Fracture Dislocations About the Knee

Fracture dislocations about the knee joint are relatively rare injuries involving both bony and ligamentous disruptions resulting in instability. Fracture dislocations can occur about the tibiofemoral, patellofemoral, and tibiofibular joints; and in paediatric patients often through surrounding physes. There is a high risk of associated vascular and neurological injuries underscoring the importance of having a thorough and organized approach to knee fracture dislocations for both the trauma and general orthopaedist. There are well-described classification systems for ligamentous injuries following true knee dislocations; however, there is no standard system to describe the range of femoral, tibial, fibular and patellar injuries that can occur in association. Selection of appropriate management will depend on the fracture pattern, stability of the fracture fragments and the associated joint. Before preparing any management plans, consideration must be given to associated soft tissue compromise with high-energy patterns, patient factors (age, activity level etc.), neurovascular status and available surgical specialty support. Given the broad scope of this topic, we herein focus on: intra-articular distal femur and proximal tibia fractures; acute tibiofibular injuries; patellar fracture dislocations; and paediatric physeal injuries about the knee.