Knee fractures: Difference between revisions
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==Background== | ==Background== | ||
*Most pts with severe ligamentous or meniscal injury have normal radiographs | *Most pts with severe ligamentous or meniscal injury have normal radiographs | ||
*Lipohemarthrosis | *Lipohemarthrosis suggests occult fx | ||
**Lateral view: Fat-fluid level indicates intra-articular fracture | **Lateral view: Fat-fluid level indicates intra-articular fracture | ||
Revision as of 18:59, 1 November 2012
Background
- Most pts with severe ligamentous or meniscal injury have normal radiographs
- Lipohemarthrosis suggests occult fx
- 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 Fracture
- Avulsion fx of margin of lateral tibial plateau just below joint line
- Associated w/ 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
- CT or MRI should be considered if plain film negative but high clinical suspicion
Schatzker Classification
- Schatzker I Lateral split
- Schatzker II Split with depression
- Schatzker III Pure lateral depression
- Schatzker IV Pure medial depression
- Schatzker V Bicondylar
- Schatzker VI Split extends to metadiaphysis
See http://uwmsk.org/schatzker/
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
See Also
Source
- Tintinalli