Your patient is a 34 yo man who has a painful left knee after “twisting” it during a basketball game.
= small vertical avulsion injury of the lateral aspect of the proximal tibia immediately distal to the tibial plateau, at the site of attachment of the lateral capsular ligament
Mechanism: axial load on a semiflexed knee, with internal rotation and varus stress
Why is it important?
It is associated with:
– anterior cruciate ligament tear in 75% to 100% of cases!
– meniscal injury 67% to 75%
– secondary anterolateral rotatory instability of the knee
– a haemarthrosis is commonly present
– the bone fragment located on the lateral edge of the tibial condyle, best visualized on the anterior-posterior view
– elevation / ice / crutches / knee immobilization
– Orthopaedics referral
I assume the ortho referral is to the trauma clinic rather than immediately? And just Richard splint for immobilisation?
That’s correct – immobilize the knee in a Richard’s splint and refer to the trauma clinic to be seen within one week.
Loving the education pearls…just out of curiosity, with the knee xray I was able to magnify in which was helpful. I was just looking at the CXR of the inhaled FB on my laptop, and there was no tool to zoom in. Have you now added the magnifying tool on xrays…coz it’s useful when viewing on a laptop screen? Thanks so much for this Ioana
Hmmm… I’ll have to ask Colin or John to answer this one, as far as I know I attached all the files in exactly the same way.
Probably a browser issue. WordPress handles all uploaded images in the same way, not influenced by the post author. Maybe try again, using a different browser, eg Firefox or Chrome? If you Ctrl-click on the image, it should open in a new tab, on most browsers.
Conversly, the reverse segond fracture (very rare) is the identical injury but on the medial aspect and associated with medial capsular ligament tear:
1.Posterior cruciate ligament tear
2.Medial meniscus injury
3.medial instability of the knee
Ionna, love these pearls. Just enough info for my brain.
Thanks Yusuf.You’re right, it is rare but worth knowing about. And management is the same, Richard’s splint + Ortho follow-up within one week.