These Patients Knee’d Your Help
Knee pain, fracture, and dislocation are common consequences of car accidents and falls, but differentiating between x-rays can be an obstacle of its own. Four patients, four diagnoses—can you identify the problem represented in each radiograph?
Match the primary diagnosis to the photo by letter
a. Medially dislocated distal femur
b. Nondisplaced proximal fibula fracture
c. Lateral dislocation of the patella
d. Comminuted and depressed fracture of the lateral tibial plateau
For answers, see next issue; for discussion, go to https://www.mdedge.com/clinicianreviews/picture
3. A 70-year-old woman presents for evaluation of right knee pain secondary to a fall. When she tripped and fell, all her weight landed on her right knee; she says it is now “extremely painful” to bear weight on that leg. Inspection of her right knee shows no obvious deformity, but a moderate amount of swelling and limited range of motion. She also has moderate tenderness circumferentially around the knee. There is additional swelling and mild bruising on both the medial and lateral aspects of the right ankle.
Diagnosis: The radiograph has several findings, one of which is a nondisplaced proximal fibula fracture. In addition, there is a moderate suprapatellar joint effusion. The patient also has fairly advanced tricompartment degenerative arthrosis. (To review, the tricompartment comprises all three anatomic areas of the knee: the patellofemoral, lateral tibiofemoral, and medial tibiofemoral joints.) The patient was placed in a knee immobilizer, and orthopedic evaluation was coordinated.
For more information, see “In Middle of Trip, Woman Falls.” Clinician Reviews. 2016;26(6):20,53.
