LOW RISK

This *** patient presents with knee pain, suspicious for ***. Able to flex and extend although somewhat limited by pain. Considered, but doubt, tibial plateau fracture, septic arthritis, other acute unstable fracture, or significant neurovascular compromise.

Plan: XR, pain control, reassessment

HI RISK – Tibial Plateau

This *** patient presents with knee pain suspicious for a tibial plateau fracture given history, exam, and mechanism. No e/o compartment syndrome, septic arthritis, other acute fracture. Range of motion is ***. Will get plain films, consider CT, likely ortho consultation, pain control, NWB.

PEARLS:

• Knee EXTENSION is an extremely important motor finding to document. Inability to extend is a key indicator of serious pathology.
• In peds, follow the medial tibial diaphysis up to the epiphysis – it should be smooth all the way. A bump should make you suspicious for a buckle fracture; it’s frequently missed by radiology.
• Proximal fibular fractures are associated with a peroneal nerve injury (you should document its status)
• Tibial plateau fractures are high risk for compartment syndrome.
• Tibial spine fractures are a) associated with ACL tears and b) often missed unless you order a tunnel view plain film.