Knee fractures: Difference between revisions
m (moved Knee (Fx) to Knee Fracture) |
No edit summary |
||
| Line 2: | Line 2: | ||
*Most pts with severe ligamentous or meniscal injury have normal radiographs | *Most pts with severe ligamentous or meniscal injury have normal radiographs | ||
*Lipohemarthrosis | *Lipohemarthrosis | ||
**Lateral view | **Lateral view: Fat-fluid level indicates intra-articular fracture | ||
==Patella== | ==Patella Fracture== | ||
===Background=== | |||
*Occurs via direct blow or forceful contraction of quadriceps muscle | |||
*Do not confuse a bipartite patella with a fx | *Do not confuse a bipartite patella with a fx | ||
===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 | |||
**Lateral view: Distance from tibial tubercle | *Consider skyline (sunset) view if suspect fx of articular surface | ||
***If | ===Management=== | ||
*Nondisplaced w/ intact extensor mechanism: knee immobilizer, rest, ice | |||
== | *Displaced >3mm or disruption of extensor mechanism: above + early referral for ORIF | ||
* | |||
==Tibial Plateau | ==Tibial Plateau Fracture== | ||
===Background=== | ===Background=== | ||
* | *Occurs via axial load that drives femoral condyle into tibia | ||
*Ligamentous and meniscal injuries are common | *Ligamentous and meniscal injuries are common | ||
*Compartment syndrome may occur | *Compartment syndrome may occur | ||
| Line 27: | Line 26: | ||
**Has strong association with tear of ACL and meniscal ligaments | **Has strong association with tear of ACL and meniscal ligaments | ||
== | ==Imaging=== | ||
*AP, lateral, oblique views (internal for lateral plateau, external for medial plateau) | |||
*AP, lateral | |||
**AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it | **AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it | ||
*If suspicion high but | *If suspicion high but x-ray negative consider MRI or CT | ||
===Management=== | ===Management=== | ||
* | *Knee immobilizer w/ non-weightbearing and ortho referral in 2-7d | ||
===Disposition=== | ===Disposition=== | ||
| Line 48: | Line 38: | ||
**Significant displacement or depression | **Significant displacement or depression | ||
**Suspected or documented ligamentous injury | **Suspected or documented ligamentous injury | ||
[[Category:Ortho]] | [[Category:Ortho]] | ||
Revision as of 06:50, 12 February 2012
Background
- Most pts with severe ligamentous or meniscal injury have normal radiographs
- Lipohemarthrosis
- Lateral view: Fat-fluid level indicates intra-articular fracture
Patella Fracture
Background
- Occurs via direct blow or forceful contraction of quadriceps muscle
- Do not confuse a bipartite patella with a fx
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
- Lateral view: Distance from tibial tubercle:lower pole of patella ~ length of patella +/- 20%
- 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
- Ligamentous and meniscal injuries are common
- Compartment syndrome may occur
- Segond's Fracture
- Avulsion fx of margin of lateral tibial plateau just below joint line
- Has strong association with 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
- If suspicion high but x-ray negative consider MRI or CT
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