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Every KNEE Must Bend
MI Zucker, MD
A dr Z Lecture
On Injuries of the KNEE
The KNEE Series
• Lateral (cross-table)
• Anterior-posterior (AP)
• Obliques: internal/external
• Patella (“sunrise”)
• Notch
Lateral, AP, Obliques
Patella and Notch
• Patella or “sunrise” is tangential• Notch is a bended knee AP
Anatomy
• Lateral
Anatomy
• AP
Anatomy
• Patella
Soft Tissue Swelling
• Loss of tissue planes
Joint Effusion
• Distension of SUPRAPATELLA BURSA
• Normal
Joint Effusion
• NOT predictive of fracture.
• Can be due to ligament, meniscus or bone injury.
Lipohemarthrosis
• IS predictive of fracture: 100%• Need cross-table lateral to see it
Patella Fracture
• Direct blow
• Fragments not very distracted
CAVEAT
• Bipartite patella: developmental variant of the superior-lateral corner, often bilateral
The EXTENSOR APPARATUS
• Quadriceps muscles• Common ext. tendon• Patella and
retinaculum• Patella ligament• Ant. tibia tubercle
Patella Fracture: Indirect
• Fragments are distracted
• ORIF
Extensor Apparatus Injuries
• Common extensor tendon injury
• Patella ligament injury
KID Extensor Injury
• Anterior tibia tubercle: Injury of the PHYSIS
Tibia Plateau Fractures
• Lateral 80%• Medial 10%• Lateral and medial
10%
Tibia Plateau Fractures
• Vertical, with or without depressed articular surface
• Impacted type can be very subtle
Tibia Spine Fracture
• Can occur at any age, but common in kids especially after fall onto flexed knee from bicycle: “Bicycle Fracture”
Segond’s Fracture
• At attachment of lat cap lig to lat margin of tibia
• Same mechanism as ACL injury
• 95% predictive of ACL tear
Collateral Ligament Injuries
• Usually, nonspecific: joint effusion, soft tissue swelling
• Torn lig occasionally calcifies later
Fibula Head Fracture
• Usually, direct blow
• Can be associated with PCL tear
Osteochondral Fracture
• Articular surface of femur, lat aspect of medial condyle
Acute
Stress: osteochondritis dissicans
Distal Femur Fractures
• Big mechanism• Intercondylar,
supracondylar.
• ORIF
Patella Dislocation
Almost always LATERAL
Can fracture edge of
patella/femur
Acute management is closed reduction
Knee Dislocation
• Big mechanism
• Big risk of arterial injury
• So, big emergency!
Tibia-Fibula Fractures
• Serious injuries• Poor blood supply to
tibia, so delayed healing frequent.
• ORIF
Exception: Stress Fracture of Tibia
• Repetitive injury causing microfractures
• Usually, FATIGUE type
• Non-operative management
Toddler’s Fracture
• Child just learning to walk
• Twisting injury• NOT predictive of
child abuse• Non-operative
management
Corner/Bucket Handle Fracture
• Twisting of joint• Intentional injury• Pathognomonic of
child abuse
GOODBYE
• Copyright 2004• MI Zucker