Knee Pathology- fractures Flashcards
knee fracture percentages
40% patella
32% tibial plateau
5-10% distal femur, tibial spine
<5% tibial tuberosity, segond fracture
fracture screenings
ottawa knee rule
sn- 90-100%
sp-50%
pittsburgh knee rule
sn->90%
sp- 60%
ottawa knee rule
age 55 or older
isolated tenderness of patella
tenderness over fibular head
unable to flex knee >90
unable to weight bear immediately or 4 steps in ER
pittsburg knee rule
blunt trauma or a fall and…
older than 50 or younger than 12
inability to take 4 steps in ER
imaging options
xray
ct
mri
us
xray
bony assessment
quick and inexpensive
ct scan
bones
more sensitive than xrays
quick, more expensive
MRI
assesses soft tissue injuries
also bony assessment
more time more expensive
dont do with metal in body
ultrasound
non invasive
soft tissues
good for identifying cysts
rehab during immobilization
minimal visits
maximize safe functions
prevent complications
maintain health of other tissues
minimize pressure sores
cardiopulmonary system
rehab for post immobilization
make sure bony stability is achieved
pain control
patient education
progressive manual therapy
HEP
return to desired activities
patellar fracture
MOI- trauma to anterior knee
impact
hyperflexion/ contraction of quadriceps
sunrise xray
transverse most common
bipartate patella
patellar fx treatments
nondisplaced- immobilize 6 wks; decreased wt bearing
displaced- surgery can be necessary; immobilize and limit wt bearing
initiate pain control activities, ROM, strengthening
patellar dislocations
MOI- impact or sudden twisting of knee, valgus
majority dislocate laterally
girls > boys
osteochondral fracture can occur
patellar dislocation rehab
patient education
immobilization - brace
PWB with crutches
PRICE
taping/bracing
NMES
ROM, strengthening,
femoral condyle fracture
MOI- axial loading fall or MVA
femoral condyle fx treatments
traction or bracing
surgery
femoral condyle fx rehab
immobilization
non-weight bearing 3 mo
patient education
ROM
strengthening
prognosis up to a 1 yr
epiphyseal complex fx
pediatric fx
on any long bone
MOI- direct trauma with rotation, hyperextension, valgus stress
5 types
2 is most common
5 is least common and most severe
salter harris 1
S
separated growth plate
salter harris 2
A
above growth plate
most commonn
salter harris 3
L
below growth plate
salter harris 4
T
through growth plate
salter harris 5
ER
erasure of growth plate
least common
most severe
which salter harris types do well without surgery
1 and 2
often immobilized in long leg casts with hip and foot
4-6wks
which SH type may result in malalignment
4
which SH may result in arrest of bony growth
5
tibial spine fracture
intra articular fx
most common in children at 8-14 years old
MOI - rapid acceleration or hyperextension/rotation
Fall from bike very common
Other injuries that can occur at the same time
Osteochondral fracture
ligament injury
Femoral condyle or tibial plateau fracture
tibial spine fx treatment
non-operative for nondisplaced fractures
Surgery for displaced and comminuted fractures
tibial spine fx rehab
immobilization
Weight-bearing restrictions
Education
ROM
Strengthening
Prognosis - usually within six months
Tibial tubercle fracture
most common in adolescence
Males >females
Less than one percent of pediatric fractures
MOI - strong contraction of quads while jumping or during forced knee flexion
tibial tubercle fracture treatments
non-operative for non-displaced or closed reduction injuries
Surgery for displaced or more involved injuries - immobilization
tibial tubercle fracture rehab
cast immobilize
Weight-bearing restrictions
Education
ROM
Strengthening
Prognosis- within six months
tibial plateau fracture MOI
axial loading fall or MVA
Tibial plateau fracture rehab
immobilization as needed
Nonweightbearing up to three months
Patient education
ROM
Strengthening
Prognosis - complications are not uncommon. Moderate functional outcomes are achieved may take greater than a year and increased risk of OA
Tibial plateau fracture treatments
traction or casting
Often less desirable due to inactivity
Surgery
Lots of options
segond fx
avulsion fracture of lateral aspect of the tibial plateau
Often occurs in conjunction with ACL injuries
MOI- most commonly occurs via forceful, internal rotation and varus stretch
Different from common MOI for ACL
segond fx treatments
Address under my injury, most commonly the ACL injury
Surgery for segond fracture may help with rotary stability
segond fx rehab
symptoms management
Protect knee early on
If surgery is performed, follow protocol
tibiofemoral disocation
MOI- severe traumatic injury
Rare .02% of orthopedic injuries
tibiofemoral dislocation treatment
imaging and neurovascular assessment
Reduction
reassessment of neurovascular integrity
Extensive surgery is often needed to reconstruct multiple injuries
tibiofemoral dislocation common complications
Neurovascular damage
avascular necrosis
persistent weakness
Persistent stiffness
Tibiofemoral instability
Patellar instability
Arthritis
physical therapist role during immobilization
Minimal visits
Safe return to function
Protect injured and uninjured tissues
