Disclosures: Andrea E. Dockry, MD: No financial relationships or conflicts of interest
Case Description: A 28 year old female with a history of traumatic SCI with incomplete tetraplegia presented to SCI Rehabilitation follow up clinic with resolving right knee swelling and pain from a fall during a transfer three months earlier. Her primary care physician diagnosed an MCL sprain; imaging was not performed. She continued with physical therapy, ambulating with bilateral knee immobilizers and a walker. Right knee exam revealed mild fullness over medial femoral condyle, no effusion, and no tenderness to palpation. Passive range of motion (ROM) testing demonstrated 110 degrees of flexion and loss of 10 degrees of full extension compared with normal flexion and extension of the left knee. Ligamentous testing was negative. X-ray revealed a medial condyle femur fracture with 5 mm articular step off and moderate callus formation.
Setting: Tertiary care hospital.
Patient: A 28 year old female with traumatic spinal cord injury (SCI) and incomplete tetraplegia Assessment/
Results: CT scanning of the right femur revealed a distal femur fracture with articular incongruity, lack of bridging callus, and periosteal callus in the proximal medial metaphysis. She underwent surgical stabilization with local bone grafting; she was hospitalized for one night after surgery to monitor for autonomic dysreflexia and was discharged home on the first post-operative day. She was allowed ROM as tolerated with no weight bearing for six weeks.
Discussion: Patients with SCI are at increased risk for osteoporosis, and fracture must be on the differential when patients present with knee pain or swelling. Most femur fractures in patients with SCI occur in the distal femur.
Conclusion: Patients with spinal cord injuries may have an atypical presentation after sustaining fracture. A heightened awareness of this complication is essential to avoid undetected fractures.
Level of Evidence: Level V
To cite this abstract in AMA style:
Dockry AE, Colachis S. Knee Swelling in a Patient with Incomplete Tetraplegia: The Importance of Heightened Awareness. A Case Report [abstract]. PM R. 2020; 12(S1)(suppl 1). https://pmrjabstracts.org/abstract/knee-swelling-in-a-patient-with-incomplete-tetraplegia-the-importance-of-heightened-awareness-a-case-report/. Accessed May 8, 2025.« Back to AAPM&R Annual Assembly 2020
PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/knee-swelling-in-a-patient-with-incomplete-tetraplegia-the-importance-of-heightened-awareness-a-case-report/