From the Guidelines
The initial step in treating a suspected knee occult fracture involves obtaining a CT scan as the next imaging study to evaluate for the presence of radiographically occult fractures, as it has been shown to be superior to knee radiographs in detection and classification of fractures. This approach is based on the findings of a study published in the Journal of the American College of Radiology in 2020 1, which highlights the effectiveness of CT scans in detecting tibial plateau fractures and characterizing fracture severity.
When considering the treatment plan, the following steps should be taken:
- Protected weight-bearing using crutches or a knee immobilizer for 2-4 weeks to prevent further injury
- Implementation of the RICE protocol (Rest, Ice, Compression, Elevation) to reduce pain and inflammation
- Pain management using acetaminophen (500-1000mg every 6 hours) or NSAIDs like ibuprofen (400-600mg every 6-8 hours) if not contraindicated
- Further imaging with an MRI if CT scan results are inconclusive or if there is a high suspicion of internal derangements, as MRI is highly accurate in evaluating bone marrow contusions, occult fractures, meniscal, and ligamentous injuries 1
- Physical therapy to restore range of motion and strength after the acute phase
- Orthopedic consultation for possible surgical fixation if imaging reveals a displaced fracture or one in a high-risk location.
It is essential to note that the choice between CT and MRI scans depends on the specific clinical scenario and the suspected type of injury, with CT being more suitable for detecting bony avulsion fractures and MRI being necessary for preoperative detection of meniscal injuries 1.
From the Research
Treatment for Suspected Knee Occult Fracture
- The treatment for a suspected knee occult fracture is not directly addressed in the provided studies, but some information can be inferred from the diagnosis and management of occult fractures in other areas, such as the hip and femur 2, 3, 4.
- For occult fractures of the knee, diagnostic procedures such as a Lachman test, aspiration of effusions, examinations under anesthesia including stress films, and arthroscopy are recommended 2.
- In cases of suspected knee occult fracture, it is essential to consider the patient's overall condition, including any other injuries or trauma, and to use imaging studies such as tomography or MRI to confirm the diagnosis 3, 4.
- The management of occult fractures around the hip and knee may involve immobilization, surgery, or other treatments, depending on the severity and location of the fracture, as well as the patient's overall health and medical history 4, 5, 6.
- Immobilization periods can vary, but studies suggest that shorter periods of immobilization (1-3 weeks) may produce superior short-term outcomes compared to longer periods (6 weeks) in terms of function, range of motion, and pain 6.