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    Knee Fractures

    Orthopedic, Trauma

    Last Updated Jun 17, 2023
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    By Joe Finkler, Allie Cui

    First 5 Minutes

    • 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.


    Diagnostic Process

    • 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.


    Recommended Treatment

    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.

    Criteria For Hospital Admission

    Hospital admission should be considered for patients with:

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

    Criteria For Transfer To Another Facility

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

    Quality Of Evidence?



    Related Information


    Reference List

    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.


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