Makindo Medical Notes.com

Tibial plateau

Common: Longitudinal compression or blow to lateral side of knee (lateral tibial plateau). High violence injury in young

Common peroneal nerve may be damaged.

Above knee backslab. Will usually require fixation. Undisplaced fractures may be treated non-operatively. Consider urgent CT to assess fully

Immediate referral to ortho

Mid shaft tibia

Direct blow or rotational force.

Compartment syndrome

Above knee POP and split cast. Analgesia.

Open fractures should be transferred to trauma centre.

Immediate referral to ortho for elevation and compartment syndrome observation.

Toddler’s #.

Undisplaced midshaft, spiral # in a walking child <7yrs old

Often minimal force. Consider NAI if before walking age. Ability to crawl without discomfort indicates that the pathology is below the knee

May not be evident on initial films.

Periosteal reaction is often visible on repeat film at day 10

Long leg cast.

If no # initially evident then review in local MIU/ED in 2 days. If persistent refusal to weight- bear then replace cast and repeat XR at day 10 post-injury

See also pathway on management

of limping child

Fracture clinic when # evident on XR

Osgood Schlatter’s Disease

Recurrent pain, tenderness & swelling over tibial tubercle usually in teenagers.

May have associated # of tibial tuberosity but this can be tricky to distinguish from usual appearance. X-ray is not always required.

Analgesia, rest and reassurance.

Discharge Patient’s own GP can refer on to physio as needed

Fibula Head or shaft

Rarely # in isolation. Isolated # may occur with direct blow. Displacement seldom severe.

Common peroneal injury: Check ankle dorsiflexion Check for integrity of ankle as may have rupture of inferior tibio-fibular ligament or medial ligament complex.

If isolated and stable, patients can present after several days. Analgesia and walking below knee cast if needed. Some don’t require a cast, but manage to partially WB with crutches

Fracture clinic for isolated # Refer associated injuries as indicated