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

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 ?

• For patient young healthy and no associated injuries ?

• ** Knee reconstruction

• Patient with severe head injury, intubated in ICU with increased ICP + unstable ???

** EXFIX***

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