Page 145 - ASOP Orthopedic Casting Manual

3.5.3 Clinical Diagnosis Review ...

Fracture Diagnosis Process
1. Physic al Examination

• Palp ation for tender ness, defor mit y, and effusion
• Assess knee ex tension function (cr itic al for deter mining ex tensor mechanism integr it y)
• Check neurovascular status, p ar ticular ly for poplite al ar ter y injur y in tibial plate au fractures
2. Imaging Studies

• X-ray LAP, lateral, sunr ise views for p atella fractures; AP, lateral, oblique views for tibial plate au fractures)
• CT sc an for complex tibial plate au fractures
• MRI for suspected ligamentous injur ies or occul t tendon ruptures

Differential Diagnosis / Associated Injuries

• Knee disloc ations (c an be mistaken for tibial plate au fractures)
• Menisc al te ars (often co-exist with tibial plate au fractures)
• Femoral condyle fractures (may present similar ly to tibial plate au injur ies)
• Severe p atellofemoral osteo ar thr itis (mimicking p ain from p atellar fractures)

Tre atment / Management Considerations
Non-Surgic al Management LLong Leg Cylinder Cast Indic ations)

• Stable, nondisplaced p atella fractures → LLCC for 4^6 weeks with gradual range of motion exercises after 3^4
weeks.
• Minimally displaced tibial plate au fractures → LLCC for 6 weeks, followed by p ar tial weight-be ar ing with a
hinged knee brace.
• Postoperative c are for tendon rep airs (quadr iceps/p atellar tendon ruptures) → LLCC in ex tension for 4^6
weeks, with progressive mobilization.
• Severe ligamentous injur ies (high-grade MCL injur ies requir ing immobilization) → LLCC with restr icted weight-
be ar ing until ligamentous he aling occurs.

Surgic al Considerations LCases Not Suitable for LLCC Alone)

• Displaced fractures of the p atella or tibial plate au require open reduction and inter nal fixation LORIFM.
• Complex tibial plate au fractures involving joint depression may require surgic al elevation and fixation.
• Complete ex tensor mechanism disruption (p atellar/quad tendon rupture with retraction) mandates surgic al
rep air with e ar ly immobilization in LLCC.