KNEE FRACTURE Flashcards
DDX
KNEE DISLOCATION
PATELLAR DISLOCATION
DISTAL FEMUR FRACTURE
Supracondylar
Intercondylar
Condylar
Distal Femoral Epiphyseal
PROXIMAL TIBIA FRACTURE
(at or above the tuberosity)
Tibial Plateau
Tibial Tuberosity
Tibial Epiphyseal (children)
Tibial subcondylar
PATELLAR FRACTURE
FIBULAR HEAD FRACTURE
DOCUMENTATION
PHYSICAL EXAM
INSPECT
pain, ecchymosis, effusion, and deformity.
leg shortening and external rotation of the femoral shaft.
varus or valgus deformity.
Assess for open fracture:
PALPATE
Patella
Tibeal Plateau
Fibular Head
Femoral / Patellar Tendon
Knee effusion
Popliteal space for hematoma
ROM
Note maximum range
STRAIGHT LEG TEST: ASSESS EXTENSOR MECHANISM
CHECK PULSES
Popliteal artery
Popliteal pulse
Distal Pulse
ABI if concern
NEUROLOGICAL EXAM
Drop Foot (peroneal n.)
Web Space between first and second toe (peroneal n. )
OTTAWA ANKLE RULES
X-ray is recommended for patients with knee trauma and the following:
Age >55 y
Isolated tenderness to patella*
Unable to flex to 90°
Tenderness at head of fibula
Unable to bear weight both immediately after injury and in the ED (4 steps)**
Clinically significant fracture can be ruled out with pooled sensitivity and specificity of 98.5% and 48.6%, respectively.
If used, these rules reduce knee X-ray by 25%-50%
XRAY: INTERPRETATION
AP, Lateral, Oblique +/- Sunrise
Check AP, Lateral, Oblique: TAB
Tibial Plateau
Alignment
Bones
Sunrise View: Patellar Fracture
CTA if abnormal ABI OR signs of arterial insufficiency
CT KNEE:
concerns for occult fracture not visible on X-rays, nonunion, or malunion.
CT/MRI can be used to assess for associated tendon and ligament injuries.
MANAGEMENT: TIBIAL PLATEAU
MANAGEMENT: PATELLAR FRACTURE
MECHANISM
Direct fall on anterior knee
OR
Forcefull contraction of the knee
CLINICAL FEATURES
Focal patella tenderness
Swelling
Effusion
Check integrety of extension mechanism with straight leg raise
XRAY
Knee Series: AP / Lat
Include Skyline view of patella
May be undisplaced, transverse, lower or upper pole, communuted, vertical
MANAGEMENT: NON OPERATIVE
Intact extensor mechanism
Minimally displaced / non-displaced
<2 mm of step-off
<3 mm of fracture displacement
knee immobilizer, in extension
Rest
Ice
ortho follow-up in ~1 week
MANAGEMENT: OPERATIVE
Open
Communuted
NV Compromise
Avulsion
> 2 mm articular step-off
> 3 mm fractment separation
Disruption of extensor mechanism
Knee Immobilizer
Rest
Ice
Analgesia
Referral to Ortho from ED
