Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Knee Fracture Treatment & Management

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

Prehospital Care

Document the neurovascular status. Apply a sterile dressing to open wounds.

Splint the injury.

Administer parenteral analgesics for isolated extremity injury.

Next

Emergency Department Care

Care for various fractures is as follows:[15, 16, 17]

Patella fracture

Nondisplaced transverse fractures with an intact extensor mechanism are treated with a knee immobilizer, crutches, restriction to only partial weight bearing, and 6 weeks of immobilization.

Displaced fractures, or fractures associated with a disrupted extensor mechanism, are referred to orthopedics for possible open reduction and internal fixation. A partial or total patellectomy may be required for severe comminution.

Patients with open fractures should receive antibiotics and orthopedics should be consulted for emergency irrigation and debridement.

Femoral condyle fracture

These may be supracondylar, intercondylar, or condylar.

Due to the proximity of the neurovascular structures, a thorough neurovascular examination must be obtained.

Obtain an orthopedic consult. Nonoperative management may be used for nondisplaced or incomplete fractures. Open fractures, displaced fractures, and those with neurovascular injury will need operative fixation.[16]

Tibial spine fracture

For a nondisplaced fracture (and stable knee joint), immobilize the knee.

Obtain an orthopedic consultation for an unstable knee, a complete avulsion of the tibial spine, or a displaced fracture for possible surgical fixation.

Tibial tubercle fracture

For nondisplaced fractures, immobilize the knee.

Obtain an orthopedic consultation for displaced fracture to consider open reduction and internal fixation.

Tibial plateau fracture

Immobilize nondisplaced fractures and have patient remain nonweightbearing.

Obtain an orthopedic consultation for displaced (depressed) fractures, which require open reduction and internal fixation.[18] Articular depression of greater than 3 mm may be considered for surgery.

The goal of treatment is a stable, aligned, mobile, and painless knee joint to minimize risk of posttraumatic osteoarthritis.[19]

Previous
Next

Consultations

Orthopedic referral is recommended for all knee fractures. Nondisplaced fractures may be splinted, with orthopedic follow-up care within a few days. Displaced or open fractures require prompt orthopedic consultation.

Previous
 
 
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.

References
  1. Accousti WK, Willis RB. Tibial eminence fractures. Orthop Clin North Am. 2003 Jul. 34(3):365-75. [Medline].

  2. Wiss DA, Watson JT, Johnson EE. Fractures of the knee. 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. 2002 Jul. 33(3):565-74. [Medline].

  4. Plett SK, Hackney LA, Heilmeier U, Nardo L, Yu A, Zhang CA, et al. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome. Skeletal Radiol. 2015 Aug 20. [Medline].

  5. Walker CW, Moore TE. Imaging of skeletal and soft tissue injuries in and around the knee. Radiol Clin North Am. 1997 May. 35(3):631-53. [Medline].

  6. Gray SD, Kaplan PA, Dussault RG. Acute knee trauma: how many plain film views are necessary for the initial examination?. Skeletal Radiol. 1997 May. 26(5):298-302. [Medline].

  7. Davis DS, Post WR. Segond fracture: lateral capsular ligament avulsion. J Orthop Sports Phys Ther. 1997 Feb. 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. 1997 Sep. 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. 2005 Oct. 87(10):1361-3. [Medline].

  10. Nichol G, Stiell IG, Wells GA. An economic analysis of the Ottawa knee rule. Ann Emerg Med. 1999 Oct. 34(4 Pt 1):438-47. [Medline].

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

  12. Molenaars RJ, Mellema JJ, Doornberg JN, Kloen P. Tibial Plateau Fracture Characteristics: Computed Tomography Mapping of Lateral, Medial, and Bicondylar Fractures. J Bone Joint Surg Am. 2015 Sep 16. 97 (18):1512-20. [Medline].

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

  14. Lazaro LE, Wellman DS, Klinger CE, Dyke JP, Pardee NC, Sculco PK, et al. Quantitative and qualitative assessment of bone perfusion and arterial contributions in a patellar fracture model using gadolinium-enhanced magnetic resonance imaging: a cadaveric study. J Bone Joint Surg Am. 2013 Oct 2. 95(19):e1401-7. [Medline].

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

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

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

  18. Lee TC, Huang HT, Lin YC, Chen CH, Cheng YM, Chen JC. Bicondylar tibial plateau fracture treated by open reduction and fixation with unilateral locked plating. Kaohsiung J Med Sci. 2013 Oct. 29(10):568-77. [Medline].

  19. Forman JM, Karia RJ, Davidovitch RI, Egol KA. Tibial Plateau Fractures with and without Meniscus Tear - Results of a Standardized Treatment Protocol. Bull Hosp Jt Dis (2013). 2013. 71(2):144-51. [Medline].

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

  21. Petrie J, Sassoon A, Langford J. Complications of patellar fracture repair: treatment and results. J Knee Surg. 2013 Oct. 26 (5):309-12. [Medline].

  22. Herman MJ, Martinek MA, Abzug JM. Complications of tibial eminence and diaphyseal fractures in children: prevention and treatment. Instr Course Lect. 2015. 64:471-82. [Medline].

  23. Pandya NK, Edmonds EW, Roocroft JH, Mubarak SJ. Tibial tubercle fractures: complications, classification, and the need for intra-articular assessment. J Pediatr Orthop. 2012 Dec. 32 (8):749-59. [Medline].

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

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

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

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

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.