Knee Fractures

MANUAL MINORS

Knee fractures affect the bones that form the knee joint: the distal femur, proximal tibia, and patella. These fractures usually result from direct trauma (such as falls, blows, or traffic accidents) and can impact the stability and function of the knee, requiring accurate diagnosis and appropriate management to prevent complications like post-traumatic osteoarthritis.

Diagnosis

Diagnosis is based on the presence of severe pain, swelling, inability to move the knee, deformity, and, in some cases, instability. Depending on the fracture’s location, the patient may be unable to extend the knee (patellar fracture) or bear weight (distal femur or proximal tibia fractures).

Confirmation is done through knee X-rays (anteroposterior and lateral views), and in cases of intra-articular or complex fractures, a computed tomography (CT) scan is performed to better assess the extent of the injury.

Differential Diagnosis

Condition	Key Differentiation
Cruciate Ligament Injury	Knee instability, with no visible fracture on imaging.
Meniscus Injury	Pain with joint locking, with no evidence of fracture on imaging studies.
Femoral Shaft Fracture	Affects the mid-portion of the femur, with no direct involvement of the joint.
Knee Dislocation	Joint displacement without visible associated fracture.
Bone Contusion	Pain with oedema on MRI, but without cortical bone disruption.

Emergency Management

Initial management of knee fractures in emergency settings includes:

• Immobilisation: A knee splint or immobiliser is applied to prevent movement and relieve pain.

  
  

• Analgesia: NSAIDs and, if necessary, opioids are administered for pain control.

  
  

• Patient Stabilisation: In cases of open fractures or significant trauma, antibiotics and tetanus prophylaxis are provided. Circulation and neurological function of the affected leg should also be assessed.

  
  

In cases of open fractures or severe instability, emergency surgical treatment may be required.

Definitive Treatment

Definitive treatment varies depending on the type and severity of the fracture:

• Patellar Fracture:

  
  

  • For non-displaced fractures, conservative management with immobilisation (cast or splint) and weight-bearing restriction is usually sufficient.

    
    

  • Displaced or comminuted fractures generally require surgical fixation with screws, cerclage wiring, or even partial or total patellectomy in severe cases.

    
    

• Distal Femoral Fracture:

  
  

  • Stable, minimally displaced fractures can be managed conservatively with immobilisation and physiotherapy.

    
    

  • Displaced or unstable fractures require surgical fixation, typically with plates and screws or a retrograde intramedullary nail.

    
    

• Tibial Plateau Fracture:

  
  

  • Non-displaced fractures can be treated with immobilisation and weight-bearing restriction, while displaced fractures require surgery, usually with plates and screws, to restore the joint surface and knee alignment.

    
    

Rehabilitation

Following either conservative or surgical treatment, it is essential to begin physiotherapy as soon as possible to restore range of motion and strengthen the muscles around the knee.

In many knee fractures, weight-bearing on the affected limb is restricted for several weeks until sufficient bone healing is seen on X-rays. Regular follow-up imaging is necessary to ensure proper bone healing and to prevent complications such as post-traumatic osteoarthritis or joint stiffness.