Knee Fracture Management in the Emergency Department

Updated: Apr 13, 2020
  • Author: Mark Steele, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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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]