Knee Fracture Treatment & Management

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

Prehospital Care

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

Splint the injury.

Administer parenteral analgesics for isolated extremity injury.

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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]

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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.

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