(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