KNEE INJURIES

• Make note of joint effusion, tenderness,

increased temperature, strength, sensation, and
location of pulses.
• Examine the patella for size, shape, and location
with the knee in flexion

NEUROVASCULAR INJURIES
• Popliteal artery injury
• Peroneal nerve injuries

OTTAWA KNEE RULES

PITTSBURGH KNEE RULES

PATELLA FRACTURES

Most common is the TRANSVERSE patella fracture

LIGAMENTOUS AND MENISCAL INJURIES

ASSESSMENT
• Assess gait, functional range of motion, and the
ability to perform a straight leg raise
• Check the knee for ecchymoses, swelling,
effusion, masses, patella location and size,
muscle mass, erythema, and evidence of local
trauma
• Determine whether leg lengths are equal or
unequal
• Palpate the patella, patellar facets, proximal
fibula, and femoral and tibial condyles for pain
and crepitus
DIAGNOSIS FOR ANTERIOR CRUCIATE LIGAMENT INJURY PIVOT SHIFT

LACHMAN TEST

DIAGNOSIS FOR POSTERIOR CRUCIATE LIGAMENT INJURY

ANTERIOR DRAWER TEST
LIGAMENTOUS INJURIES • a severely injured knee that is unstable in
• with a knee immobilizer multiple directions raises suspicion of a
• ice packs spontaneously reduced knee dislocation
• Elevation • timely reduction of the dislocated knee is
• nonsteroidal anti-inflammatory drugs essential. Apply longitudinal traction to the
• ambulation as soon as is comfortable for the affected knee. Document neurovascular status of
patient the extremity before and after reduction.
• surgical • Splint the lower extremity with the knee at 20
• arthrocentesis degrees of flexion after dislocation reduction to
prevent redislocation
• Reimage after splint application
MENISCAL INJURIES
• Hospitalization is required along with emergent
• If a tentative diagnosis of a meniscal tear is
orthopedic and vascular surgery consultation
considered, refer to an orthopedic surgeon or
the patient’s primary care provider and instruct
partial weight bearing, as tolerated PATELLAR DISLOCATION
• Definitive diagnosis can be made by MRI or • Reduction
arthroscopy, with the latter also allowing for • Knee immobilizer
definitive surgical treatment (usually • Surgery
partial meniscectomy or meniscal repair).
QUADRICEPS OR PATELLAR TENDON RUPTURE
LOCKED KNEE • Quadriceps or patellar tendon rupture disrupts
• describes when a knee cannot actively or the extensor mechanism of the knee
passively fully extend • Immobilization and close follow up
• Historically the treatment includes one attempt • Surgery
at closed reduction under procedural sedation
• Position the patient with the leg hanging over PATELLA ALTA
the edge of the table and the knee in 90 degrees
of flexion
• After a period of relaxation, apply longitudinal
traction to the knee, along with internal and
external rotation, in an attempt to unlock the
joint. If this maneuver is unsuccessful,
orthopedic consultation for operative
arthroscopy is indicated
• If the unlocking is successful, referral to an
orthopedist for MRI and/or
arthroscopy is appropriate.

KNEE DISLOCATION

PATELLAR TENDINITIS
• Jumper’s knee
• nonsteroidal anti-inflammatory drugs
• Eccentric quadriceps-strengthening exercises
• activity modification
• Steroid injections predispose to tendon rupture
and thus should be avoided
LEG INJURIES
GENERAL TREATMENT
• Cleanse wounds and debride loose tissue and
foreign material.
• Administer tetanus immunizations
• Splint fractures before obtaining radiographs;
this will prevent further damage to soft tissue
caused by movement of bone fragments.
• Irrigate open wounds and administer parenteral
antibiotics for open fractures
TIBIAL SHAFT INJURIES
• A long leg splint from high above the knee with
the knee at 5 degrees of flexion and the foot in
slight plantarflexion can be applied.
• Tight-fitting splints or casts may increase the risk
of compartment syndrome
PILON FRACTURES
• an axial force on the foot can drive the talus into
the articular surface of the tibia, grinding or
crushing the distal tibia
• tibial plafond fracture
• Pilon fractures may be accompanied by
compartment syndrome or by vertebral body
fractures, particularly a fracture of the first
lumbar vertebrae (L1)
• The goal of treatment is reduction of the fracture
fragment and optimal alignment of the articular
surfaces
• An external fixation device may temporarily be
used to allow this tissue time to heal before
definitive surgery
• If compartment syndrome is suspected –
fasciotomy
PROXIMAL FIBULA FRACTURE
• MAISSONNEUVE’S FRACTURE
• results from an external rotation force applied to
the foot
• The surgical treatment for this injury is to reduce
and stabilize the fractured medial malleolus and
to secure the fibula to the distal tibia, allowing
the ruptured interosseous membrane to heal
ACHILLES TENDON RUPTURE
• largest and strongest tendon in the human body
• Its vascular supply is the weakest in the area 2 to
6 cm above the calcaneus, and this is the area
that is most frequently ruptured
• Risk factors for rupture include older age, prior
quinolone use, and prior steroid injection
• THOMPSON TEST
The examiner squeezes the calf: an
intact Achilles tendon will transmit this force to
the foot resulting in its plantarflexion. If the
Achilles tendon is ruptured, the foot will not
plantarflex when the calf is squeezed
• Treatment: Immobilization and surgery
SHIN SPLINTS
• presents with exerciseinduced pain over the
medial aspect of the tibia
• medial tibial stress syndrome
• Physical examination findings may include
tenderness over the medial or posterior tibia.
Radiographs are normal.
• mainstay of treatment is a several-week
cessation of activity that precipitated the pain