Nonoperative treatment

Relative indications for nonoperative treatment of these fracture patterns are less than 5° of frontal and/or sagittal plane malalignment, and displacement of less than 5–10 mm.

However, even in situations where these criteria are satisfied, operative treatment may still be chosen in the setting of neurovascular injury, compartment syndrome, a multiply injured patient, associated injuries of the limb, etc.

If there is any question about associated ligamentous instability, then further investigations such as MRI can be obtained.

Seven to ten days of long-leg posterior plaster splinting is indicated, with the knee in 0–20° of flexion as comfort allows. Patients can then be transitioned to a knee immobilizer or hinged knee brace and begin range of motion exercises.

These devices provide relative immobilization of the knee joint, allowing pain relief. Regardless of the device used, patients must be instructed to begin knee range of motion exercises as pain subsides, typically beginning within one to two weeks. During this time, ankle range of motion is to be encouraged, as are quadriceps setting exercises, and straight leg raising. These devices can be used for all fractures as a means of temporary splinting.

Patients should take off the immobilizer, or knee brace, for hygiene, quiet time, and range of motion.

Strong consideration for DVT prophylaxis should be considered in both nonoperatively and operatively managed patients.

Aftercare and rehabilitation following nonoperative treatment should be individualized according to the patient, fracture, and local protocol specifics.

Pain and neurovascular status should continue to be monitored, particularly in the immediate post-injury time period. Active motion of the joint should begin within 7–14 days. Full weight bearing is often restricted for 6–8 weeks.

Early weekly radiographic follow-up is indicated to ensure there is no change in alignment.