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Approach to the knee radiograph for bony injuries

Approach to the knee radiograph for bony injuries. Jasmin Fauteux August 25 th 2011. Objectives. Review: Indications The views The approach Fractures Cases. Knee rules. Pittsburgh Decision rule potentially more specific . PDR’s applicability has yet to be proven. The views. Lateral.

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Approach to the knee radiograph for bony injuries

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  1. Approach to the knee radiograph for bony injuries JasminFauteux August 25th 2011

  2. Objectives Review: • Indications • The views • The approach • Fractures • Cases

  3. Knee rules

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

  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! Thank you!

  32. Bibliography • Verma A, et al: A screening method for knee trauma.  AcadRadiol  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 • SteilIG, Wells GA, McDowell I, et al. Use of radiography in acute knee injuries: need for clinicaldecisionrules. AcadEmerg Med 1995;2:966–973. • Bauer SJ, Hollander JE, Fuchs SH, et al. A clinicaldecisionrule in the evaluation of acute knee injuries. J Emerg Med 1995;13:611–615. • ImparanzaJI, Aginaga JR. Validation of the Ottawa kneerules. Ann Emerg Med 2001;38:364–368. • StiellIG, Greenberg GH, Wells GA, et al. Prospective validation of a decisionrule 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, RadioGraphicsOctober 1, 2008 28:1755-1770 • Mettler: Essentials of Radiology, 2nd ed, • Marx, John: Rosen‘s Emergency Medicine: concepts and clinical practice, 7th ed. • Tintinalli, Judith; Tintinalli’s Emergency medicine, 7th edition • Krishnam, Mayil S: Emergency radiology • Schwartz, David: Emergency radiology: case studies • Marincek, Borut: Emergency radiology: Imaging and intervention

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