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Knee Injuries Clinical Serise
 

Knee Injuries Clinical Serise

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Dr Ahmed Al Jabri

Dr Ahmed Al Jabri
Jan 26th 2010

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    Knee Injuries Clinical Serise Knee Injuries Clinical Serise Presentation Transcript

    • KNEE
INJURIES
 Ahmed
AL
Jabri

    • outlines
 •  Relevant
anatomy

 •  History
(
focused
)

 •  Knee
examinaBon
(
special
tests
)

 •  To
xray
or
not
?

 •  Specific
injuries
(
interac0ve
format
)
.


    • ANATOMY/physiology
 •  The
knee
is
the
largest
and
most
complicated
 joint
in
the
body
.
 •  MoBon
at
the
knee
is
a
complex
interacBon
of
 flexion,
extension,
rotaBon,
gliding,
and
 rolling.
 •  modified‐hinge
diarthrodial
synovial
joint
.
 •  3
bones
,
2
meniscus,
4
main
ligaments.
 •  Great
stability
mainly
depends
on
the
integrity
 of
the
ligamentous
structures

    • Which
of
the
following
is
False
?

 1.
FuncBonally,
the
knee
joint
can
be
divided
into
three
 compartments:
patellofemoral,
medial
Bbiofemoral,
 lateral
Bbiofemoral.
 




2.Found
within
the
popliteal
space
are
the
 popliteal
artery,
the
popliteal
vein,
and
the
 peroneal
and
Bbial
nerves.
 




3.The
lateral
and
medial
femoral
epicondyles
 serve
as
important
sites
of
origin
for
the
medial
 and
lateral
collateral
ligaments,
respecBvely
 



4.

1&2

 



5.
None
of
the
above


    • Which
of
the
following
is
False
?

 1.
FuncBonally,
the
knee
joint
can
be
divided
into
three
 compartments:
patellofemoral,
medial
Bbiofemoral,
 lateral
Bbiofemoral.
 




2.Found
within
the
popliteal
space
are
the
 popliteal
artery,
the
popliteal
vein,
and
the
 peroneal
and
Bbial
nerves.
 




3.The
lateral
and
medial
femoral
epicondyles
 serve
as
important
sites
of
origin
for
the
medial
 and
lateral
collateral
ligaments,
respec0vely
 



4.

1&2

 



5.
None
of
the
above


    • Regarding
popliteal
artery
?
 •  represents
the
direct
conBnuaBon
of
the
femoral
 artery
beyond
the
adductor
hiatus
 •  descends
across
the
posterior
aspect
of
the
knee
joint
 and
terminates
at
the
level
of
the
Bbial
tubercle.
 •  it
divides
into
the
anterior
and
posterior
Bbial
arteries
 at
the
level
of
the
Bbial
tubercle
 •  It
is
anchored
firmly
at
the
proximal
and
distal
ends
of
 the
popliteal
fossa
.
 •  Blood
supply
to
the
knee
joint
comes
from
the
 popliteal
artery
via
the
geniculate
arteries
 •  All
of
the
above


    • Regarding
popliteal
artery
?
 •  represents
the
direct
conBnuaBon
of
the
femoral
 artery
beyond
the
adductor
hiatus
 •  descends
across
the
posterior
aspect
of
the
knee
joint
 and
terminates
at
the
level
of
the
Bbial
tubercle.
 •  it
divides
into
the
anterior
and
posterior
Bbial
arteries
 at
the
level
of
the
Bbial
tubercle
 •  It
is
anchored
firmly
at
the
proximal
and
distal
ends
of
 the
popliteal
fossa
.
 •  Blood
supply
to
the
knee
joint
comes
from
the
 popliteal
artery
via
the
geniculate
arteries
 •  All
of
the
above


    • HISTRORY

    • IniBal
Assessment:
History
 •  Injury
history
 •  Pain
 •  Clicking
 •  Locking
 •  Giving
way
 •  Instability
 •  Swelling

    • Injury
history
 •  High‐energy
trauma
without
knee
swelling
should
 raise
the
suspicion
of
disrupBon
of
the
joint
 capsule
with
expulsion
of
joint
fluid
and
 hemorrhage
into
the
thigh
or
lower
leg
.
 •  Lower
energy
injuries
are
more
commonly
 associated
with
meniscal
tears,
patella
 dislocaBons,
and
less
severe
ligament
injuries.
 •  acBviBes
with
twisBng
and
turning
are
associated
 with
anterior
cruciate
tears
and
meniscal
 pathology.

    • Focused
History
QuesBons

 •  Onset
of
Pain
 – Date
of
injury
or
when
symptoms
started

 •  Loca0on
of
pain
 – Anterior

 – Medial

 – Lateral

 – Posterior


    • Focused
History
QuesBons 2
 •  Mechanism
of
Injury
‐helps
 predict
injured
structure
 –  Contact
or
noncontact
injury?
 •  If
contact,
what
part
of
the
knee
was
 contacted?

 –  
Anterior
blow?

 –  
Valgus
force?

 Valgus
alignment
=

distal
 –  
Varus
force?
 segment
deviates
lateral
 with
respect
to
proximal
 segment.

 –  Was
foot
of
affected
knee
planted
on
 the
ground?

    • Focused
History
QuesBons 
 •  Injury‐Associated
Events
 – Pop
heard
or
felt?

 – Swelling
acer
injury
(immediate
vs
delayed)
 – Catching
/
Locking
 – Buckling
/
Instability
(“giving
way”)

    • Historical
Clues
to
Knee
Injury
 Diagnoses
 Noncontact injury with “pop” ACL tear Contact injury with “pop” MCL or LCL tear, meniscus tear, fracture Acute swelling ACL tear, PCL tear, fracture, knee dislocation, patellar dislocation Lateral blow to the knee MCL tear Medial blow to the knee LCL tear Knee “gave out” or “buckled” ACL tear, patellar dislocation Fall onto a flexed knee PCL tear
    • Common
Symptoms
 Factor Meniscal Cruciate MCL/ Chronic LCL Instability Swelling + +++ - ++ delayed early absent recurrent Locking yes no no yes Clicking yes no no yes Giving yes yes no yes way
    • EXAMINATION
 •  
 


1.



Outline
areas
of
tenderness.
 


2.



Note
whether
any
effusion
is
present.
 


3.



Check
for
range
of
moBon,
valgus
stress
at
0
and
30
degrees
of
flexion,
and
 varus
stress
at
0
and
30
degrees
of
flexion.
 


4.



Evaluate
the
patellar
and
extensor
mechanism
of
the
knee
(quadriceps
and
 patella
tendons).
 


5.



Perform
Lachman's
,
anterior
drawer,
posterior
drawer,
and
pivot
shic
tests
 to
check
for
anterolateral

rotatory
instability
and
further
delineate
possible
injury
 to
the
anterior
cruciate
ligament.
 


6.



Perform
meniscal

examinaBon
with
McMurray's
and
Apley's

tests.

    • 1,
quadriceps
 tendiniBs;
2,
 prepatella
 bursiBs,
patella
 pain;
3,
 reBnacular
pain
 acer
patella
 subluxaBon;
4,
 patella
 tendiniBs;
5,
fat
 pad
tenderness;
 6,
Osgood‐ Schlamer
 disease
(Bbial
 tubercle
pain);
 7,
meniscus
 pain;
8,
 collateral
 ligament
pain;
 9,
pes
anserine
 tendiniBs
 bursiBs

    • STABILITY
TESTING
 •  Anterior
Drawer
Test.
 •  Lachman's
Test.

 •  Posterior
Drawer
Test.
 •  McMurray's
Test.
 •  Apley's
Test.
 •  Pivot
Shi.
 •  Collateral
Ligament
Stress
Test.

    • Anterior
Drawer
Test
 •  The
anterior
drawer
test
is
a
test
for
disrupBon
 of
the
anterior
cruciate
ligament
(ACL)
.
 •  HOW
TO
DO
IT
?


VIDEOsknee
injury.flv

    • Anterior
Drawer
Test
 •  A
posiBve
test
is
defined
as
the
ability
of
the
Bbia
to
 move
forward
relaBve
to
the
femur
compared
with
the
 other
knee.
 •  False‐negaBve
findings
may
occur
from
an
effusion
 prevenBng
knee
flexion
to
90
degrees,
hamstring
 muscle
spasm
caused
by
pain,
or
insufficient
force
 applied
during
performance
of
the
test
 •  A
false‐posiBve
test
can
be
caused
by
posterior
cruciate
 ligament
(PCL)
insufficiency,
which
allows
the
Bbia
to
 slip
back
on
the
femur,
showing
an
abnormal
amount
 of
displacement
when
pulled
forward

    • Lachman's
Test
 •  currently
the
best
clinical
test
for
determining
 the
integrity
of
the
ACL
;
 •  RELIABLE
when
there
is
an
acute
hemarthrosis
 •  the
knee
flexed
20
to
30
degrees
with
one
hand
 grasping
the
thigh
and
stabilizing
it.
The
Bbia
is
 pulled
forward
with
an
anteriorly
directed
force













 














VIDEOsKnee
Exam

Lachman
Test.flv

    • Lachman's
Test:

grades
of
instability
 1.  1+
(0
to
5mm
more
displacement
than
the
 normal
side),

 2.  2+
(5
to
10mm),
 3.  
or
3+
(>10mm).


    • Lachman's
Test:
limitaBons
 •  PCL
must
be
intact
for
the
test
to
be
valid
 •  
false‐negaBve
tests
include
hamstring
spasm,
 meniscal
tears,
and
third‐degree
MCL
tears
with
 posterior
medial
extension.

 •  Specific
limitaBons
of
Lachman's
test
include
 difficulty
quanBtaBng
the
amount
of
anterior
 translaBon
and
inability
to
limit
moBon
of
the
 femur.

 •  Lachman's
test
also
may
be
diffi
culmo
perform
if
 the
examiner's
hands
are
small
relaBve
to
the
 paBent's
thigh.

    • Posterior
Drawer
Test
 •  The
posterior
drawer
test
remains
the
“gold
 standard”
for
evaluaBng
PCL
injury
 •  How
to
do
it
?










 










VIDEOsPosterior
Drawer
Test
‐
Knee.flv

    • Posterior
Drawer
Test
 Posterior
displacement
of
the
Bbia
more
than
5
 mm,
 or
 a
 “soc”
 endpoint,
 indicates
 injury
 to
 the
 PCL.
 A
 normal
 knee
 should
 exhibit
 no
 significant
posterior
excursion

    • McMurray's
Test

 •  McMurray's
test
is
used
to
idenBfy
meniscal
 tears
 •  How
to
do
it
?
VIDEOsMcMurrays
test.flv

    • McMurray's
Test

 1.  A
posiBve
test
occurs
when,
with
the
other
 hand,
a
“clicking”
sensaBon
is
felt
along
the
 joint
line
or
the
paBent
experiences
pain
 during
internal
and
external
rotaBon.
 2.  
By
twisBng
the
leg
into
internal
rotaBon,
the
 posterior
segment
of
the
lateral
meniscus
is
 tested.

 3.  External
rotaBon
tests
the
posterior
segment
 of
the
medial
meniscus

    • Apley's
Test

 1.  Apley's
test
also
aids
in
diagnosing
meniscal
 tears.
 2.  
With
the
paBent
prone,
the
knee
is
flexed
90
 degrees,
and
the
leg
is
internally
and
externally
 rotated
with
pressure
applied
to
the
heel.

 3.  Downward
pressure
eliciBng
pain
suggests
 meniscal
pathology.
 4.  
The
pain
should
be
relieved
with
distracBon
of
 the
knee
and
rotaBon
of
the
leg
back
to
a
 neutral
posiBon.

    • Pivot
Shi

 •  It
should
be
done
carefully
as
it
may
exacerbate
 the
iniBal
injury.
 •  Used
to
detect
anterolateral
rotatory
instability
 associated
with
an
injury
to
the
ACL
or
lateral
 capsular
structure.
 •  UNCOMFORTABLE,
Usually
done
pre‐operaBvely

 •  How
to
do
it
?




 














VIDEOsPivot
shic
test.flv

    • Collateral
Ligament
Stress
Test

 The
collateral
ligament
stress
test
is
used
to
test
 the
integrity
of
the
MCL
and
LCL.
 Valgus
and
varus
tesBng

at
both
0
and
30
 degrees
of
flexion?



    • It
is
imperaBve
that
the
injured
knee
be
stress
tested
to
detect
 ligamentous
injury.
Which
of
the
following
statements
describing
 the
stress
tests
for
the
knee
is
FALSE?

 1.  Lachman's
test:
amempt
to
move
the
parBally
flexed
Bbia
anteriorly
and
 posteriorly
on
the
femur;
laxity
indicates
cruciate
injury.

 2.  Apply
varus
and
valgus
stress
with
the
knee
in
20‐30
degrees
flexion.
 Detects
medial
or
lateral
ligament
injury
UNLESS
the
cruciates
are
intact.

 3.  Apply
varus
and
valgus
stress
in
full
extension.
Instability
indicates
injury
 to
the
cruciates
as
well
as
the
medial
or
lateral
ligaments.

 4.  Posterior
sag
of
the
upper
Bbia
or
posterior
drawer
sign:
rupture
of
the
 posterior
cruciate.

 5.  Anterior
drawer
sign:
rupture
of
the
anterior
cruciate.

 6.  Lateral
pivot
shic:
one
hand
applies
a
valgus
force
to
the
extended
knee
 with
the
thumb
on
the
fibular
head
and
the
other
hand
internally
rotates
 the
foot
while
flexing
the
knee.
Near
30
degrees,
the
lateral
Bbia
will
 palpably
reduce
with
lateral
and
anterior
cruciate
instability.

    • It
is
imperaBve
that
the
injured
knee
be
stress
tested
to
detect
 ligamentous
injury.
Which
of
the
following
statements
describing
 the
stress
tests
for
the
knee
is
FALSE?

 Apply
varus
and
valgus
stress
with
the
knee
in
 20‐30
degrees
flexion.
Detects
medial
or
 lateral
ligament
injury
UNLESS
the
cruciates
 are
intact.

 




(In
slight
flexion
the
cruciates
are
unstressed
 and
varus/valgus
stress
can
detect
isolated
 medial
or
lateral
ligament
injury.
In
full
 extension
the
cruciates
stabilize
the
knee
to
 varus/valgus
stress
)


    • All
of
the
physical
examinaBon
findings
are
consistent
with
a
 meniscus
knee
injury
EXCEPT:
 1.  Joint
line
tenderness.


 2.  Knee
or
groin
pain,
locking,
and
limited
excursion
of
the
 joint.
 3.  

Effusion
that
tends
to
develop
rapidly
acer
the
injury.


 4.  Apley
test:
flex
the
knee
90
degrees
and
compress
and
 rotate
the
Bbia
on
the
condyles;
pain
implies
a
torn
 posterior
horn
of
the
medial
meniscus.


 5.  PosiBve
McMurray
test:
With
the
thumb
and
fingers
 palpaBng
the
lateral
and
medial
joint
lines,
extend
the
 knee
while
rotaBng
the
foot
externally;
repeat
while
 rotaBng
the
foot
internally
with
the
opposite
hand.
Pain,
 locking
and
grinding
are
suggesBve
of
a
meniscus
injury.

    • All
of
the
physical
examinaBon
findings
are
consistent
with
a
 meniscus
knee
injury
EXCEPT:
 1.  Joint
line
tenderness.


 2.  Knee
or
groin
pain,
locking,
and
limited
excursion
of
the
 joint.
 3.  

Effusion
that
tends
to
develop
rapidly
aer
the
injury.


 4.  Apley
test:
flex
the
knee
90
degrees
and
compress
and
 rotate
the
Bbia
on
the
condyles;
pain
implies
a
torn
 posterior
horn
of
the
medial
meniscus.


 5.  PosiBve
McMurray
test:
With
the
thumb
and
fingers
 palpaBng
the
lateral
and
medial
joint
lines,
extend
the
 knee
while
rotaBng
the
foot
externally;
repeat
while
 rotaBng
the
foot
internally
with
the
opposite
hand.
Pain,
 locking
and
grinding
are
suggesBve
of
a
meniscus
injury.

    • Radiographic
Evalua0on

 to
xray
or
not

    • All
of
the
following
are
component
of
 Omawa
Knee
Rule,
except
?


 1.  the
paBent
is
55
years
or
older
 2.  
there
is
tenderness
at
the
head
of
the
fibula
 3.  there
is
isolated
tenderness
of
the
patella
 4.  
the
paBent
is
unable
to
flex
the
knee
to
90º
 5.  
there
is
knee
effusion

 6.  
the
paBent
is
unable
to
take
four
steps
both
 at
the
Bme
of
the
injury
and
at
the
Bme
of
 the
evaluaBon

    • All
of
the
following
are
component
of
 Omawa
Knee
Rule,
except
?


 1.  the
paBent
is
55
years
or
older
 2.  
there
is
tenderness
at
the
head
of
the
fibula
 3.  there
is
isolated
tenderness
of
the
patella
 4.  
the
paBent
is
unable
to
flex
the
knee
to
90º
 5.  
there
is
knee
effusion

 6.  
the
paBent
is
unable
to
take
four
steps
both
 at
the
Bme
of
the
injury
and
at
the
Bme
of
 the
evaluaBon

    • Omawa
Knee
Rule
 •  More
than
$1
billion
is
spent
on
emergency
 radiography
of
the
knee
each
year
in
the
 United
States,
with
90%‐92%
of
these
studies
 showing
no
fracture
.
 •  The
rule
is
almost
100%
sensiBve
and
97%
 specific
.


    • Pimsburgh
Knee
Rule
in
blunt
knee
 trauma
 
states
that
radiography
is
necessary
only
if
the
 paBent
fell
or
sustained
blunt
trauma
to
the
 knee,
and
either
of
two
condiBons
is
present:
 •  
(1)
age
younger
than
12
or
older
than
50
or

 •  (2)
inability
to
walk
four
full
weight‐bearing
 steps
in
the
emergency
department.

    • TRUE
OR
FALSE
?

 •  In
Trauma
The
tradiBonal

“knee
series”


is
 anteroposterior,
lateral,
and
sunrise
view
.

    • FALSE
 CORRECT:
In
Trauma
The
tradiBonal

“knee
 series”


is
anteroposterior,
lateral,
and
tunnel
 views
 Tunnel”
views,
which
image
the
intercondylar
 notch,
are
used
to
detect
Bbial
spine
fractures
 and
loose
bodies
within
the
notch

    • Specific
injuries

    • Knee
disloca0on
requires
immediate
orthopedic
 consulta0on
due
to
the
high
incidence
of
 complica0ons,
including
all
of
the
following
EXCEPT:

 •  unstable
ligament
injury

 •  meniscus
injury

 •  popliteal
artery
injury
 •  
sciaBc
nerve
injury
 •  
Bbial
nerve
injury

 •  peroneal
nerve
injury

    • Knee
disloca0on
requires
immediate
orthopedic
 consulta0on
due
to
the
high
incidence
of
 complica0ons,
including
all
of
the
following
EXCEPT:

 •  unstable
ligament
injury

 •  meniscus
injury

 •  popliteal
artery
injury
 •  
scia0c
nerve
injury
 •  
Bbial
nerve
injury

 •  peroneal
nerve
injury

    • KNEE
DISLOCATION
 •  50%‐60%
are
anterior

 •  popliteal
artery
injury
is
most
commonly
 associated
with
posterior
dislocaBons
 •  Peroneal
nerve
injury
is
the
most
common
 major
neurological
problem
associated
with
 knee
dislocaBon.
 •  WHEN
TO
ORDER
AN

ANGIOGRAPHY
?


    • Bi‐parBte
patella
(
normal
variant)

    • Transverse
and
avulsion
fractures
of
the
patella
are
most
ocen
due
to
 excessive
quadriceps
tension
rupturing
the
patella,
whereas
comminuted
 fractures
are
caused
by
direct
trauma.

 Which
of
the
following
statements
describing
the
treatment
of
patella
 fractures
is
FALSE?
 1.  nondisplaced
transverse
fracture:
ankle
to
groin
 cylinder
cast
 2.  transverse
fracture
displaced
>2‐3
mm
or
large
 avulsion:
wire
fixaBon
 3.  minor
comminuBon
with
minimal
separaBon:
 meBculous
alignment
and
wire
fixaBon
of
the
 fragments
 4.  comminuted
fracture:
excision
of
bone
 fragments
and
direct
anastomosis
of
the
 quadriceps
tendon
to
the
patellar
ligaments

    • Transverse
and
avulsion
fractures
of
the
patella
are
most
ocen
due
to
 excessive
quadriceps
tension
rupturing
the
patella,
whereas
comminuted
 fractures
are
caused
by
direct
trauma.

 Which
of
the
following
statements
describing
the
treatment
of
patella
 fractures
is
FALSE?
 1.  nondisplaced
transverse
fracture:
ankle
to
groin
 cylinder
cast
 2.  transverse
fracture
displaced
>2‐3
mm
or
large
 avulsion:
wire
fixaBon
 3.  minor
comminu0on
with
minimal
separa0on:
 me0culous
alignment
and
wire
fixa0on
of
the
 fragments
 4.  comminuted
fracture:
excision
of
bone
 fragments
and
direct
anastomosis
of
the
 quadriceps
tendon
to
the
patellar
ligaments

    • Segond
fracture

 •  represents
a
bony
avulsion
of
the
lateral
Bbial
plateau
 •  an
important
marker
of
ACL
disrupBon

    • Tibial
Plateau
Fractures
 •  Because
the
iniBal
injury
is
usually
a
valgus
stress
 with
an
abducBon
force
on
the
leg,
55%
to
70%
of
 condylar
fractures
involve
the
lateral
plateau
 •  The
most
impt
aspect
of
the
iniBal
examinaBon
is
the
 neurovasc
status

 •  Displaced
fractures
of
the
lateral
condyle
may
 produce
peroneal
nerve
paralysis
in
addiBon
to
injury
 to
the
anterior
Bbial
artery

    • four
factors
determine
the
prognosis
of
 Bbial
plateau
fractures:

 1.  degree
of
arBcular
depression,

 2.  extent
and
separaBon
of
the
condylar
fracture
lines,

 3.  diaphyseal‐metaphyseal
comminuBon
and
 dissociaBon,

 4.  integrity
of
the
soc
Bssue
envelope
(i.e.,
open
versus
 closed)

    • Management
 •  As
a
rule,
accurate
reducBon
and
prolonged
non– weight
bearing
are
the
guidelines
to
be
followed
in
 Bbial
condylar
fractures.
 •  Main
techniques
 – compression
dressing,
closed
reducBon
and
casBng,
skeletal
 tracBon,
and
open
reducBon
with
internal
fixaBon
 •  In
general,
with
more
severely
depressed
#s,
operaBve
 treatment
has
bemer
results
than
nonoperaBve
 therapy;
however,
no
universal
agreement
exists
on
the
 acceptable
amount
of
arBcular
depression

    • Osteochondri00s
Dissecans
 •  The
disorder
is
found
mainly
in
adolescents
and
results
in
a
 segment
of
arBcular
carBlage
and
subchondral
bone
 becoming
parBally
or
totally
separated
from
the
underlying
 bone
 •  The
management
of
these
paBents
is
based
on
the
stability
 of
the
osteochondral
fragment
and
the
maturity
of
the
 skeleton

 –  If
the
epiphyses
are
open,
conservaBve
treatment
with
 protecBve
weight
bearing
usually
results
in
healing
of
the
lesion.

 –  Once
the
epiphyses
are
closed,
the
prognosis
for
healing
is
 guarded.
If
the
fragments
are
detached,
the
loose
fragments
 require
surgery
for
removal
or
fixaBon.
Protected
range
of
 moBon
with
non–weight‐bearing
acBvity
for
6
to
10
weeks
is
 generally
advised

    • A
boy
has
fallen
from
a
low
limb
of
a
tree
or
from
his
bicycle
 onto
his
right
knee
and
fractured
the
anterior
Bbial
spine
 (intercondylar
eminence)
of
the
Bbia.
Which
of
the
following
 statements
concerning
his
injury
is
FALSE?
 1.  His
exam
will
reveal
a
posiBve
drawer
sign
and
 Lachman's
test,
and
possibly
laxity
of
the
medial
 collateral
ligament
on
valgus
stress.
 2.  
His
x‐ray
will
reveal
a
fracture
of
the
Bbial
spine.

 3.  Usually,
surgical
treatment
with
screw
or
wire
 fixaBon
is
preferred.
 4.  
Usually
closed
treatment
(if
posiBoning
can
 achieve
anatomic
reducBon)
is
preferred;
 otherwise
open
or
arthroscopic
fixaBon
may
be
 required.

    • A
boy
has
fallen
from
a
low
limb
of
a
tree
or
from
his
bicycle
 onto
his
right
knee
and
fractured
the
anterior
Bbial
spine
 (intercondylar
eminence)
of
the
Bbia.
Which
of
the
following
 statements
concerning
his
injury
is
FALSE?
 1.  His
exam
will
reveal
a
posiBve
drawer
sign
and
 Lachman's
test,
and
possibly
laxity
of
the
medial
 collateral
ligament
on
valgus
stress.
 2.  
His
x‐ray
will
reveal
a
fracture
of
the
Bbial
spine.

 3.  Usually,
surgical
treatment
with
screw
or
wire
 fixa0on
is
preferred.
 4.  
Usually
closed
treatment
(if
posiBoning
can
 achieve
anatomic
reducBon)
is
preferred;
 otherwise
open
or
arthroscopic
fixaBon
may
be
 required.

    • Segond
 fracture
 and
Bbial
 spine
 avulsion
 fracture

    • •  CT
image
of
 knee
 demonstra Bng
Segond
 fracture
 and
Bbial
 spine
 avulsion
 fracture

    • Fracture
of
the
Tibial
Spine
 (intercondylar
eminence)
 •  The
spine
has
two
prominences:
the
medial
and
 lateral
tubercles
 •  The
ACL
and
the
anterior
horns
of
both
the
 medial
and
the
lateral
menisci
amach
in
the
 anterior
intercondylar
fossa.
The
PCL
and
the
 posterior
horns
of
the
menisci
amach
in
the
 posterior
intercondylar
fossa.
 •  Radiographic
evaluaBon
should
include
standard
AP
and
 lateral
views,
but
a
tunnel
view
provides
a
clearer
look
at
 the
intercondylar
area
and
may
be
necessary
to
confirm
 the
diagnosis

    • intercondylar
eminence:
 CLASSIFICATION
 –  Type
I
involves
incomplete
avulsion
of
the
 Bbial
spine
without
displacement.

 –  Type
II,
there
is
an
incomplete
avulsion
 with
minimal
displacement
of
the
 anterior
third
of
the
fracture
fragment,
 but
the
posterior
porBon
remains
 adherent.

 –  Type
III
is
characterized
by
complete
 separaBon
of
the
fragment
from
its
 fracture
bed
and
has
a
higher
associated
 rate
of
collateral
ligament
injuries
and
 peripheral
meniscal
tears
 •  Type
IIIA,
fractures
with
complete
 displacement,

 •  Type
IIIB,
fractures
with
displacement
and
 rotaBon

    • THANK
YOU