Intended for healthcare professionals

Endgames Case Review

Diagnosis and management of an acute knee injury

BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.i6783 (Published 19 January 2017) Cite this as: BMJ 2017;356:i6783
  1. Duncan Steele, cardiothoracic specialty registrar1,
  2. William Morley, orthopaedic specialty registrar2
  1. 1King’s College Hospital, London, UK
  2. 2Cheltenham General Hospital, Cheltenham, UK
  1. Correspondence to D Steele: duncansteele{at}nhs.net

A 47 year old presented to the emergency department with a severely painful left knee after she was hit while skiing by a fellow skier who approached at high speed from behind. The pain occurred immediately after impact with the skier, with marked general swelling of the joint and she was unable to bear weight. On examination, the limb was neurovascularly intact and the skin was not broken. She had no relevant medical, family, or social history. Anteroposterior (AP) and lateral x rays of her left knee were taken (fig 1).

Fig 1 Anteroposterior radiograph of patient’s left knee

Questions

1. What does the radiograph show and what is the diagnosis?

2. How would you classify this injury?

3. How would you manage this patient?

Answers

1. What does the radiograph show and what is the diagnosis?

Short answer

The AP radiograph shows a fracture line extending from the medial proximal tibia border and a vertical fracture line extending into the joint. The lateral image shows some posterior displacement of the segment. The diagnosis is tibial plateau fracture.

Discussion

Tibial plateau fractures are intra-articular fractures that show extension of the fracture line into the joint surface of the proximal tibia. They can exist in isolation or be accompanied by other injuries either to local structures of the knee or elsewhere on the patient. Identifying extension into the joint is vital as it affects the urgency and decision making process for treatment, as well as the prognosis. Neurovascular status is a key component in evaluation of the injury, as the common peroneal nerve …

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