How Do I Know if I Have a Knee Fracture?


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How would I know if I fractured my knee? How would my Doctor or I know if I perhaps needed an Xray? According to the Ottawa rules we can know with good certainty if you likely have a fracture in your knee or not. Here are the rules below.

If the patient has one or more of the following criteria they need an Xray:

  • Age 55 years or older.
  • Tenderness at head of fibula (outside lower leg bone)
  • Isolated tenderness of patella (knee cap)
  • Inability to flex  (bend the knee) to 90°
  • Inability to bear weight both immediately and in the emergency department (4 steps)


In an article in JAMA 1997 it showed the following results for the Ottawa rules:

Results. The rule was found to have a sensitivity of 1.0 (95% confidence interval [Cl], 0.94-1.0) for detecting 58 knee fractures. The κ coefficient for interpretation of the rule was 0.91 (95% Cl, 0.82-1.0). Compared with nonfracture patients who underwent radiography during the after-intervention period, those discharged without radiography spent less time in the emergency department (85.7 minutes vs 118.8 minutes) and incurred lower estimated total medical charges for physician visits and radiography(US $80 vs US $183).

Conclusions.  —Implementation of the Ottawa Knee Rule led to a decrease in use of knee radiography without patient dissatisfaction or missed fractures and was associated with reduced waiting times and costs. Widespread use of the rule could lead to important health care savings without jeopardizing patient care.

Article | Implementation of the Ottawa Knee Rule for the Use of Radiography in Acute Knee Injuries Ian G. Stiell, MD, MSc, FRCPC; George A. Wells, PhD; et al. JAMA. 1997;278(23):2075-2079.


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