Orthopedics should be consulted in the ED to determine if surgical intervention is indicated. An emergency department CT scan of the affected knee is commonly requested for surgical decisions. If an ED consult and CT scan are bypassed, rapid orthopedics follow-up must be ensured.
Surgical indications include:
- open fracture
- compartment syndrome
- articular surface depression (the degree of which is controversial)
- axial malalignment
- >10 degrees ligamentous instability when the knee flexed to 20 degrees
Cases not meeting those criteria are nonoperative and are treated with an above-knee cast, orthopedic follow-up within 1 week, and non-weightbearing status for 8-12 weeks.
