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Knee Fracture Clinical Presentation

  • Author: Mark Steele, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Oct 17, 2015
 

History

Patients with knee fractures may have a history of the following:

  • Direct or indirect trauma with resultant pain and edema
  • Patella fracture - Caused by a direct blow, such as a dashboard injury in a motor vehicle accident or a fall on a flexed knee, also caused by forceful quadriceps contraction while the knee is in the semiflexed position (eg, in a stumble or fall)
  • Femoral condyle fractures due to axial loading with valgus or varus stress
  • Tibial eminence fracture [1] - Due to a direct blow to the proximal tibia with the knee flexed such as falling off a bicycle, also due to hyperextension with varus or valgus stress, such as in motor vehicle collisions or athletic accidents [3] (Tibial eminence avulsion fractures occur most often in children aged 8-14 years but can also occur in the skeletally mature patient. [1] )
  • Tibial tubercle fracture - Usually occur with jumping activities such as basketball, diving, gymnastics, and football [3] , more common in males than in females, more common in adolescents; infrequent in adults
  • Tibial plateau fracture - Caused by axial loading with valgus or varus forces, such as in a fall from a height or collision with the bumper of a car, due to the impaction of the femoral condyle into the tibial plateau (In elderly persons and those with osteoporosis, tibial plateau fracture can occur with minor trauma. Patient is generally unable to bear weight. The lateral tibial plateau is fractured more frequently than the medial plateau.)
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Physical

When examining a patient for a knee fracture, one should first examine the patient for edema, ecchymosis, and point tenderness. A careful neurovascular examination should be performed. Ask the patient to perform a straight-leg raise against gravity to check the integrity of the extensor mechanism, which commonly is disrupted with transverse patellar fractures caused by indirect forces.[2]

Patella fractures

Patients present with pain directly over the patella.

The patient may have pain with leg extension or be unable to extend the knee with a severe fracture.

Femoral condyle fractures

Patient will present with pain over the distal femur and often will have a hemarthrosis.

Patients are often unable to bear weight.

Femoral condyle insufficiency fractures are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression.[4]

Tibial eminence fractures

Patients may present with a knee effusion and pain.[1]

Patients may represent with an avulsion of the tibial attachment of the anterior cruciate ligament.

Tibial tubercle fractures

Patients present with pain over the anterior tibia about 3 cm distal to the articular surface.

In severe fractures, the patient may be unable to extend the knee.

Tibial plateau fractures

Often, patients present with a knee effusion, and tenderness will be present over the medial or lateral plateau.

Up to 30% of tibial plateau fractures are associated with knee ligamentous injuries (medial collateral or anterior cruciate ligaments with lateral plateau fractures, lateral collateral or posterior cruciate ligaments with medial plateau fractures).

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Causes

Knee fractures may be caused by the following:

  • Trauma (direct or indirect)
  • Chronic stress
  • Pathologic conditions
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Contributor Information and Disclosures
Author

Mark Steele, MD Professor, Department of Emergency Medicine, Chief Medical Officer, Truman Medical Center, University of Missouri-Kansas City School of Medicine

Mark Steele, MD is a member of the following medical societies: American Academy of Emergency Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey G Norvell, MD Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine

Jeffrey G Norvell, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Professor Clinical, Department of Emergency Medicine, State University of New York Downstate College of Medicine

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, Council of Emergency Medicine Residency Directors, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Michelle Ervin, MD Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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