Practice Essentials

Fractures of the knee include fractures of the patella, femoral condyles, tibial eminence, tibial tuberosity, and tibial plateau.^{[1, 2]} Direct and indirect forces can cause these fractures, including trauma (direct or indirect), chronic stress, or pathologic conditions. Obtain anteroposterior, lateral, and oblique radiographs of the knee.^{[3, 4]} Arthrocentesis may be of diagnostic and therapeutic benefit for tense effusions. The presence of blood and glistening fat globules indicates lipohemarthrosis, which is pathognomonic for intraarticular knee fracture.

Document the neurovascular status. Apply a sterile dressing to open wounds. Splint the injury. Administer parenteral analgesics for isolated extremity injury. The goal of treatment is a stable, aligned, mobile, and painless knee joint to minimize risk of posttraumatic osteoarthritis.^[5]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.

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 prospective study in patients with tibial plateau fractures showed that only 14% of patients recover full quadriceps muscle strength 1 year after injury and 20% will have residual knee stiffness after 1 year.^[6]

Clinical Presentation

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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, MBA, RDMS Associate Professor, Program Director, Department of Emergency Medicine, University of Kansas Medical Center

Jeffrey G Norvell, MD, MBA, RDMS 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 Professor and Chair, Department of Emergency Medicine, Mount Sinai St Lukes and Mount Sinai West; Vice Chair of Academic Affairs, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai

Eric L Legome, MD is a member of the following medical societies: American College of Emergency Physicians, Eastern Association for the Surgery of Trauma, New York 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.

Sections Knee Fracture Management in the Emergency Department
Overview
Presentation
DDx
Workup
Treatment
Medication
References

Knee Fracture Management in the Emergency Department

Practice Essentials

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