Evaluation of the frequency of fracture and the necessity of a CT scan in patients with acute knee trauma and normal radiography

Background: The anatomy of the knee joint and its exposure to external forces make it particularly vulnerable to injury, while current classification systems for complete knee dislocations may not adequately capture the severity and complexity of associated injuries. Objective: This study aimed to assess the prevalence of fractures in computed tomography (CT) scans ordered for patients with acute knee trauma in the emergency department (ED), despite normal plain radiographs. Methods: This cross-sectional study was conducted on individuals with acute knee trauma who sought treatment at the EDs of Imam Reza Hospital and Shahid Hashminejad Hospital in Mashhad, Iran, throughout 2017. Data on demographics, trauma mechanisms, prior history, and underlying conditions were systematically recorded. Results: Involving 500 patients with knee trauma, 78% showed no CT fractures, while 6% had patellar fractures, and 16% exhibited tibial plateau fractures. Patients without CT fractures were younger (32.3 ± 13.1 years) than those with fractures (38.8 ± 13.4 years), showing a significant age association ( p = 0.001). Female patients with knee trauma and normal radiographs had a higher CT fracture frequency than males ( p = 0.017). Conclusion: The study recommends relying on plain radiography, especially in younger patients, as CT scans yielded positive results in only 22% of cases. It advocates judicious CT use in older patients and cases suspected of intra-articular fractures to optimize treatment.