Easily missed injuries around the knee

Area of Science:

• Orthopedic imaging
• Radiographic diagnosis of knee injuries

Background:

• Many knee fractures are evident on radiographs, but subtle injuries pose diagnostic challenges.
• Musculotendinous and ligamentous injuries often present with non-specific radiographic findings.

Purpose of the Study:

• To highlight subtle knee fractures and soft tissue injuries that may be missed on standard radiographs.
• To describe specific radiographic views and diagnostic considerations for challenging knee injuries.

Main Methods:

• Review of radiographic findings for various subtle knee injuries.
• Emphasis on specialized radiographic projections and clinical correlation.

Main Results:

• Tibial plateau fractures may require tangential or tunnel views.
• Segond fractures are often best seen on tunnel views.
• Fibular head dislocations necessitate careful evaluation of the tibiofibular joint on lateral views.
• Patellar fractures require specific views (sunrise, Merchant, lateral, oblique) based on fracture type.
• Salter I fractures may be visualized with stress views or identified by periosteal reaction on follow-up.

Conclusions:

• Radiography remains the primary imaging modality for knee fractures.
• Clinical suspicion combined with targeted radiographic techniques is essential for diagnosing subtle knee injuries.
• Advanced imaging is rarely needed for fracture detection but aids in assessing displacement and soft tissue injuries.