A fracture is a break in a bone. The knee is formed by the femur, tibia and patella. A fracture of the knee is a fracture of one or more of the aforementioned bones.

Knee fractures are caused by direct trauma related to either a fall or a direct blow.

There is pain and swelling over the patella. When the knee is actively extended, there is pain. Full extension of the knee brings comfort. The joint contains blood (hemarthrosis). Fractures of the patella are stellate (star-shaped) with numerous fissures radiating from the center of the injury.

Radiography is used to confirm the diagnosis of fracture.

A cylinder cast is applied if the fracture is not displaced. Displaced fractures are treated with an open reduction and internal fixation. When stability is not achieved by these measures, a partial or total patellectomy is performed.

Rehabilitation will be needed to restore strength and mobility.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)). Federal Register that updated the musculoskeletal schedule per 85 FR 76453.

• Shin splints can be evaluated based on impairment of the tibia and fibula including nonunion, malunioin, or medical tibial stress syndrome (MTSS) or based on pain associated with shin splints.

• For evaluating impairment of the tibia and fibula including nonunion, malunion (evaluated under the corresponding knee or ankle codes based on associated impairment), or MTSS. Evaluations based on MTSS are based on conservative treatment, i.e., rest, ice, elevation, medication, compression socks, and/or massage.

• MTSS, or shin splints, is a type of joint or periarticular pathology which is a requirement for application of 38 CFR 4.59, for assignment of the minimum compensable evaluation under 38 CFR 4.71a, DC 5262 when painful motion is shown and shin splints are otherwise noncompensable.

• The minimum compensable evaluation is warranted when painful motion due to shin splints occurs in nearby affected joints such as the ankle or knee or when shin pain or other similar pain occurs with motion.  However, when a separate knee or ankle disability exists and has been compensably evaluated, do not assign a compensable evaluation under 38 CFR 4.59 for shin splints causing painful motion in an already-compensable SC knee or ankle joint.

• Shin splints without pain that is not associated with motion, such as pain on palpation, are noncompensable under 38 CFR 4.59.

• Where service connection (SC) of a fracture or fracture residuals is claimed, SC will be established when sufficient evidence, such as x-rays, a surgical report, casting, or a physical evaluation board report, documents the fracture. If SC of a fracture has not been claimed and objective evidence such as x-ray report documents an in-service fracture, invite a claim for SC for the fracture.

• When there is evidence showing a history of in-service trauma to a joint, utilize 38 CFR 4.71a, DC 5010 for rating purposes, which indicates the etiology of the condition is trauma-based. Post-traumatic arthritis is evaluated based on limitation of motion (LOM), dislocation, or other specified instability of the affected joint under the corresponding DC for the joint, and not evaluated utilizing arthritis criteria, such as 38 CFR 4.71a, DC 5003.

• Evaluate under diagnostic codes 5256, 5257, 5260, or 5261 for the knee, or 5250-5254 for the hip, whichever results in the highest evaluation.