Children's Unit
 
SE/B06/41: Knee trauma in 12 year old
 
Child on bed
Back to St Emlyn's Reception

1. Describe what you see on the X-rays.

This is an interesting set of X-rays. It's a great example of a lipohaemarthrosis. There is fat and blood in the joint, and since the fat must come from bone there must be a fracture.

The lipo is best seen on the lateral at the superior pole of the patella. Always look for this in knee injuries.

Now that you know there is a fracture it's easy to pick up the fracture on the proximal tibia around the tibial spines. He has a;lost certainly avulsed his cruciate ligaments taking a chunck of bone off. In adults the ligaments go before the bone, not so in kids.


2. How would you manage him in the ED?

In the ED the mainstays of management will be analgesia, splintage (POP back slab or cricket pad splint) and crutches for non-weight bearing. At this age and with this condition there is no harm in speaking to the on call ortho team for advice. It's quite an unusual injury.


3. What treatment options are available for him later on?

If the bony fragment settles and does not displace these can be managed successfully. If not, it's an ORIF but many orthopaedic surgeons like to avoid this in this age group.

It's likely that an MR scan will aid decision making here.

http://www.ncbi.nlm.nih.gov/pubmed/19633462