Knee Fracture Clinical Presentation

  • Author: Mark Steele, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 9, 2011
 

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.

Tibial eminence fractures [1]

Patients may present with a knee effusion and pain.

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  Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eric L Legome, MD  Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

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

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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  2. Wiss DA, Watson JT, Johnson EE. Fractures of the knee. In: Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1996:1919-2001.

  3. Bharam S, Vrahas MS, Fu FH. Knee fractures in the athlete. Orthop Clin North Am. Jul 2002;33(3):565-74. [Medline].

  4. Thomas AL, Wilson RH, Thompson TL. Quadriceps avulsion through a bipartite patella. Orthopedics. Jun 2007;30(6):491-2. [Medline].

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  7. Davis DS, Post WR. Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther. Feb 1997;25(2):103-6. [Medline].

  8. Hall FM, Hochman MG. Medial Segond-type fracture: cortical avulsion off the medial tibial plateau associated with tears of the posterior cruciate ligament and medial meniscus. Skeletal Radiol. Sep 1997;26(9):553-5. [Medline].

  9. Hardy JR, Chimutengwende-Gordon M, Bakar I. Rupture of the quadriceps tendon: an association with a patellar spur. J Bone Joint Surg Br. Oct 2005;87(10):1361-3. [Medline].

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  11. Stiell IG, Wells GA, Hoag RH. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. JAMA. Dec 17 1997;278(23):2075-9. [Medline].

  12. Mustonen AO, Koskinen SK, Kiuru MJ. Acute knee trauma: analysis of multidetector computed tomography findings and comparison with conventional radiography. Acta Radiol. Dec 2005;46(8):866-74. [Medline].

  13. Kilgore KP. The knee. In: Emergency Management of Skeletal Injuries. St Louis, Mo: Mosby-Year Book; 1995:439-99.

  14. Newton EJ, Love J. Emergency department management of selected orthopedic injuries. Emerg Med Clin North Am. Aug 2007;25(3):763-93, ix-x. [Medline].

  15. Roberts DM, Stallard TC. Emergency department evaluation and treatment of knee and leg injuries. Emerg Med Clin North Am. Feb 2000;18(1):67-84, v-vi. [Medline].

  16. Konstantakos EK, Dalstrom DJ, Nelles ME, Laughlin RT, Prayson MJ. Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective. Am Surg. Dec 2007;73(12):1199-209. [Medline].

  17. Gaston P, Will EM, Keating JF. Recovery of knee function following fracture of the tibial plateau. J Bone Joint Surg Br. Sep 2005;87(9):1233-6. [Medline].

  18. Koval KJ, Zuckerman JD. Lower extremity fractures and dislocations. In: Handbook of Fractures. 2002:210-234.

  19. Sanders AK, Boggess BR, Koenig SJ. Medicolegal issues in sports medicine. Clin Orthop Relat Res. Apr 2005;38-49. [Medline].

  20. Mustonen AO, Koskinen SK, Kiuru MJ. Acute knee trauma: analysis of multidetector computed tomography findings and comparison with conventional radiography. Acta Radiol. Dec 2005;46(8):866-74. [Medline].

 
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