Evaluation

How will my fracture be evaluated?

First aid for fractures of the knee requires splinting the leg from thigh to ankle to make sure the knee is immobilized. Any wound needs to be dressed. The patient should be kept warm and transported to hospital as quickly as possible.

In the Emergency Room the focus will be on treating shock, making the patient comfortable and making sure that the full extent of injury is diagnosed. Examination of the leg will reveal tenderness at the fracture site, swelling, bruising and pain if the part is moved. If there is a fracture going into the joint (intra-articular fracture), the knee will be distended with blood.

It is quite common for the joint to be aspirated and the fluid removed. To aspirate a knee joint, the surgeon will insert a needle into the knee and remove or aspirate the fluid. Fat globules in the blood drawn off in this way is a sign that marrow fat has leaked through a fracture into the joint. Fat globules in the fluid confirms that there is an intraarticular fracture.

Sensation and circulation of the foot will be carefully checked.

The diagnosis is established by x-ray. Multiple x-rays from different angles are taken to provide a clear picture of all the fractures and to look for any loose fragments inside the knee joint. Where the anatomy of the fracture is complex with many fragments it may be helpful to obtain a CT scan. MRI is not commonly used unless the main focus of the injury is a ligament tear.

Most knee fractures require evaluation and treatment from an orthopaedic surgeon. The orthopaedic evaluation includes a full medical history, including previous fractures and any on-going medical problems or allergies. The examination is often not particularly helpful since, by then, the location of the fracture is known. The surgeon will examine the foot and leg to make sure that the nerve supply and blood supply are intact. If further x-ray, CT scan or MR scan tests are required they will be ordered.

The orthopaedic surgeon will then discuss treatment options, the prognosis, the likely outcome and potential complications. A treatment plan will then be formulated and discussed, describing the method of treatment chosen, the length of time in hospital, the amount of time on crutches and full recovery time.