Knees / Lower limb VFC

Traumatic Knee Pathway

A&E management

Suspected meniscal / ligament injury

A&E management

WB as tolerated, offer cricket pad splint for pain (note: no more than 7 days use, remove regularly for ROM exercises), crutches if needed, RICE, A&E advice card.

Follow-up

Refer to MSK review Clinic (Run by ESP at MGH and TWH A&E)

Atraumatic knee swelling

A&E management

Obs, bloods (FBC, CRP, Urate), follow Sepsis 6 (if signs of sepsis), XR knee (AP and lateral)

Follow-up

Refer to Ortho on-call if raised infection markers or prosthesis in-situ

Patella / Quads tendon rupture

A&E management

Cricket pad splint, request USS, COVID swab

Follow-up

Refer to Ortho on-call

Patella fracture

A&E management

XR knee AP and lateral, cricket pad splint, crutches if needed, full weight bearing.

Follow-up

On-line referral to VFC. If displaced --> Refer to Ortho on-call

Patella dislocation

A&E management

reduce, check XR, cricket pad splint if needed, full weight bearing

Follow-up

On-line referral to VFC

Distal tibial / Pilon fracture

A&E management

elevate

Follow-up

Refer to Ortho on-call

Tibial plateau fracture

A&E management

Above knee backslab, check XR (AP+lateral)

Follow-up

Refer to Ortho on-call

Tibial shaft fracture

A&E management

above knee backslab, check XR (AP + lateral)

Follow-up

Refer to Ortho on-call

Fibula proximal / midshaft fracture

A&E management

screen for medial ankle pain / Maisonneuve injury (weight bearing AP and lateral ankle x rays).
If negative --> weight bear as tolerated, crutches if needed.
If positive --> refer to Ortho oncall

Follow-up

On-line referral to VFC if isolated injury.
Refer to Ortho oncall if suspected Maisonneuve injury