The Weak Links

​"Can you look at a knee film?""Sure, what is the issue?" I was the coverage doc for Fast Track."It's a 15-year-old who hobbled in here with knee pain. Just before coming in, he was in football practice where he forcefully hyperextended his knee and heard a pop. Since then, he hasn't been able to bear full weight on the leg. He pointed to the fibular head area as the point of maximal pain. What do you think of the fibular head, and is that oval in the femur anything?""The femur oval is likely a benign bone cyst. The fibular head is probably OK, but it is a kid with growth plates. It is still early in the day, why don't you send it to radiology?" I said while I tried to think of other things to be concerned about.A proximal fibular fracture is rarely one in isolation. Obviously, we should check the ankle so we do not miss a Maisonneuve fracture. Usually though the more "silent" part is the fibular head, not the ankle. In consultation with Dr. Google, I learned that the most common mechanism for fibular head fractures is a direct blow to the anteriomedial aspect of an extended knee. I never saw it before, but it seemed possible.Then came the call. "The radiologist said to get a CT. They are calling a tibial plateau fracture."Yep, the kid had a tibial plateau fracture. Looking back, the irregularity was subtle but present. I should have been more suspicious that a smooth contour of the medial tibial plateau was missin...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs