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How can multiple fractures in the kneecap be treated?

Q: I am a 35 years old man having multiple fractures in my left kneecap due to slipping at home. The doctor has put a full fibre plaster on the left leg for 4 weeks. Now my left leg and kneecap is paining a lot even after taking painkillers. Is there any antibiotic with which I can get some relief? Is there any option other than a fibre plaster? How can I manage the itchiness inside the plaster?

A:Fracture of the kneecap is a major injury to the knee. This is because the main muscle that straightens the knee is inserted on the kneecap. Usually fracture of the kneecap is pull-off fractures with the fragments lying far apart. Such fractures always need surgical intervention.

In your case the injury seems to be a direct injury and if your doctor has decided to treat you in plaster it is unlikely to be a pull off (avulsion) fracture. Plaster treatment indicates that fracture segments are not separated from the extensor mechanism (the quadriceps muscle patella and ligament complex). Quite often such fractures only need a temporary splint and do not need a plaster. You could easily get the fibreglass cast removed in consultation with your doctor and use only the back of the cast as a splint slab for a week or two and then get on with exercises.

To answer your specific questions:

  1. You do not need antibiotics for pain. Antibiotics are given for infection and not for pain. Antibiotics may relieve pain by controlling infection however; these are not to be misused for pain control.

  2. Fibreglass cast may have become tight because of the swelling in the knee. If it is persistent pain please get the fibre cast cut.

  3. Itching will always be there within a plaster. This is because normal skin keeps shedding the superficial cells, which get washed off when you bathe or wash yourself. When your limb is encased in a plaster, this does not happen. The dead cells keep accumulating in the surface of your skin and it is this, which causes itching. Different techniques are described to reduce the itching at the time of plaster casting. But I do not think they make a significant difference. Any way you normally get used to it in a short time.

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