Radiology Review

Knee Pain After Falling Off Ladder

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A 25-year-old woman presents for evaluation of left knee pain secondary to a fall. She states she was descending a ladder when she missed a step while still several feet above the ground. She landed on her left foot, awkwardly twisting her leg. She now has swelling and pain in her knee and difficulty bearing weight on that leg. Her medical history is unremarkable. Examination reveals a moderate amount of swelling that limits her ability to flex her left knee. She has diffuse tenderness throughout the knee. Because of the swelling and the patient’s severe discomfort, instability tests are not performed. She has good distal pulses and sensation. Radiographs of the knee are obtained. What is your impression?


 

ANSWER
The radiograph shows a lucency within the lateral tibial plateau and tibial metaphysis, consistent with a fracture. It is mildly depressed and slightly comminuted.

Fluid collection is also evident on the lateral view, likely reflecting a lipohemarthrosis. The patient was placed in a knee immobilizer and made non–weight-bearing. She was instructed to follow up with an orthopedist when she returned home (as she was visiting from out of town).

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