Knee fractures

Background

• Most pts with severe ligamentous or meniscal injury have normal radiographs
• Lipohemarthrosis suggests occult fx
  • Lateral view: Fat-fluid level indicates intra-articular fracture

Differential Diagnosis

Knee diagnoses

Acute knee injury

• Knee dislocation
• Knee fractures
  • Patella fracture
  • Segond fracture
  • Tibial plateau fracture
• Meniscus and ligament knee injuries
• Patella dislocation
• Patellar tendonitis
• Patellar tendon rupture
• Quadriceps tendon rupture

Nontraumatic/Subacute

• Arthritis
• Gout and Pseudogout
• Osgood-Schlatter disease
• Patellofemoral syndrome (Runner's Knee)
• Patellar tendonitis (Jumper's knee)
• Pes anserine bursitis
• Popliteal cyst (Bakers cyst)
• Prepatellar bursitis (nonseptic)
• Septic bursitis
• Septic joint
• DVT

Tibial plateau fracture

Background

• Occurs via axial load that drives femoral condyle into tibia
• ACL and MCL injuries assoc w/ lateral plateau fx
• PCL and LCL assoc w/ medial plateau fx
• Compartment syndrome may occur
• Segond Fracture
  • Avulsion fx of margin of lateral tibial plateau just below joint line
  • Associated w/ tear of ACL and meniscal ligaments

Imaging

• AP, lateral, oblique views (internal for lateral plateau, external for medial plateau)
  • AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it
• CT or MRI should be considered if plain film negative but high clinical suspicion

Schatzker Classification

• Schatzker I Lateral split
• Schatzker II Split with depression
• Schatzker III Pure lateral depression
• Schatzker IV Pure medial depression
• Schatzker V Bicondylar
• Schatzker VI Split extends to metadiaphysis

Schatzker Classification of Tibial Plateau Fractures

Management

• Knee immobilizer w/ non-weightbearing and ortho referral in 2-7d

Disposition

• Indications for referral within 48hr:
  • Significant displacement or depression
  • Suspected or documented ligamentous injury

See Also

• Fractures (Main)
• Knee (Main)

Source

• Tintinalli