Knee dislocation: Difference between revisions
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==Background== | ==Background== | ||
*Popliteal artery injury occurs in ~25% of cases | *Popliteal artery injury occurs in ~25% of cases | ||
*Spontaneous reduction occurs in up to 50% of dislocations | **neurologic injury/deficit may indicate vascular injury | ||
*Spontaneous reduction occurs in up to 50% of dislocations; often occurs prior to ED arrival | |||
*Types | *Types | ||
**Anterior (40%) | **Anterior (40%) | ||
***hyperextension mechanism | |||
***often involves PCL, ACL and either medial or lateral ligs are injured | |||
**Posterior (33%) | **Posterior (33%) | ||
***popliteal artery often injured | |||
***dash board injury | |||
**Lateral (18%) | **Lateral (18%) | ||
**Medial (4%) | **Medial (4%) | ||
==Signs== | |||
*Suggestive by severely injured knee that is unstable in multiple directions | |||
*lateral collateral ligament injured with peroneal nerve palsy = knee dislocation | |||
==Management== | ==Management== | ||
*Reduce immediately | |||
**Apply longitudinal traction | |||
**Splint in 20 degrees of flexion | |||
*Vascular assessment | |||
**Assess popliteal and distal pulses | |||
**Measure ABIs | |||
***ABI >0.9 - serial exams | |||
***ABI <0.9 - arterial duplexes or CT angio | |||
**no pulses: reduce immediately | |||
**no pulses post reduction: surgical exploration | |||
***ischemia time >8 hours has amputation rates as high as 86% | |||
*Neurological assessment | |||
**Peroneal nerve most commonly injured | |||
***Test for sensation in 1st dorsal web space, dorsiflexion of foot, extension of toes | |||
==Complications== | |||
*nerve injury | |||
**common peroneal nerve injury (25%) | |||
***Test for sensation in 1st dorsal web space, dorsiflexion of foot, extension of toes | |||
**tibial nerve injured less often | |||
*fractures | |||
**femur and tibia most common | |||
**check hip and ankle joints for associated fx | |||
**avulsion fractures common | |||
*compartment syndrome risk high with vascular compromise | |||
==Disposition== | ==Disposition== | ||
*type of insitution will dictation admission process | |||
*trauma consult depending on mechanism and additional injuries | |||
*Strong distal pulses + ABI >0.9 + normal UTZ = Admit for obs with ortho consult | |||
*Otherwise, obtain vascular surgery consult and additional study (e.g. arteriogram, CTA) | |||
==Source== | ==Source== | ||
*Tintinalli | *Tintinalli | ||
*UpToDate | *UpToDate | ||
*Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012 | |||
*AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009 | |||
*Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, Marx RG, Stuart MJ. Knee Dislocation Study Group. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009 Apr;17(4):197-206. http://www.ncbi.nlm.nih.gov/pubmed/19307669 | |||
==See Also== | ==See Also== | ||
Revision as of 15:37, 29 December 2014
Background
- Popliteal artery injury occurs in ~25% of cases
- neurologic injury/deficit may indicate vascular injury
- Spontaneous reduction occurs in up to 50% of dislocations; often occurs prior to ED arrival
- Types
- Anterior (40%)
- hyperextension mechanism
- often involves PCL, ACL and either medial or lateral ligs are injured
- Posterior (33%)
- popliteal artery often injured
- dash board injury
- Lateral (18%)
- Medial (4%)
- Anterior (40%)
Signs
- Suggestive by severely injured knee that is unstable in multiple directions
- lateral collateral ligament injured with peroneal nerve palsy = knee dislocation
Management
- Reduce immediately
- Apply longitudinal traction
- Splint in 20 degrees of flexion
- Vascular assessment
- Assess popliteal and distal pulses
- Measure ABIs
- ABI >0.9 - serial exams
- ABI <0.9 - arterial duplexes or CT angio
- no pulses: reduce immediately
- no pulses post reduction: surgical exploration
- ischemia time >8 hours has amputation rates as high as 86%
- Neurological assessment
- Peroneal nerve most commonly injured
- Test for sensation in 1st dorsal web space, dorsiflexion of foot, extension of toes
- Peroneal nerve most commonly injured
Complications
- nerve injury
- common peroneal nerve injury (25%)
- Test for sensation in 1st dorsal web space, dorsiflexion of foot, extension of toes
- tibial nerve injured less often
- common peroneal nerve injury (25%)
- fractures
- femur and tibia most common
- check hip and ankle joints for associated fx
- avulsion fractures common
- compartment syndrome risk high with vascular compromise
Disposition
- type of insitution will dictation admission process
- trauma consult depending on mechanism and additional injuries
- Strong distal pulses + ABI >0.9 + normal UTZ = Admit for obs with ortho consult
- Otherwise, obtain vascular surgery consult and additional study (e.g. arteriogram, CTA)
Source
- Tintinalli
- UpToDate
- Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
- AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
- Levy BA, Fanelli GC, Whelan DB, Stannard JP, MacDonald PA, Boyd JL, Marx RG, Stuart MJ. Knee Dislocation Study Group. Controversies in the treatment of knee dislocations and multiligament reconstruction. J Am Acad Orthop Surg. 2009 Apr;17(4):197-206. http://www.ncbi.nlm.nih.gov/pubmed/19307669