• Assess the neurovascular status of the injured extremity. Check for changes in sensation, motor function and pulses distal to the fracture site.
• Look for evidence of obvious deformities or compound fracture.

• The knee is a synovial joint that connects the femur to the tibia and patella, and is stabilized by 4 major ligaments.
  

  Figure 1: Anterior view of the knee joint. https://commons.wikimedia.org/wiki/File: 202108_Anterior_view_of_knee_joint.svg. Image adapted from Wikimedia Commons.

   

• Assess for presence of knee effusion fluid with a positive bulge sign or with the patella tap test.
• Confirm distal neurovascular status.
• Ensure no open (compound) fracture or skin tenting (leads to skin breakdown if not resolved expeditiously).
• Palpate the popliteal space for masses, swelling, and pulse.
• Check for extensor function, as disruption of the quadriceps tendon is routinely missed.
• X-rays are typically ordered as the initial imaging study.

Orthopedic Referral:

• Displaced or open fractures require prompt orthopedic consultation.
• Nondisplaced fractures may be splinted or casted, with orthopedic follow-up care within a few days.

Non-operative Management (with orthopedic follow-up)

• Non-displaced fractures with extensor mechanism in place.
• Immobilization by a cast or knee splint.
  • Long leg cast: Used for knee or lower leg fractures, knee dislocations, or after surgery.

Figure 2: Long leg cast. https://commons.wikimedia.org/wiki/File:Long_leg_cast.jpg. Accessed from Wikimedia Commons.

• • Posterior knee splint: Used for the stabilization of acute soft tissue injuries, patellar fractures/dislocations, or when a cast cannot be applied due to swelling.

Figure 3: Posterior knee splint1.

• Limit weightbearing with the use of crutches for 6-8 weeks to support proper healing.

Hospital admission should be considered for patients with:

• Open, displaced or complex fractures,
• Vascular or neurological compromise, or
• Inability to attend follow-up.

• Requires care that is not available at the current facility.

1. Knee Exam: https://youtu.be/LqRrsVCpuBU

   
   

1. Boyd AS, Benjamin HJ, Asplund C. Splints and Casts: Indications and Methods. afp. 2009 Sep 1;80(5):491–9.

   
   

2. Knee Exam [Internet]. Stanford Medicine 25. [cited 2023 May 19]. Available from: https://stanfordmedicine25.stanford.edu/the25/knee.html

   
   

3. Roberts DM, Stallard TC. Emergency Department Evaluation and Treatment of Knee and Leg Injuries. Emergency Medicine Clinics of North America. 2000 Feb 1;18(1):67–84.