Knee Dislocation and its management

 Like any other joint dislocation, its a surgical emergency.



                            https://www.orthobullets.com/trauma/1043/knee-dislocation

Causes 

     Motor Vehicle Collision

     Sports related injuries

     Falls

Initial Assessment

    - NV status before and after reduction

    - If any vascular injury ,exploration and angiography 

    - Normal pulse does not rule out vascular injury , measure ABPI (< 0.9 - ABNORMAL )


Classification 

 Based on direction of dislocation of tibia in relation to femur 

        Anterior - dislocation most common.

    upto 20 % spontaneously relocate and dont fit into classification.


            https://emedicine.medscape.com/article/823589-clinical?form=fpf

    Association

        Ligaments injury

        Arterial Injury - as high as 40 % 

                       how to proceed ?

                        arrange for patient to go urgently  to a theatre where plastic surgeons will be available.

                        prompt reconstruction with interposition vein grafting

                        knee stabilized with a spanning ex-fixator. 

                        lower limb fasciotomy done

        Nerve Injury - CPN Involvement - 20-30 % 

                        treat expectantly , large proportion dont recover fully


    Definite treatment of unstable knee ? 

                    MRI - to characterize ligament structures    

                    EUA 

                    Repair / Reconstruct ligament structures 

   Treatment 

            If no Arterial injury , relocate knee dislocation under IV sedation at ER then treat other                            associated injuries ,  

            Early reconstruction of PLC and PCL 

            Delayed ACL reconstruction

            Early Bracing, Rehab with late reconstruction

            If associated with arterial injury , treat as mentioned above. 



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