eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Fracture, Knee

Author: Mark Steele, MD, Associate Dean for Truman Medical Center Programs, Professor, Department of Emergency Medicine, University of Missouri-Kansas City
Coauthor(s): Jeffrey G Norvell, MD, Clinical Assistant Professor of Emergency Medicine, University of Kansas School of Medicine
Contributor Information and Disclosures

Updated: Mar 31, 2008

Introduction

Background

Fractures of the knee include fractures of the patella, femoral condyles, tibial eminence, tibial tuberosity, and tibial plateau. Direct and indirect forces can cause these fractures.

Frequency

United States

Patellar and tibial plateau fractures each account for 1% of all skeletal fractures. Distal femoral condyle fractures account for 4% of all femur fractures.

Mortality/Morbidity

  • Fractures of the knee can result in neurovascular compromise or compartment syndrome, with resultant risk of limb loss. Soft-tissue infection or osteomyelitis can occur with open fractures.
  • Other complications include nonunion, delayed union, osteoarthritis, avascular necrosis, fat embolism, and thrombophlebitis.

Clinical

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
    • 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
    • Tibial eminence avulsion fractures occur most often in children aged 8-14 years but can also occur in the skeletally mature patient.
  • Tibial tubercle fracture
    • Usually occur with jumping activities such as basketball, diving, gymnastics, and football 
    • 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.

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. 

  • 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
    • 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).

Causes

Knee fractures may be caused by the following:

  • Trauma (direct or indirect)
  • Chronic stress
  • Pathologic conditions

More on Fracture, Knee

Overview: Fracture, Knee
Differential Diagnoses & Workup: Fracture, Knee
Treatment & Medication: Fracture, Knee
Follow-up: Fracture, Knee
References
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References

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

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

  4. 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].

  5. 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].

  6. 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].

  7. 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].

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

  9. 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].

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

  11. 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].

  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].

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  14. 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].

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  17. 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].

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

  19. 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].

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

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Further Reading

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Keywords

knee fracture, patellar fracture, patella fracture, femoral condyle fractures, tibial eminence fracture, tibial spine fracture, tibial tubercle fracture, tibial plateau fracture, fracture of the knee, knee injury

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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 College of Emergency Physicians and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Eric Legome, MD, Residency Director, Assistant Professor of Emergency Medicine, Department of Emergency Medicine New York University, New York University Hospital, Bellevue Hospital Center, Manhattan VA
Eric 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.

CME Editor

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, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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