2. 28 YOM soccer player presenting
with severe left knee pain.
Patient was trying to forcefully
kick a long range ball when he
was swept from behind from
another player. Pt landed on the
grass on a flexed while fully
extending is left lower extremity.
No LOC. Experienced severe
pain which continues in the ED
and was carried out of the field
on a stretcher. Denies any
numbness or tingling to his
lower extremities.
T 97.9 P 118 BP 135/75 RR 16 O2
95% on RA
Gen: Uncomfortable and in
distress 2/2 pain, GCS 15.
Pulm: BS equal and CTA
bilaterally. Trachea midline.
CV: S1S2 tachycardia, pulses
equal throughout.
Pelvis: stable
LLE: knee TTP, contusion and
swelling with 3 cm abrasion over
the anterior knee, unable to
extend knee, flexing knee 20°
with difficulty, normal pulses
and sensation distally.
3.
4. Transverse and
displaced patellar
fracture
Most Common
patellar fracture.
Note the significant
soft tissue swelling
and effusion.
5. ABC’s of trauma resuscitation
Pain management
Open Fracture: antibiotics, IV fluids and copious
irrigation, update Tetanus, admission for further
debridement/irrigation in the OR.
Non-displaced/minimally-displaced fractures: Knee
immobilizer, RICE therapy, pain meds, non-weight
bearing, Ortho outpatient referral.
Urgent Ortho consult: If >3 mm displacement on
transverse fractures/severely comminuted fractures or
disruption of the extensor mechanism.
6. Always obtain a sunrise (skyline) view of the knee
since occult non-displaced or marginal patellar
fractures can be missed on routine knee radiographs.
Evaluate the Knee Extender Apparatus for possible
disruption with concomitant patellar fracture.
7.
Normal appearing lateral knee
radiograph in an elderly patient.
Sunrise View: Non-displaced Patellar Fracture of the
same elderly patient with normal radiographs on the left.
