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.
- 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.
- 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.
- 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.
- 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?
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
OTHER RELEVANT INFORMATION
Knee Exam: https://youtu.be/LqRrsVCpuBU
Boyd AS, Benjamin HJ, Asplund C. Splints and Casts: Indications and Methods. afp. 2009 Sep 1;80(5):491–9.
Knee Exam [Internet]. Stanford Medicine 25. [cited 2023 May 19]. Available from: https://stanfordmedicine25.stanford.edu/the25/knee.html
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.
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by Emergency Care BC (formerly the BC Emergency Medicine Network) and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. Emergency Care BC is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. Emergency Care BC also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Jun 17, 2023
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