1. Every KNEE Must Bend MI Zucker, MD

2. A dr Z Lecture

3. On Injuries of the KNEE

4. The KNEE Series Lateral (cross-table) Anterior-posterior (AP) Obliques: internal/external Patella (“sunrise”) Notch

5. Lateral, AP, Obliques

6. Patella and Notch Patella or “sunrise” is tangential Notch is a bended knee AP

7. Anatomy Lateral

8. Anatomy AP

9. Anatomy Patella

10. Soft Tissue Swelling Loss of tissue planes

11. Joint Effusion Distension of SUPRAPATELLA BURSA Normal

12. Joint Effusion NOT predictive of fracture. Can be due to ligament, meniscus or bone injury.

13. Lipohemarthrosis IS predictive of fracture: 100% Need cross-table lateral to see it

14. Patella Fracture Direct blow Fragments not very distracted

15. CAVEAT Bipartite patella: developmental variant of the superior-lateral corner, often bilateral

16. The EXTENSOR APPARATUS Quadriceps muscles Common ext. tendon Patella and retinaculum Patella ligament Ant. tibia tubercle

17. Patella Fracture: Indirect Fragments are distracted ORIF

18. Extensor Apparatus Injuries Common extensor tendon injury Patella ligament injury

19. KID Extensor Injury Anterior tibia tubercle: Injury of the PHYSIS

20. Tibia Plateau Fractures Lateral 80% Medial 10% Lateral and medial 10%

21. Tibia Plateau Fractures Vertical, with or without depressed articular surface Impacted type can be very subtle

22. Tibia Spine Fracture Can occur at any age, but common in kids especially after fall onto flexed knee from bicycle: “Bicycle Fracture”

23. Segond’s Fracture At attachment of lat cap lig to lat margin of tibia Same mechanism as ACL injury 95% predictive of ACL tear

24. Collateral Ligament Injuries Usually, nonspecific: joint effusion, soft tissue swelling Torn lig occasionally calcifies later

25. Fibula Head Fracture Usually, direct blow Can be associated with PCL tear

26. Osteochondral Fracture Articular surface of femur, lat aspect of medial condyle Acute Stress: osteochondritis dissicans

27. Distal Femur Fractures Big mechanism Intercondylar, supracondylar. ORIF

28. Patella Dislocation Almost always LATERAL Can fracture edge of patella/femur Acute management is closed reduction

29. Knee Dislocation Big mechanism Big risk of arterial injury So, big emergency!

30. Tibia-Fibula Fractures Serious injuries Poor blood supply to tibia, so delayed healing frequent. ORIF

31. Exception: Stress Fracture of Tibia Repetitive injury causing microfractures Usually, FATIGUE type Non-operative management

32. Toddler’s Fracture Child just learning to walk Twisting injury NOT predictive of child abuse Non-operative management

33. Corner/Bucket Handle Fracture Twisting of joint Intentional injury Pathognomonic of child abuse

34. GOODBYE Copyright 2004 MI Zucker