Knee Fracture Follow-up

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

Transfer

Transfer is appropriate if inpatient beds or operating rooms are unavailable or if an orthopedic specialist's services are indicated.

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Complications

Complications include the following:

  • 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. [20] Compartment syndrome by definition has increased compartment pressures; therefore, palpation of the affected area frequently aids in the diagnosis. [20] 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. [20]
  • Soft-tissue infection
  • Osteomyelitis secondary to an open fracture
  • Delayed union or nonunion
  • Fat embolism
  • Thrombophlebitis
  • Posttraumatic arthritis or knee stiffness
  • Chondromalacia patella

Nonunion, infection, posttraumatic arthritis, arthrofibrosis, symptomatic hardware, and extensor mechanism insufficiency have all been described following patellar repair, and the risk of their occurrence may be augmented by patient-, injury-, and treatment-related factors. [21]

In pediatric patients, complications of healing after tibial fractures are uncommon, although some tibial shaft fractures exhibit delayed union or nonunion, infection, and soft-tissue complications. [22]

Tibial tubercle fractures represent high-energy injuries with potential complications such as compartment syndrome and/or vascular compromise. [23]

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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. [24] Also, 20% will have residual knee stiffness after 1 year.

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Patient Education

For excellent patient education resources, visit eMedicineHealth's First Aid and Injuries Center. Also, see eMedicineHealth's patient education articles Knee Dislocation and Knee Injury. [25]

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