Knee Trauma

Question 1

Patellar fracture

• causes
• presentation
• types of injury and management

Answer 1

Direct injury
-pain, difficulty standing, walking

Undisplaced

• Older adults => bandage, ortho referral
• Young => knee cast

Displaced/comminuted

• internal fixation/excision
• ortho referral

Question 2

Dislocated patella

• pathophysiology
• presentation
• investigations
• management

Answer 2

Medial patellofemoral ligament => lateral shift of patella
-from leg twisting or direct blow from side

Pain
Knee instability, locking

Xray - rule out osteochondral fracture

Reducible with N2O
Aspirate large effusions
POP cylinder with fracture clinic follow up

Question 3

Segond fracture

• pathophysiology
• presentation
• management

Answer 3

Avulsion of soft tissue from lateral tibial plateau

• from medial rotation, varus stress => abnormal tension on lateral sides
• ACL, medial/lateral meniscus most often affected

Pain, swelling, low ROM

Surgical intervention

Question 4

Tibial plateau fractures

• pathophysiology
• presentation
• management

Answer 4

Strong force on lower leg
-RTAs, high impact accidents

Swelling, bruise, pain
Inability to weight bear
Low ROM

Surgical intervention

Question 5

Fractured tibial/fibula shaft

• causes
• presentation
• management

Answer 5

High energy collisions

• cannot weight bear, leg instability
• bone tending over skin at fracture site/open fracture

Assess for

• common peroneal nerve injury at neck
• compartment syndrome

Nonsurgical => splint/cast

• unsuitable for surgery
• closed fracture with minimal mv
• splint/cast

Surgical => IMD/plates screws/ext fixation

• open, many fragments, very displaced
• no recovery with nonsurgical

Question 6

Pretibial lacerations

• pathophysiology
• management

Answer 6

V thin skin with poor blood supply => slow healing

Avoid suturing
-use steristrips

Keep leg elevated
Rest leg but move foot and knee to reduce DVT risk
Monitor for signs of infection

Question 7

GENERAL ASSESSMENT FOR LIMB INJURIES

Answer 7

Mechanism of injury
Xray joint, above and below
Assess neurovasculature
Analgesia
Fluids especially in femoral fractures
WATCH OUT FOR COMPARTMENT SYNDROME
Refer to ortho if in doubt