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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.

    Context

    • 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?

    Justification

    Moderate

    Related Information

    OTHER RELEVANT 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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