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Approach to the knee radiograph for bony injuries Jasmin Fauteux August 25 th 2011.

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Presentation on theme: "Approach to the knee radiograph for bony injuries Jasmin Fauteux August 25 th 2011."— Presentation transcript:

1 Approach to the knee radiograph for bony injuries Jasmin Fauteux August 25 th 2011

2 Objectives Review: Indications The views The approach Fractures Cases

3 Knee rules

4 PDR’s applicability has yet to be proven Pittsburgh Decision rule potentially more specific

5 The views

6 Lateral

7 Anteroposterior

8 Obliques

9 Tunnel view

10 Skyline

11 The approach

12 S-ABC Targeting your approach to look for suspected fracture OR Soft tissue Alignment Bone Cartilage and joints

13 Soft tissue Lipohemarthrosis Effusion

14 Lipohemarthrosis

15 Effusion May be caused by a bone injury in 53% of cases

16 Alignment Condyle with plateau Patellar alignment

17 Bone Cortices Trabecular pattern Intra-articular bodies

18 Cartilages and joints Patellofemoral Femorotibial

19 Tibial plateau Lipohemarthrosis Oblique views Low force required in osteoporosis

20 16% are missed by EP

21 Tibial plateau Trabecular density Widening of joint space Lateral displacement

22 Schatzker classification

23 Segond’s fracture

24 Reverse Segond’s

25 Arcuate complex avulsion -Prox. Fibula -Horizontal -Posterolateral

26 Tibial spine -Children > Adults -ACL avulsion

27 Case 1 -26yo M -Fell onto flexed knee -Isolated patellar pain

28 Case 2 62yo F Twisted knee while moving Walking with cane Flexion to 60 degrees

29 Case 3 34yo M Snowboarding Painful lateral joint line

30 Case 4 -33yo F -High intensity MVA -Painful prox. fib

31 Thank you!

32 Bibliography Verma A, et al: A screening method for knee trauma. Acad Radiol 2001; 8:392. Stiell I, et Al: Implementation of the Ottawa Knee Rule for the Use of Radiography in Acute Knee Injuries. JAMA 1997;278(23):2075-2079 Simon LV, et al: The Pittsburgh Decision rule: triage nurse versus physician utilization in the emergency department. J Emerg Med 2006 Oct; 31(3) 247-50 Seaberg DC, et Al, Multicenter comparison of two clinical decision rules for the use of radiography in acute, high-risk knee injuries, Ann Emerg Med 1998 Jul; 32(1): 8-13 Seaberg DC, et al: Clinical decision rule for knee radiographs, Am J Emerg Med 1994 Sep; 12 (5):541-3 Steil IG, Wells GA, McDowell I, et al. Use of radiography in acute knee injuries: need for clinical decision rules. Acad Emerg Med 1995;2:966–973. Bauer SJ, Hollander JE, Fuchs SH, et al. A clinical decision rule in the evaluation of acute knee injuries. J Emerg Med 1995;13: 611–615. Imparanza JI, Aginaga JR. Validation of the Ottawa knee rules. Ann Emerg Med 2001;38:364–368. Stiell IG, Greenberg GH, Wells GA, et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries. JAMA 1996;275:611–615. Gottsegen C, et al: Avulsion Fractures of the Knee: Imaging Findings and Clinical Significance, RadioGraphics October 1, 2008 28:1755-1770 Mettler: Essentials of Radiology, 2nd ed, Marx, John: Rosen ‘s Emergency Medicine: concepts and clinical practice, 7 th ed. Tintinalli, Judith; Tintinalli’s Emergency medicine, 7 th edition Krishnam, Mayil S: Emergency radiology Schwartz, David: Emergency radiology: case studies Marincek, Borut: Emergency radiology: Imaging and intervention

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