Pediatric emergency medicine trisk 0848 0848
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FIGURE 42.7 Testing for meniscal injury with the Apley compression test. With the patient
prone and the knee flexed to 90 degrees, apply pressure to the heel while the tibia is rotated. If
this produces pain that resolves when the tibia is distracted from the femur, a meniscal injury
should be suspected.
Posttraumatic Infection
Although not considered injuries, acute infections may present after a vague
history of trauma. Physical findings of acute infection will be present. The most
common disorders are septic arthritis, osteomyelitis, cellulitis, and septic
prepatellar bursitis (see Chapters 94 Infectious Disease Emergencies and 121
Musculoskeletal Emergencies ).
Subacute Injuries
Many subacute knee problems may present in the ED. Osgood–Schlatter disease
of the tibial tubercle may present with similar symptoms as a traumatic avulsion
of the tubercle; however, the symptoms have likely been noted for days or weeks.
The symptoms of Osgood–Schlatter disease are exacerbated by squatting or
jumping, but they do not cause the same disability as an acute avulsion. The
disease is usually seen in patients between 11 and 15 years of age. It may be
caused by recurrent contractions of the patellar tendon during knee extension,
