JANU BHAGNAM (PATELLAR FRACTURE)

  • 🔺 CASE STUDY: JANU BHAGNAM (PATELLAR FRACTURE)

    (Janu Bhagnam = Fracture involving the patella/knee region)


    🔺 NIDANAM (ETIOLOGICAL FACTORS)

    • Abhighāta (trauma)

    • Chyuta sthāna (joint dislocation or misalignment)

    • Balavat vegāt cha patanam (fall from height or forceful impact)

    • Vega dhāraṇa (suppression of natural urges, leading to Vata vitiation)

    • Asātmya yoga (improper use of body/mind)

    Classical References:

    • Sushruta Samhita, Chikitsa Sthāna 3/6

    • Charaka Samhita, Chikitsa Sthāna 28


    🔺 PURVAROOPAM (PRODROMAL SYMPTOMS)

    • Stiffness and pain in the knee joint

    • Swelling or discomfort

    • Reduced range of motion

    • Joint instability and weakness


    🔺 LAKSHANA (SIGNS AND SYMPTOMS)

    • Vedanā (severe pain)

    • Śopha (swelling at knee)

    • Asvasthāna (joint instability)

    • Chalana (abnormal movement at fracture site)

    • Kriyāhāni (inability to walk or use joint)

    • Raktasrāva (bleeding in open fractures)

    • Sphutana śabda (crackling sound during injury)

    Reference: Sushruta Samhita, Chikitsa Sthāna 3/13–15


    🔺 GENERAL AND SYSTEMIC EXAMINATION

    • General:

      • Observation: Swelling, deformity, ecchymosis, gait disturbance

      • Palpation: Tenderness, crepitus, warmth, abnormal bony protrusions

      • Movement: Painful/restricted

      • Gait: Limping or unable to bear weight

    • Systemic:

      • Vitals: Pulse, BP, respiratory rate (check for shock)

      • Neurological exam: Peroneal nerve (check for foot drop)

      • Vascular exam:

        • Distal pulses (dorsalis pedis/posterior tibial)

        • Capillary refill time


    🔺 LABORATORY INVESTIGATIONS

    • CBC – to rule out anemia or infection

    • ESR / CRP – elevated in inflammation

    • Coagulation profile – prior to surgery

    • Blood group & cross-matching – if surgery is indicated

    • Serum calcium, Vitamin D – in elderly or osteoporotic patients


    🔺 RADIOLOGICAL INVESTIGATIONS

    • X-ray (AP and lateral knee) – confirms type/location of fracture

    • MRI – evaluates soft tissue injury (ACL, PCL, meniscus)

    • CT scan – for intra-articular/complex fractures

    • USG – for effusion, soft tissue evaluation

    • Doppler – if vascular injury suspected


    🔺 DIFFERENTIAL DIAGNOSIS

    • Patellar fracture

    • Distal femur fracture

    • Proximal tibial fracture

    • Knee dislocation

    • Ligament injuries (ACL, PCL, MCL, LCL)

    • Meniscal tear

    • Septic arthritis

    • Osteoarthritis flare

    • Prepatellar bursitis

    • Synovial sarcoma (rare)


    🔺 SAMPRAPTI (PATHOGENESIS)

    • Abhighāta → Vata prakopa → Bhagna (fracture)

    • Vata affects Asthi & Sandhi, causing:

      • Shoola (pain)

      • Sthambana (stiffness)

      • Chalana (abnormal movement)

      • Kriyā hāni (functional loss)

    Samprapti Ghataka:

    • Dosha: Vata

    • Dushya: Asthi, Majjā

    • Adhisthāna: Janu sandhi (knee joint)

    • Roga mārga: Abhyantara


    🔺 SAMANYA CHIKITSA (GENERAL MANAGEMENT)
    (As per Sushruta's Bhagna Chikitsa principles)

    • Shamana & Brimhana:

      • Sneha abhyanga with Mahanārāyaṇa taila or Dhanvantaram taila

      • Nādi swedana – to relieve stiffness

      • Vatahara, brimhana āhāra – milk, ghee, black gram, sesame

    • Bhagna Sthāpana Vidhi (Fracture Management):

      • Avasthāpana – proper bone setting

      • Bandhana – immobilization with splints or support

      • Bheshaja – internal medicines to aid bone healing

    Reference: Sushruta Samhita, Chikitsa Sthāna 3/44–50


    🔺 UPASHAYA (RELIEVING FACTORS)

    • Immobilization and elevation

    • External Sneha & Swedana

    • Nourishing (Brimhana) diet

    • Asthi dhātu poshaka drugs – Laksha, Guggulu


    🔺 ANUPASHAYA (AGGRAVATING FACTORS)

    • Limb movement

    • Exposure to cold wind (vata-vardhaka)

    • Improper bandaging

    • Rūkṣa, laghu, katu-tikta dominant food


    🔺 VISHESHA CHIKITSA (SPECIFIC TREATMENT)

    • Internal Medicines:

      • Lakshādi Guggulu

      • Abha Guggulu

      • Asthishrinkhalā (Cissus quadrangularis)

      • Ashwagandhā, Shatāvarī – for nourishment

      • Dashamoola kaṣāya – for Vatahara effect

    • External Therapies:

      • Abhyanga with Mahanārāyaṇa taila

      • Upanāha sweda – poultice with vatahara herbs

      • Lepa – Laksha choorna + taila application


    🔺 SURGICAL / ORTHOPEDIC MANAGEMENT (IF DISPLACED)

    • Traction, reduction, and immobilization (bandhana)

    • Rest period: 21–45 days depending on bone & injury severity

    • Physiotherapy and movement to follow after union

    Reference: Sushruta Samhita, Chikitsa Sthāna 3/56–60


    🔺 REHABILITATION

    • Mild basti therapy with Eranda taila or Dashamoola taila

    • Progressive physiotherapy after union

    • Brimhana diet: milk, ghee, urad, sesame

    • Yoga and gentle joint movements after full recovery