Pediatric emergency medicine trisk 0853 0853
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head of the fibula, (iii) inability to flex to 90 degrees, (iv) inability to bear weight
both immediately after the injury and in the ED (four steps) regardless of limping.
Figure 42.8 summarizes an approach to the child with an acutely injured knee.
If the initial evaluation suggests vascular compromise, traction and reduction of
the knee should be attempted and an emergent orthopedics consultation should be
obtained. If the patella is obviously dislocated, it may be reduced before obtaining
radiographs. If the patient’s knee is too painful or swollen to allow a complete
examination, and radiographs are negative, ligament or meniscal damage should
be suspected. The patient should be instructed to use crutches and remain
completely non–weight bearing until medical or surgical follow-up or until the
patient improves. If radiographs demonstrate air in the joint, orthopedics should
be consulted to assess for penetrating intra-articular injury. If there is a puncture
wound or laceration near the knee joint, a saline load test or CT imaging should
be performed to assess for penetrating intra-articular injury (see Chapter 121
Musculoskeletal Emergencies ).
