Knee fractures: Difference between revisions

Latest revision as of 21:41, 21 May 2020

Background

Anatomy of anterolateral aspect of right knee.

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

Types

Differential Diagnosis

Knee diagnoses

Acute knee injury

Nontraumatic/Subacute

References

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Most pts with severe ligamentous or meniscal injury have normal radiographs
+[[File:Knee diagram2.png|thumb|Anatomy of anterolateral aspect of right knee.]]
-*Lipohemarthrosis
+*Most patients with severe ligamentous or meniscal injury have normal radiographs
+*Lipohemarthrosis suggests occult fracture
 **Lateral view: Fat-fluid level indicates intra-articular fracture
-==Patella Fracture==
+===Types===
-===Background===
+*[[Patella fracture]]
-*Occurs via direct blow or forceful contraction of quadriceps muscle
+*[[Tibial plateau fracture]]
-*Do not confuse a bipartite patella with a fx
+*[[Segond fracture]]
-===Clinical Features===
+==Differential Diagnosis==
-*Focal patellar tenderness, swelling, effusion
+{{Knee DDX}}
-*Check integrity of knee extensor mechanism by having pt perform straight-leg raise
-===Imaging===
-*AP and lateral
-**Lateral view: Distance from tibial tubercle:lower pole of patella ~ length of patella +/- 20%
-***If greater than this suspect patellar ligament rupture
-*Consider skyline (sunset) view if suspect fx of articular surface
-===Management===
-*Nondisplaced w/ intact extensor mechanism: knee immobilizer, rest, ice
-*Displaced >3mm or disruption of extensor mechanism: above + early referral for ORIF
-==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
-See http://uwmsk.org/schatzker/
-===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==
@@ Line 58: / Line 17: @@
 *[[Knee (Main)]]
-== Source ==
+==References==
-*Tintinalli
+<references/>
-[[Category:Ortho]]
+[[Category:Orthopedics]]