Skeletal Trauma
description
Transcript of Skeletal Trauma
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