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Musculoskeletal trauma
Published in Ian Greaves, Keith Porter, Chris Wright, Trauma Care Pre-Hospital Manual, 2018
Ian Greaves, Keith Porter, Chris Wright
Knee dislocation occurs as a result of a high-energy injury and is a rare injury. It is usually part of a multisystem trauma. (Patellar dislocation is often referred to by lay people as knee dislocation.) This is a serious injury which is often limb-threatening. It is inevitably associated with rupture of several of the knee ligaments, and the popliteal artery is particularly vulnerable to compression over the distal aspect of the femur. This compromises the blood supply to the distal limb and risks ischaemia and myonecrosis.
Knee Dislocation
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
These are AP and lateral radiographs of a left knee showing an anterior knee dislocation. My immediate concern for this patient would be that this injury may be part of a high-energy injury. I would manage them in line with ATLS guidelines in order to ensure that all life- and limb-threatening injuries are identified and prioritised. My immediate concern for the affected limb would be the neurovascular status. An arterial injury, although less common than a nerve injury, may require surgical intervention with disastrous complications (including amputation) if missed. Approximately 25% have a common peroneal nerve injury.
Knee and proximal tibia
Published in Sebastian Dawson-Bowling, Pramod Achan, Timothy Briggs, Manoj Ramachandran, Stephen Key, Daud Chou, Orthopaedic Trauma, 2014
Knee dislocation is a rare but potentially catastrophic injury, invariably resulting from high-energy trauma. For true tibiofemoral dislocation to occur, significant ligamentous disruption is necessary. Even once reduced, the joint is likely to remain grossly unstable, and there is a high risk of associated neurovascular compromise. Careful ongoing clinical assessment is mandatory.
To be or not to be ringside? Ethical issues pertaining to combat sports medicine
Published in The Physician and Sportsmedicine, 2022
Standardizing medical stoppages in combat sports is no easy task, but certainly something for which combat sports medicine physicians should strive. One easily adoptable approach is to establish clearly defined NO-GO medical criteria. These would include subjective criteria such as complaint of headache and objective criteria such as gross motor instability (GMI), confusion, impaired coordination, loss of visual acuity, restriction of visual field, brief loss of consciousness after a knockdown, ACL tear, patellar dislocation, knee dislocation, shoulder dislocation, and major tendon tear. If any NO-GO criteria are encountered, the bout should be stopped on medical grounds even if the combatant and the referee want the fight to continue [8]. Standardizing medical stoppages in combat sports will help protect combatants from life-threatening neurological and devastating orthopedic and ophthalmological injuries causing lifelong disability and discomfort.
Scoping review of complications associated with epinephrine use in arthroscopy fluid
Published in The Physician and Sportsmedicine, 2021
Taher Abdelrahman, Scott Tulloch, Kate Lebedeva, Ryan M. Degen
Nemani et al [7] reported on a 19 year old female who suffered popliteal venotomy during a posterior cruciate ligament (PCL) reconstruction with subsequent cardiopulmonary arrest, attributed to enhanced epinephrine access into the systemic circulation. This patient was planned for a multi-ligament reconstruction, 4 months following a traumatic knee dislocation complicated with a vascular injury requiring a popliteal bypass saphenous vein graft for popliteal insufficiency. During surgery and after preparation of the PCL tibial footprint a 5 mm venotomy was noted in the vein. During preparation for vascular repair, the patient developed severe HTN (200/100 mm Hg). Irrigation fluid was stopped and replaced with normal saline. Despite this measure, and treating the patient with beta-blockers, the patient went into a cardiac arrest requiring cardiopulmonary resuscitation. Vascular repair was addressed, and multi-ligament surgery was postponed. The patient was extubated on the 2nd postoperative day and discharged on day 4. The author’s conclusion was mainly related to the reported vascular injury and systemic effects of epinephrine.
Tibial lengthening using a retrograde magnetically driven intramedullary lengthening device in 10 patients with preexisting ankle and hindfoot fusion
Published in Acta Orthopaedica, 2020
Bjoern Vogt, Robert Roedl, Georg Gosheger, Gregor Toporowski, Andrea Laufer, Christoph Theil, Jan Niklas Broeking, Adrien Frommer
Patients with an unstable knee due to congenital deficiencies are exposed to a risk of knee dislocation (Shabtai et al. 2014, Black et al. 2015, Szymczuk et al. 2019). Despite 6 of our 10 patients having a congenital deficiency, no knee dislocation was observed. We believe that distal tibial distraction via retrogradely inserted ILN might especially be beneficial for patients with an unstable knee and preexisting ankle and hindfoot fusion, i.e., due to congenital deficiencies.