Immediate life-saving interventions
›Immediate stabilization
›If hemorrhagic shock then trauma resuscitation pathway
›If open wound then open injury pathway
›If vascular compromise then emergent vascular and ortho escalation
›Analgesia early
›Acetaminophen PO 1000 mg
›Maximum 4000 mg per day
›Maximum 3000 mg per day if chronic alcohol use or liver disease risk
›Ibuprofen PO 400 mg
›Every 6 hours as needed
›Avoid in high GI bleed risk or significant renal dysfunction
›Naproxen PO 500 mg
›Then 250 mg every 6 to 8 hours as needed
›Avoid in high GI bleed risk or significant renal dysfunction
›Hydromorphone PO 1 mg
›Every 4 to 6 hours as needed for severe pain
›Older adult start 0.5 mg if frailty or opioid naive
›If severe pain then hydromorphone IV 0.2 mg
›Repeat every 10 to 15 minutes to effect
›Respiratory monitoring and sedation scale
Immobilization and Splinting
›Immobilization selection
›Knee immobilizer
›Locked in full extension
›Worn continuously except hygiene if approved by ortho
›Hinged knee brace
›Locked in extension initially if provided
›ROM progression per ortho protocol
›Key principles
›Extension positioning reduces tendon gap
›Avoid active knee extension against resistance
›Ice and elevation for swelling control
›Post immobilization checks
›Pain trend
›Skin pressure points
›Distal neurovascular reassessment
›Not typically applicable
›No fracture reduction target in isolated tendon rupture
›If associated patellar dislocation then standard reduction pathway
Open fracture medications and timing
›Open extensor mechanism laceration pathway
›If tendon exposed then treat as open joint or open extensor mechanism injury until proven otherwise
›Cefazolin IV 2 g
›Every 8 hours while awaiting operative plan
›If weight 120 kg or more then 3 g per dose per local protocol
›If severe beta lactam allergy then clindamycin IV 900 mg
›Every 8 hours
›MRSA risk add vancomycin per local protocol
›Tetanus prophylaxis per immunization status
›Tdap if incomplete or unknown
›TIG if high risk wound and incomplete series
DVT prophylaxis when relevant
›Risk assessment for lower limb immobilization
›Surgery planned
›Pharmacologic prophylaxis per ortho protocol
›Mechanical prophylaxis if anticoagulation contraindicated
›Nonoperative immobilization
›Individual risk assessment prior VTE
›Individual risk assessment active cancer
›Individual risk assessment thrombophilia
›Contraindications
›Active bleeding
›High fall risk with anticoagulation
›Evidence note
›Prophylaxis approach varies by jurisdiction and local protocol
Definitive management overview
›Operative management typical for complete rupture
›Early repair recommended in many reviews :contentReference[oaicite:13]{index=13}
›Technique options transosseous tunnels
›Patellar bone tunnels
›Nonabsorbable sutures
›Postop brace locked extension initially
›Technique options suture anchors :contentReference[oaicite:14]{index=14}
›Anchor fixation to patella
›Comparable functional restoration reported
›Nonoperative management options for selected partial tears
›Extension immobilization
›Early protected rehab per specialist plan