0071643192.pdf

ORTHOPEDICS

TIBIALPLATEAUFRACTURE

■ Most common fracture of the knee

■ Most involve the lateral plateau.

MECHANISM

Impact that drives the femoral condyles into the tibial plateau, such as fall

from height or impact with automobile bumper

DIAGNOSIS

Maintain a high index of suspicion. X-rays (AP, lateral, and oblique views)

often reveal the fracture, but sometimes only show an effusion. CT is some-

times needed to diagnose the fracture.

TREATMENT

■ Nondisplaced fractures can be treated with knee-immobilizer and non-

weight bearing.

■ Displaced fractures require ORIF.

COMPLICATIONS

Popliteal and anterior tibial artery injuries can occur. Associated ligamentous

injuries are present in one-third of cases. Early arthritis can occur if the frac-

ture is intra-articular.

RUPTURE OFEXTENSORMECHANISM OF THEKNEE

CAUSES

■ Quadriceps tendon rupture (>40 years old)

■ Patellar tendon rupture (<40 years old)

■ Patella fracture

■ Avulsion of the tibial tuberosity

MECHANISM

Forceful contraction of quadriceps muscle or fall on a flexed knee

DIAGNOSIS

■ Knee pain and swelling with inability to extend knee

■ May have high-riding patella with patellar tendon rupture

TREATMENT

Orthopedics consult for surgical repair

CHONDROMALACIAPATELLA(PATELLOFEMORALSYNDROME)

This is an overuse syndrome of the articular cartilage of the patella that stems

from malalignment of the patellofemoral tracking complex. It is the most com-

mon cause of knee pain(frequently seen in female athletes) and is often bilateral.

SYMPTOMS/EXAM

■ Anterior knee pain worsens after prolonged sitting, climbing stairs, or squat-

ting. Sticking or buckling of the knee may occur. There is usually no history

of trauma.

Arthrocentesis may be

performed to relieve some of

the pressure associated with a

large joint effusion. If

lipohemarthrosisis present,

this is indicative of an intra-

articular knee fracture.