When in doubt, refer out!
*The Ottawa Knee Rules (OKR) are rules used to identify individuals who should be referred for radiographic examination of the knee following acute trauma. The criteria for referral is as follows:
- The patient is 55 or older
- The patient demonstrates a tenderness of the fibular head
- The patient has palpable, isolated tenderness of the patella
- the patient is unable to flex the knee to 90 degrees
OR
- The patient is unable to bear weight immediately after the trauma and/or during clinical examination.
These rules were designed to be highly sensitive and the use of these rules could reduce the need for plain knee radiographs by 25%.
*Immediate action in the form of 911 is needed when the victim is experiencing trauma, if there is an obvious fracture (such as a femur popping out of the skin), the victim is unconscious, the victim is not breathing, or there is severe bleeding (such as a severed femoral artery).
*If the patient has been started on a rehab program, but the symptoms have not subsided, it's time to refer.
- The patient is 55 or older
- The patient demonstrates a tenderness of the fibular head
- The patient has palpable, isolated tenderness of the patella
- the patient is unable to flex the knee to 90 degrees
OR
- The patient is unable to bear weight immediately after the trauma and/or during clinical examination.
These rules were designed to be highly sensitive and the use of these rules could reduce the need for plain knee radiographs by 25%.
*Immediate action in the form of 911 is needed when the victim is experiencing trauma, if there is an obvious fracture (such as a femur popping out of the skin), the victim is unconscious, the victim is not breathing, or there is severe bleeding (such as a severed femoral artery).
*If the patient has been started on a rehab program, but the symptoms have not subsided, it's time to refer.