Knee fractures

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Background

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

Patella

  • Do not confuse a bipartite patella with a fx
  • Imaging
    • AP and lateral
    • Consider skyline (sunset) view if suspect fx of articular surface
  • Positioning
    • Lateral view: Distance from tibial tubercle to lower pole of patella ~ length of patella +/- 20%
      • If > than this suspect patellar ligament rupture

Fibular Neck Fx

  • Often associated w/ severe knee injury including damage to collateral and cruciate ligaments


Tibial Plateau Fx

Background

  • Medial condyle + intercondylar eminence + lateral condule
    • Intercondylar eminence is where ACL attaches
  • 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


Diagnosis

  • TTP
  • Knee effusion

Work-Up

  • AP, lateral
    • AP - line drawn at lateral margin of femur should not have >5mm of tibia beyond it
  • If suspicion high but xray negative consider MRI or CT


Management

  • Plateau Fracture
    • RICE
    • Splint in full extension
    • NWB

Disposition

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