Fracture distal femur, patella and proximal tibia

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Knee Region Fractures: NEET PG Essentials

1. Distal Femur

  • Classification: Supracondylar and intercondylar (often AO/OTA classification).
  • Deformity: The distal fragment is typically flexed due to the pull of the gastrocnemius muscle.
  • Treatment: Locked plating (LCP) is the standard; IM nails can be used but require specific distal locking configurations.

2. Patella

  • Classification: Transverse, polar, comminuted, or vertical.
  • Key Assessment: Must assess the extensor mechanism. If the patient cannot perform an active straight leg raise, the extensor mechanism is disrupted.
  • Fixation: Tension Band Wiring (TBW) is the gold standard for transverse fractures. Partial or total patellectomy is reserved for severely comminuted cases.

3. Proximal Tibia (Tibial Plateau)

  • Classification: Schatzker Classification (I–VI).
    • Type I: Split (Lateral).
    • Type II: Split-depression (Lateral).
    • Type III: Pure depression (Lateral).
    • Type IV: Medial condyle.
    • Type V: Bicondylar.
    • Type VI: Metaphyseal-diaphyseal dissociation.
  • Clinical Pearl: High risk of popliteal artery and peroneal nerve injury, especially in Type IV/VI (high-energy) fractures.

4. High-Yield Examination Pearls

Fracture/Condition High-Yield Detail
Lipohemarthrosis Fat-fluid level on cross-table lateral X-ray; indicates an intra-articular fracture.
Segond Fracture Avulsion of the lateral tibial plateau; pathognomonic for an ACL tear.
Compartment Syndrome Crucial to monitor in high-energy proximal tibia fractures (Type V/VI).