Knee fractures
Revision as of 19:50, 29 September 2014 by Rossdonaldson1 (talk | contribs)
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
Differential Diagnosis
Knee diagnoses
Acute knee injury
- Knee dislocation
- Knee fractures
- Meniscus and ligament knee injuries
- Patella dislocation
- Patellar tendonitis
- Patellar tendon rupture
- Quadriceps tendon rupture
Nontraumatic/Subacute
- Arthritis
- Gout and Pseudogout
- Osgood-Schlatter disease
- Patellofemoral syndrome (Runner's Knee)
- Patellar tendonitis (Jumper's knee)
- Pes anserine bursitis
- Popliteal cyst (Bakers cyst)
- Prepatellar bursitis (nonseptic)
- Septic bursitis
- Septic joint
- DVT
Patella fracture
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
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