Knee fractures: Difference between revisions
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*Occurs via direct blow or forceful contraction of quadriceps muscle | *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 | ||
===Clinical Features=== | |||
*Focal patellar tenderness, swelling, effusion | |||
*Check integrity of knee extensor mechanism by having pt perform straight-leg raise | |||
===Imaging=== | ===Imaging=== | ||
*AP and lateral | *AP and lateral | ||
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===Background=== | ===Background=== | ||
*Occurs via axial load that drives femoral condyle into tibia | *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 | *Compartment syndrome may occur | ||
*Segond's Fracture | *Segond's Fracture | ||
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**Has strong association with tear of ACL and meniscal ligaments | **Has strong association with tear of ACL and meniscal ligaments | ||
==Imaging=== | ===Imaging=== | ||
*AP, lateral, oblique views (internal for lateral plateau, external for medial plateau) | *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 | **AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it | ||
Revision as of 07:00, 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
Clinical Features
- Focal patellar tenderness, swelling, effusion
- 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
- 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
- ACL and MCL injuries assoc w/ lateral plateau fx
- PCL and LCL assoc w/ medial plateau fx
- 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