Evaluation and Management of Traumatic Knee Injuries in the Emergency Department

Knutson, Tristan; Bothwell, Jason; Durbin, Ricky

doi:10.1016/j.emc.2014.12.007

Cited by 13 publications

(22 citation statements)

References 42 publications

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“…A survey of emergency physicians, sports medicine physicians and orthopaedic surgeons on their practice patterns regarding the use of early immobilisation in common acute soft tissue injuries showed that emergency physicians were more likely to prescribe immobilisation than other specialties, demonstrating that there is variation in care between different health providers . Although complete knee joint immobilisation using either a splint or locked hinged brace may protect tissues and alleviate pain, there can be harmful effects of prolonged joint immobilisation such as joint stiffness and muscle atrophy . Prescription of gentle range of motion exercises, basic quadriceps strengthening exercises and consideration for early follow up for rehabilitation and clinical review is essential to avoid any deleterious effects of prolonged immobilisation.…”

Section: Discussionmentioning

confidence: 99%

“…There was a paucity of high level evidence in this review for the management of patella fractures and the different classification types of tibial plateau fractures. As patella fractures may affect the extensor mechanism function and require surgery, they should be immobilised in extension and restricted to a weight bearing status suitable for the severity or stability of the injury until orthopaedic follow up . Tibial plateau fractures can easily be missed on plain films because of subtle displacement; however, ED clinicians should use their clinical judgement and non‐osseous findings on X‐ray (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…CT has been shown to be a more accurate and easier method for the detection and evaluation of tibial plateau fractures . Similar to patella fracture, all tibial plateau fractures should be immobilised, non‐weight bearing and involve orthopaedic input …”

Section: Discussionmentioning

confidence: 99%

“…70 Although complete knee joint immobilisation using either a splint or locked hinged brace may protect tissues and alleviate pain, there can be harmful effects of prolonged joint immobilisation such as joint stiffness and muscle atrophy. 41,70,71 Prescription of gentle range of motion exercises, basic quadriceps strengthening exercises and consideration for early follow up for rehabilitation and clinical review is essential to avoid any deleterious effects of prolonged immobilisation.…”

Section: Discussionmentioning

confidence: 99%

“…74,75 Similar to patella fracture, all tibial plateau fractures should be immobilised, non-weight bearing and involve orthopaedic input. 71…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

Review article: Best practice management of common knee injuries in the emergency department (part 3 of the musculoskeletal injuries rapid review series)

Strudwick

McPhee

Bell

et al. 2017

Emerg Medicine Australasia

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Knee injuries are a common presentation to the ED and are often difficult to assess and definitively diagnose due to the patient's acute pain, effusion and guarding. The quality of ED care provided to patients with fractures or soft tissue injuries of the knee is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common knee injuries in the ED. Databases were searched in 2017, including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites. Primary studies, systematic reviews and guidelines were considered for inclusion. English-language articles published in the past 12 years that addressed the acute assessment, management, follow-up plan or prognosis were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 2250 articles, of which 54 were included in the review (n = 8 primary articles, n = 28 systematic reviews, n = 18 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the knee in the ED, a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. There is consistent evidence to support undertaking a thorough history and physical examination, including the application of special tests and clinical decision rules for imaging. In the undifferentiated knee injury, expedited follow up and further imaging is recommended to improve patient outcomes and cost-effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%