Knee Pathology- fractures

Question 1

knee fracture percentages

Answer 1

40% patella
32% tibial plateau

5-10% distal femur, tibial spine

<5% tibial tuberosity, segond fracture

Question 2

fracture screenings

Answer 2

ottawa knee rule
sn- 90-100%
sp-50%

pittsburgh knee rule
sn->90%
sp- 60%

Question 3

ottawa knee rule

Answer 3

age 55 or older
isolated tenderness of patella
tenderness over fibular head
unable to flex knee >90
unable to weight bear immediately or 4 steps in ER

Question 4

pittsburg knee rule

Answer 4

blunt trauma or a fall and…

older than 50 or younger than 12
inability to take 4 steps in ER

Question 5

imaging options

Answer 5

xray
ct
mri
us

Question 6

xray

Answer 6

bony assessment
quick and inexpensive

Question 7

ct scan

Answer 7

bones
more sensitive than xrays
quick, more expensive

Question 8

MRI

Answer 8

assesses soft tissue injuries
also bony assessment
more time more expensive

dont do with metal in body

Question 9

ultrasound

Answer 9

non invasive
soft tissues
good for identifying cysts

Question 10

rehab during immobilization

Answer 10

minimal visits
maximize safe functions
prevent complications
maintain health of other tissues
minimize pressure sores
cardiopulmonary system

Question 11

rehab for post immobilization

Answer 11

make sure bony stability is achieved

pain control
patient education
progressive manual therapy
HEP
return to desired activities

Question 12

patellar fracture

Answer 12

MOI- trauma to anterior knee

impact
hyperflexion/ contraction of quadriceps

sunrise xray

transverse most common
bipartate patella

Question 13

patellar fx treatments

Answer 13

nondisplaced- immobilize 6 wks; decreased wt bearing

displaced- surgery can be necessary; immobilize and limit wt bearing

initiate pain control activities, ROM, strengthening

Question 14

patellar dislocations

Answer 14

MOI- impact or sudden twisting of knee, valgus

majority dislocate laterally
girls > boys

osteochondral fracture can occur

Question 15

patellar dislocation rehab

Answer 15

patient education
immobilization - brace
PWB with crutches
PRICE
taping/bracing
NMES
ROM, strengthening,

Question 16

femoral condyle fracture

Answer 16

MOI- axial loading fall or MVA

Question 17

femoral condyle fx treatments

Answer 17

traction or bracing

surgery

Question 18

femoral condyle fx rehab

Answer 18

immobilization
non-weight bearing 3 mo
patient education
ROM
strengthening

prognosis up to a 1 yr

Question 19

epiphyseal complex fx

Answer 19

pediatric fx
on any long bone

MOI- direct trauma with rotation, hyperextension, valgus stress

5 types
2 is most common
5 is least common and most severe

Question 20

salter harris 1

Answer 20

S
separated growth plate

Question 21

salter harris 2

Answer 21

A
above growth plate
most commonn

Question 22

salter harris 3

Answer 22

L
below growth plate

Question 23

salter harris 4

Answer 23

T
through growth plate

Question 24

salter harris 5

Answer 24

ER
erasure of growth plate
least common
most severe

Question 25

which salter harris types do well without surgery

Answer 25

1 and 2 often immobilized in long leg casts with hip and foot 4-6wks

Question 26

which SH type may result in malalignment

Answer 26

4

Question 27

which SH may result in arrest of bony growth

Answer 27

5

Question 28

tibial spine fracture

Answer 28

intra articular fx most common in children at 8-14 years old MOI - rapid acceleration or hyperextension/rotation Fall from bike very common Other injuries that can occur at the same time Osteochondral fracture ligament injury Femoral condyle or tibial plateau fracture

Question 29

tibial spine fx treatment

Answer 29

non-operative for nondisplaced fractures Surgery for displaced and comminuted fractures

Question 30

tibial spine fx rehab

Answer 30

immobilization Weight-bearing restrictions Education ROM Strengthening Prognosis - usually within six months

Question 31

Tibial tubercle fracture

Answer 31

most common in adolescence Males >females Less than one percent of pediatric fractures MOI - strong contraction of quads while jumping or during forced knee flexion

Question 32

tibial tubercle fracture treatments

Answer 32

non-operative for non-displaced or closed reduction injuries Surgery for displaced or more involved injuries - immobilization

Question 33

tibial tubercle fracture rehab

Answer 33

cast immobilize Weight-bearing restrictions Education ROM Strengthening Prognosis- within six months

Question 34

tibial plateau fracture MOI

Answer 34

axial loading fall or MVA

Question 35

Tibial plateau fracture rehab

Answer 35

immobilization as needed Nonweightbearing up to three months Patient education ROM Strengthening Prognosis - complications are not uncommon. Moderate functional outcomes are achieved may take greater than a year and increased risk of OA

Question 36

Tibial plateau fracture treatments

Answer 36

traction or casting Often less desirable due to inactivity Surgery Lots of options

Question 37

segond fx

Answer 37

avulsion fracture of lateral aspect of the tibial plateau Often occurs in conjunction with ACL injuries MOI- most commonly occurs via forceful, internal rotation and varus stretch Different from common MOI for ACL

Question 38

segond fx treatments

Answer 38

Address under my injury, most commonly the ACL injury Surgery for segond fracture may help with rotary stability

Question 39

segond fx rehab

Answer 39

symptoms management Protect knee early on If surgery is performed, follow protocol

Question 40

tibiofemoral disocation

Answer 40

MOI- severe traumatic injury Rare .02% of orthopedic injuries

Question 41

tibiofemoral dislocation treatment

Answer 41

imaging and neurovascular assessment Reduction reassessment of neurovascular integrity Extensive surgery is often needed to reconstruct multiple injuries

Question 42

tibiofemoral dislocation common complications

Answer 42

Neurovascular damage avascular necrosis persistent weakness Persistent stiffness Tibiofemoral instability Patellar instability Arthritis

Question 43

physical therapist role during immobilization

Answer 43

Minimal visits Safe return to function Protect injured and uninjured tissues