Skeletal Trauma Soft tissue injury / Knee Dislocations

> 2 ligament injuries Always suspect knee dislocation This level of injury should warrant further studies + eval Pulses, ABI, ? Angio Neuro exam

Describe how knee ligament injuries are graded

Grade I = min laxity / <5mm displacement Grade II= 5-10mm displacement / *End point Grade III= >10mm / ** No End Point

Patient with knee dislocation No pulses in ER. Next step ?

Patient with knee dislocation No pulses in ER. Next step ? Pulses return post reduction * Next step ?

Patient with knee dislocation No pulses in ER. Next step ? Pulses return post reduction * Next step ? ABI = 0.7, next step ? (what if initial exam + pulses ), post red ABI=0.9, next step ?, need to admit ?

Patient has arterial repair of popliteal artery tear. What must be done now ? How common are peroneal nerve injuries s/p knee dislocations ? And prognosis ?

Patient has arterial repair of popliteal artery tear. What must be done now ? *** Fasciotomy= all 4 compartments How common are peroneal nerve injuries s/p knee dislocations ? And prognosis ? ** up to 40% and most have poor prognosis

Treatment of Knee Dislocations

Tx of Knee Dislocations ? For patient young healthy and no associated injuries ? Patient with severe head injury, intubated in ICU with increased ICP + unstable ???

Tx of Knee Dislocations ?

ACL + Peripheral Meniscal injury Tx options and rehab protocol ??

ACL + Peripheral Meniscal injury Tx options and rehab protocol ?? Reconstruction of ACL + repair of meniscal tear Book chapter recommends allowing ROM

MCL What location are MCL tears more common ? What are the Tx recommendations for both Grade III proximal and distal MCL tears ?

MCL What location are MCL tears more common ? Proximal What are the Tx recommendations for both Grade III proximal and distal MCL tears ? Proximal = nonop (excellent blood supply, min retraction) Distal= surgical due to retraction + poorer blood supply

PCL Can grade III PCL midsubstance tears heal ? What grade III PCL injury pattern warrants surgical treatment ?

PCL Can grade III PCL midsubstance tears heal ? YES ( Shelbourne) What grade III PCL injury pattern warrants surgical treatment ? Distal avulsion

Lateral Ligament Injuries What is the timing for lateral knee ligament injury ?

Lateral Ligament Injuries What is the timing for lateral knee ligament injury ? Repair early < 3wks Reconstruction >3wks, or if repair of tissues early is not