Authors of section

Authors

Matthias Hansen, Rodrigo Pesantez

Executive Editors

Joseph Schatzker, Ernst Raaymakers, Rick Buckley

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Nonoperative treatment

1. No immobilization, non-weight bearing and early motion

Indication

Undisplaced fracture which is perfectly stable.

Nonoperative treatment is indicated if the fracture is undisplaced or minimally displaced and the joint is absolutely stable and there are no other indications for surgery (eg., neurovascular injury, compartment syndrome).

A careful knee exam with valgus/varus stress test done in both full extension and 30° of flection must be peformed. If there is any question about medial/lateral instability, or anterior/posterior stability, or rotatory instability, then further investigations such as MRI should be obtained.

Never immobilize in plaster. If splinting is necessary, then immobilize in a hinged fracture brace.

Start early active range of motion as soon as possible.

2. Posterior plaster splint

Indication

Only as a means of temporary splinting.

3. Non-hinged fracture brace (Zimmer knee brace)

Indication

All fractures as a means of temporary splinting.

Non-hinged fracture brace (Zimmer knee brace)

4. Hinged fracture brace

Indication

Angular splinting of the extremity allowing early knee motion.

As a means of definitive splinting allowing early motion.

Fracture brace

Never immobilize in plaster. If protection is required to prevent displacement, use a hinged fracture brace to permit early motion.

Axial splinting allowing knee motion.

Hinged fracture brace
Hinged fracture brace

5. Aftercare

For aftercare and rehabilitation following nonoperative treatment please refer to your local protocol.

Pay attention to the neurovascular status, avoid compartment syndrome 2) isometric muscular exercise as early as possible 3) Passive motion of the joint can begin from 4-6 weeks with non-weight bearing.