments are all good, except the medial side, which is bowed, probably from the displaced meniscus (what remained from the displaced medial meniscus, as it was shredded). Lateral meniscus was still good. There is evidence of a patellar tendinosis which is consistent with an old patellar fracture.

There is gross disruption of the articular surfaces and multiple fragmentation of the weight bearing surfaces on the medial femoral condyle. Lots of bone fragments. In the lateral compartment, evidence of a subcortical oreintated compression fracture. Lots of joint effusion and edema.

The conclusion was there was a destructive process with the medial femoral condyle destroyed. Primary consideration should be given to a septic joint. It was noted that joint aspiration tests showed no bacteria and there was no elevation in blood markers to indicate infection. Thought it might be a TB infection or acid bacteria.

I originally suggested that it was probably physical destruction of the joint, as I tried to walk with this injury. They showed me the MRI, and there was definitely a big pit - which at first I thought could be an infectious process. However, in hindsight, the pit had a very unique shape which the intern suggested was a shark bite (a bacterial pit in pipe walls forms little ridges, so the sharp star pit is different than what I am familiar with). I believe this is called a stellate fracture.

I agreed to a synovectomy, debridement, and sampling for infection. The left meniscus remains, but pretty much everything else was taken out.

The infectious disease fellow wanted to start me on vancomyacin treatment even with no infection identified, which I said no to. After a week, a staph hominous infection was grown, and Ancef was found to be effective. I agreed to IV treatment with Ancef.

The rheumatologist and I are thinking now that there was no infection and it was continued destruction from old injuries (plus caring around more weight then I need).

Using my non-exhaustive review of the literature, it appears that there can be "stellate" fractures when there is a direct blow to the knee.

Is it common to find stellate chunks of bone missing in the joint? Its just such a strange shape for a pit.

I am going to see if I can get a copy of the MRI film, all my x-rays and surgical reports. In the end, it won't really matter, as I am now a TKR patient if I ever want to walk normally again. I just don't see how a stellate would form (maybe I need to find a theoretician to ask).

Cheers,
Mike
















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