Ultrasound-Guided Geniculate Nerve Block in Combination with Intra-Articular Morphine Injection for Chronic Knee Pain Secondary to Patellar Fracture: A Case Report
Miriam Andrade-Orta
Hospital General León, Institute of Public Health from Guanajuato State, León, México.
Mariel Andrea del Rio-Parra
Hospital General León, Institute of Public Health from Guanajuato State, León, México.
Martha Sofía Cárdenas-Vega
Hospital General León, Institute of Public Health from Guanajuato State, León, México.
Nathalie Lizbeth Torres-Alarcón
Hospital General León, Institute of Public Health from Guanajuato State, León, México.
Aaron Israel Mancera-Torres
Imagenology Service, Hospital General Leon, Institute of Public Health from Guanajuato State, León, México.
Héctor Andrés Romero-González
Imagenology Service, Hospital General Leon, Institute of Public Health from Guanajuato State, León, México.
Aarón Humberto Ramírez-Mora
Hospital General León, Institute of Public Health from Guanajuato State, León, México.
Nicolás Padilla-Ragoza *
Department of Research and Technological Development, Directorate of Teaching and Research, Institute of Public Health from Guanajuato State, Guanajuato, México.
*Author to whom correspondence should be addressed.
Abstract
Background: Patellar fractures represent approximately 1% of all skeletal fractures, with a peak in young adults due to high-energy trauma and another in older adults due to bone fragility. Patients typically present with pain, joint effusion, and a palpable separation of the patella or extensor mechanism insufficiency, resulting in the inability to perform a straight leg raise.
Aims: Chronic knee pain following patellar fractures presents a therapeutic challenge when it persists despite conservative management.
Case presentation: It is present a case of a patient with refractory chronic pain following a patellar fracture and concomitant posterior cruciate ligament (PCL) injury, successfully treated with ultrasound-guided geniculate nerve blocks (superomedial, superolateral, and inferomedial) combined with intra-articular morphine injection. The relevant anatomy, ultrasound approach, and clinical course are described.
Conclusion: This case supports the combined use of minimally invasive interventional techniques as an alternative for chronic post-traumatic knee pain.
Keywords: Geniculate nerve block, patellar fracture, PCL injury, chronic knee pain, intra-articular injection