Knee Fracture and Dislocation

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Knee fractures refer to breaks in any of the bones constituting the knee joint, including the patella (kneecap), distal femur, and proximal tibia. Knee dislocations occur when the bones of the knee joint are displaced from their normal alignment, typically involving damage to the ligaments.

Aetiology

Knee fractures and dislocations can be caused by:

• High-impact trauma, such as car accidents or falls from height
• Sports injuries
• Direct blows to the knee
• Twisting injuries
• Pathological fractures due to bone diseases like osteoporosis or cancer

Pathophysiology

The pathophysiology of knee fractures and dislocations involves:

• Disruption of bone integrity, leading to fractures
• Damage to surrounding ligaments, tendons, and muscles
• Potential compromise of blood vessels and nerves, especially in dislocations
• Inflammation and haemorrhage within the joint

Risk Factors

• Participation in high-impact sports
• Advanced age
• Osteoporosis or other bone-weakening conditions
• High-risk occupations
• Previous knee injuries

Signs and Symptoms

The signs and symptoms of knee fractures and dislocations include:

• Severe pain in the knee
• Swelling and bruising around the knee
• Inability to move the knee or bear weight on it
• Visible deformity or misalignment of the knee joint
• Numbness or tingling if nerves are affected
• Instability or a feeling that the knee may give way (in dislocations)

Investigations

Specific investigations to diagnose knee fractures and dislocations include:

• Clinical examination: Physical assessment of pain, deformity, and range of motion.
• Imaging studies:
  • X-rays: To confirm the presence and type of fracture or dislocation.
  • CT scan: For detailed images of complex fractures or associated injuries.
  • MRI: To evaluate soft tissue damage and ligament injuries.
• Blood tests: To assess overall health and pre-surgical fitness, if surgery is needed.

Management

Primary Care Management

• Initial assessment and stabilisation: Prompt referral to emergency services for further evaluation and treatment.
• Pain management: Analgesics such as paracetamol or NSAIDs to relieve pain.
• Immobilisation: Splinting or using a brace to stabilise the knee joint temporarily.

Specialist Management

• Closed reduction: Manipulative reduction of dislocated knee joints under sedation or anaesthesia.
• Surgical intervention:
  • Internal fixation: Using screws, plates, or rods to stabilise the fracture.
  • Ligament repair or reconstruction: For associated ligament injuries.
• Postoperative care: Pain management, physiotherapy, and rehabilitation to restore knee function.
• Monitoring for complications: Regular follow-up to detect and manage potential complications such as avascular necrosis, infection, or chronic instability.

References

1. NHS (2024) Knee fracture and dislocation. Available at: https://www.nhs.uk/conditions/broken-leg/ (Accessed: 24 June 2024).
2. National Institute for Health and Care Excellence (2024) Knee injury overview. Available at: https://cks.nice.org.uk/topics/knee-injuries/ (Accessed: 24 June 2024).
3. British Medical Journal (2024) Knee fractures and dislocations: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/350/bmj.h2747 (Accessed: 24 June 2024).
4. American Academy of Orthopaedic Surgeons (2024) Knee Fractures and Dislocations. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/knee-fractures-and-dislocations/ (Accessed: 24 June 2024).

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