Knee fracture

Phsyical Examination

Ottawa Knee Rule Decision
1. > 55 years of age
2. Sensitivity around the fibula
3. Isolated sensitivity of the patella
4. Inability to flex the knee to 90 degrees
5. Inability of the patient to bear weight and inability to make four steps.

The test is found positive when one of the above-mentioned points from 2 to 5 are positive and means that there is an indication for an X-ray photograph.

 

Pittsburgh Knee Rule Decision
1. Patient known to have a trauma or a fall
2. inability of the patient to bear weight and inability to make four steps.
3. Age younger than 12 or older than 50 years

The test is found positive when point 1 in combination with either point 2 or 3 are found positive.

A positive test means an indication for an X-ray photograph, in order to be able to display the fracture.

 

Knee Decision Rule of Bauer

  1. Inability of the patient to bear weight and inability to make four steps.
  2. Effusion present
  3. ecchymosis presentThe test is positive in 1 of 3 points
  4. positive test means an indication for an X-ray photograph, in order to be able to display the fracture

 

Evidence Based Practice

Ottawa Knee Decision Rule Utility 1
Study Sensitivity (show) Specificity (exclude QUADAS Score 0-14
Jackson et al.2 100 49 NA
Richman et al.3 85 50 12
The Ottawa knee rule is an important instrument in the diagnostics of a knee fracture.97,98,99

 

Pittsburgh Knee Decision Rule Utility 1
Study Sensitivity (show) Specificity (exclude QUADAS Score 0-14
Seaberg & Jackson4 100 79 11
Seaberg et al5 99 60 11

 

Knee Decision Rule of Bauer  
Study Sensitivity (show) Specificity (exclude) QUADAS Score 0-14
Bauer et al.1 100 63 11
Richman et al.3 85 49 12
Literature
  1. Bauer SJ, Hollander JE, Fuchs SH, Thode HC, Jr. A clinical decision rule in the evaluation of acute knee injuries. J Emerg Med. 1995;13:611-615.
  2. Jackson JL, O’Malley PG, Kroenke K. Evaluation of acute knee pain in primary care. Ann Intern Med. 2003;139:575-588.
  3. Richman PB, McCuskey CF, Nashed A, et al. Performance of two clinical decision rules for knee radiography. J Emerg Med. 1997;15:459-463
  4. Seaberg DC, Jackon R. Clinical decision rule for knee radiographs. Am J Emerg Med. 1994;12:541-543
  5. Seaberg DC, Yealy DM, Lukens T, Auble T, Mathias S. Multicenter comparison of two clinical decision rules for the use of radiography in acute, high risk knee injuries. Ann Emerg Med. 1998;32:8-13
  6. Stiell IG, Greenberg GH, Wells Ga, et al. Prospective validation of a decision rule for the use of radiography in acute knee injuries. Jama. 1996;275:611-615
  7. Stiell IG, Greenberg GH, Wells Ga, et al. Derivation of a decision rule for the use of radiography in acute knee injuries. Ann Emerg Med. 1995;26:405-413
  8. Stiell IG, Wells Ga, Hoag RH, et al. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. Jama 1997;278:2075-2079

 

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