Traumatic osseous maladies around the knee are numerous and widely varied. These injuries can be categorized into three large groups. First, there are those injuries that should be properly diagnosed on interpretation of a standard radiographic series. This group includes most displaced fractures and significant articular malalignments. Second is a subset of injuries with radiographic findings that mandate further imaging evaluation with MRI, multidetector CT (MDCT), or focused musculoskeletal ultrasonography. With these injuries, ignorance of radiographic findings may lead to inappropriate treatment of soft tissue pathology. Finally, there exists a group of osseous injuries that may be entirely occult on radiographs but should be diagnosed in the interpretation of one of these advanced imaging modalities. For this group, clinical history and physical examination findings are essential in guiding the most appropriate imaging algorithm.