Check for lipo- haemarthrosis on lateral knee X-Ray: - Implies intra-articular injury Consider aspirating for analgesia if tense haemarthrosis. Always check hips/abdo if a knee exam is normal Patella # Direct blow, sudden contraction of quadriceps or both Check and document extensor mechanism: Ability to straight leg raise or if pain allows to straighten leg from flexed (more sensitive) Above knee backslab Congenital bi-partite patella may mimic #. Skyline view if unsure. If displaced or multifragmentary – Immediate referral to ortho If undisplaced and able to actively extend - Fracture clinic Patella dislocation Usually lateral after direct blow or sudden muscular contraction. May be recurrent. Often reduced by time of assessment. Tenderness over medial quads attachment may indicate recent dislocation Reduce with adequate analgesia & may require mild sedation: Fully extend knee then gentle pressure to lateral aspect of patella. Cylinder cast or cricket pad splint Fracture clinic - may require urgent MRI +/- repair of medial patello femoral ligament Quadriceps or patellar tendon rupture Abrupt muscular contraction +/- direct blow Check and document extensor mechanism: Ability to straight leg raise or if pain allows to straighten leg from flexed (more sensitive). If diagnosis is in question then USS is helpful. Immediate referral to ortho - tendon must be re-attached surgically Knee ligaments: Isolated medial collateral, lateral collateral, ACL or PCL injuries Injury common in sports Exclude gross instability and posterolateral corner injury (PLCI). Associations: haemarthrosis, capsular tear, meniscal tear or tibial spine #. X-Rays often normal Often too painful to assess clinically at presentation. Crutches and analgesia Must document distal N/V status ED physio appointment at 5-7 days or referral to local physio via patient’s own GP Immediate referral to ortho if gross instability. Refer associated injuries as indicated e.g PLCI Posterolateral corner injury (PLCI) Sport/RTC/Fall. Hyperextension or anteromedial trauma Often missed. Can be associated with knee ligament and nerve injury Dial Test: Patient prone, External rotation of tibia with knee at 30° and 90°. +ve if > 10° difference Immediate referral to ortho Knee dislocation Falls. RTA Neurovascular injury: Consider CT angiogram Must document neurovascular exam. Immediate referral to ortho. Consider concurrent vascular referral Meniscus Twisting injury. True locking. Bucket handle tear = springy block to full extension. Often settles over 2-3 weeks but prone to recurrent locking or giving way Crutches and analgesia Fracture clinic If locked knee despite maximal analgesia – Immediate referral to ortho Knee fractures and Injuries
INJURY SITE TYPICAL MECHANISM PITFALLS/COMPLICATIONS ED/ MIU/ UCC TREATMENT FOLLOW-UP
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Knee fractures and Injuries
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