Authors: Joanna Lumb / Editor: Steve Corry-Bass / Reviewer: Joanna Lumb / Codes: MuP2, SLO4, TP7 / Published: 30/04/2022
A male patient in his 40s was pulled over from standing height, twisting his knee as he fell. He is unsure if he hit it on the ground, but he felt an immediate sharp, severe pain, which has now settled to a constant dull ache with IV morphine. However, the slightest movement causes intense pain and he is unable to bear weight.
On examination, he is overweight, with normal vital signs. His right knee is significantly swollen and tender, with the lateral side being most painful. It is not erythematous but is mildly warm and an effusion is present. You haven’t been able to test his range of movement or ligaments as it is too painful to move it.
His past medical history includes hypothyroidism treated with levothyroxine, and sleep apnoea. He is normally independent, a non-smoker, and occasional drinker.
Following the Ottawa Knee rules1,2 an AP and lateral knee xray is requested.
13 responses
Nice module, thanks
simple but effective case – especially as the age 55 is often forgotten
Useful Module
didn’t realize that twisting the knee while being pulled can lead to a tibial plateau fracture. Will remember that next time I see a patient like that
good review – good image
Good images and reminders
Good review
great learning and review of ottawa knee rules
Interesting case.
Excellent revision post missed fracture
Excellent case revision.
good case explanation
Good Clinical Case