every knee must bend mi zucker, md. a dr z lecture
TRANSCRIPT
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Every KNEE Must Bend
MI Zucker, MD
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A dr Z Lecture
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On Injuries of the KNEE
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The KNEE Series
• Lateral (cross-table)
• Anterior-posterior (AP)
• Obliques: internal/external
• Patella (“sunrise”)
• Notch
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Lateral, AP, Obliques
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Patella and Notch
• Patella or “sunrise” is tangential• Notch is a bended knee AP
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Anatomy
• Lateral
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Anatomy
• AP
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Anatomy
• Patella
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Soft Tissue Swelling
• Loss of tissue planes
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Joint Effusion
• Distension of SUPRAPATELLA BURSA
• Normal
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Joint Effusion
• NOT predictive of fracture.
• Can be due to ligament, meniscus or bone injury.
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Lipohemarthrosis
• IS predictive of fracture: 100%• Need cross-table lateral to see it
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Patella Fracture
• Direct blow
• Fragments not very distracted
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CAVEAT
• Bipartite patella: developmental variant of the superior-lateral corner, often bilateral
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The EXTENSOR APPARATUS
• Quadriceps muscles• Common ext. tendon• Patella and
retinaculum• Patella ligament• Ant. tibia tubercle
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Patella Fracture: Indirect
• Fragments are distracted
• ORIF
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Extensor Apparatus Injuries
• Common extensor tendon injury
• Patella ligament injury
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KID Extensor Injury
• Anterior tibia tubercle: Injury of the PHYSIS
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Tibia Plateau Fractures
• Lateral 80%• Medial 10%• Lateral and medial
10%
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Tibia Plateau Fractures
• Vertical, with or without depressed articular surface
• Impacted type can be very subtle
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Tibia Spine Fracture
• Can occur at any age, but common in kids especially after fall onto flexed knee from bicycle: “Bicycle Fracture”
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Segond’s Fracture
• At attachment of lat cap lig to lat margin of tibia
• Same mechanism as ACL injury
• 95% predictive of ACL tear
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Collateral Ligament Injuries
• Usually, nonspecific: joint effusion, soft tissue swelling
• Torn lig occasionally calcifies later
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Fibula Head Fracture
• Usually, direct blow
• Can be associated with PCL tear
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Osteochondral Fracture
• Articular surface of femur, lat aspect of medial condyle
Acute
Stress: osteochondritis dissicans
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Distal Femur Fractures
• Big mechanism• Intercondylar,
supracondylar.
• ORIF
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Patella Dislocation
Almost always LATERAL
Can fracture edge of
patella/femur
Acute management is closed reduction
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Knee Dislocation
• Big mechanism
• Big risk of arterial injury
• So, big emergency!
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Tibia-Fibula Fractures
• Serious injuries• Poor blood supply to
tibia, so delayed healing frequent.
• ORIF
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Exception: Stress Fracture of Tibia
• Repetitive injury causing microfractures
• Usually, FATIGUE type
• Non-operative management
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Toddler’s Fracture
• Child just learning to walk
• Twisting injury• NOT predictive of
child abuse• Non-operative
management
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Corner/Bucket Handle Fracture
• Twisting of joint• Intentional injury• Pathognomonic of
child abuse
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GOODBYE
• Copyright 2004• MI Zucker