TABLE 2662 Pittsburgh Knee Rules

Anteroposterior, lateral, and oblique radiographs are typically obtained if x-rays are determined to be necessary. 4 Fat fluid levels (lipohemarthrosis) may be identified on a lateral view of the knee which is suggestive of intra-articular fracture. 5 Oblique views are particularly helpful at detecting subtle tibial plateau fractures (internal oblique view is best to visualize lateral plateau, external oblique film best to visualize medial plateau). A tunnel or intercondylar view provides a clear view of the intercondylar region and is particularly useful in identifying tibial spine fractures. The sunrise (skyline, axial, or tangential) view is most useful in detecting nondisplaced vertical or marginal fractures of the patella which may be missed with the conventional three views. The sunrise view is indicated if patellar subluxation or fracture is suspected. CT scanning may be necessary to fully delineate the extent of tibial plateau fractures. 6 MRI is also helpful in this regard, having the added benefit of being able to assess soft tissue injury (i.e., ligamentous and meniscal).

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