Transfer
- Transfer is appropriate if inpatient beds or operating rooms are unavailable or if an orthopedic specialist's services are indicated.
Complications
- Neurovascular injury: This includes popliteal artery injury due to displaced distal femur or tibial plateau fractures and peroneal nerve injury due to proximal fibula fractures.
- Compartment syndrome of the lower leg: Signs of compartment syndrome include pain with passive movement of the involved muscles, paresthesias, pallor, and a very late finding of pulselessness.[16] Compartment syndrome by definition has increased compartment pressures; therefore, palpation of the affected area frequently aids in the diagnosis.[16] However, a soft extremity does not rule out compartment syndrome. If compartment syndrome is suspected, obtain an emergent orthopedic consultation and measure the compartment pressures. If untreated, increased compartment syndrome can cause permanent disability.[16]
- Soft-tissue infection
- Osteomyelitis secondary to an open fracture
- Delayed union or nonunion
- Fat embolism
- Thrombophlebitis
- Posttraumatic arthritis or knee stiffness
- Chondromalacia patella
Prognosis
- A good prognosis is expected with patellar and tibial spine or tubercle fractures.
- A fair prognosis is expected with tibial plateau and femoral condyle fractures. A recent prospective study in patients with tibial plateau fractures showed that only 14% of patients recover full quadriceps muscle strength 1 year after injury.[17] Also, 20% will have residual knee stiffness after 1 year.
Patient Education
- For excellent patient education resources, visit eMedicine's Breaks, Fractures, and Dislocations Center. Also, see eMedicine's patient education articles, Knee Dislocation and Knee Injury.[18]
Accousti WK, Willis RB. Tibial eminence fractures. Orthop Clin North Am. Jul 2003;34(3):365-75. [Medline].
Wiss DA, Watson JT, Johnson EE. Fractures of the knee. In: Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1996:1919-2001.
Bharam S, Vrahas MS, Fu FH. Knee fractures in the athlete. Orthop Clin North Am. Jul 2002;33(3):565-74. [Medline].
Thomas AL, Wilson RH, Thompson TL. Quadriceps avulsion through a bipartite patella. Orthopedics. Jun 2007;30(6):491-2. [Medline].
Walker CW, Moore TE. Imaging of skeletal and soft tissue injuries in and around the knee. Radiol Clin North Am. May 1997;35(3):631-53. [Medline].
Gray SD, Kaplan PA, Dussault RG. Acute knee trauma: how many plain film views are necessary for the initial examination?. Skeletal Radiol. May 1997;26(5):298-302. [Medline].
Davis DS, Post WR. Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther. Feb 1997;25(2):103-6. [Medline].
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].
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].
Nichol G, Stiell IG, Wells GA. An economic analysis of the Ottawa knee rule. Ann Emerg Med. Oct 1999;34(4 Pt 1):438-47. [Medline].
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].
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].
Kilgore KP. The knee. In: Emergency Management of Skeletal Injuries. St Louis, Mo: Mosby-Year Book; 1995:439-99.
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].
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].
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].
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].
Koval KJ, Zuckerman JD. Lower extremity fractures and dislocations. In: Handbook of Fractures. 2002:210-234.
Sanders AK, Boggess BR, Koenig SJ. Medicolegal issues in sports medicine. Clin Orthop Relat Res. Apr 2005;38-49. [Medline].
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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