Makindo Medical Notes"One small step for man, one large step for makindo" |
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Check for lipo- haemarthrosis on lateral knee X-Ray: - Implies intra-articular injury Consider aspirating for analgesia if tense haemarthrosis. Always check hips/abdo if a knee exam is normal
INJURY SITE | TYPICAL MECHANISM | PITFALLS/COMPLICATIONS | ED/ MIU/ UCC TREATMENT | FOLLOW-UP |
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Patella # |
Direct blow, sudden contraction of quadriceps or both |
Check and document extensor mechanism: Ability to straight leg raise or if pain allows to straighten leg from flexed (more sensitive) |
Above knee backslab Congenital bi-partite patella may mimic #. Skyline view if unsure. |
If displaced or multifragmentary – Immediate referral to ortho If undisplaced and able to actively extend - Fracture clinic |
Patella dislocation |
Usually lateral after direct blow or sudden muscular contraction. May be recurrent. |
Often reduced by time of assessment. Tenderness over medial quads attachment may indicate recent dislocation |
Reduce with adequate analgesia & may require mild sedation: Fully extend knee then gentle pressure to lateral aspect of patella. Cylinder cast or cricket pad splint |
Fracture clinic - may require urgent MRI +/- repair of medial patello femoral ligament |
Quadriceps or patellar tendon rupture |
Abrupt muscular contraction +/- direct blow |
Check and document extensor mechanism: Ability to straight leg raise or if pain allows to straighten leg from flexed (more sensitive). |
If diagnosis is in question then USS is helpful. |
Immediate referral to ortho - tendon must be re-attached surgically |
Knee ligaments: Isolated medial collateral, lateral collateral, ACL or PCL injuries |
Injury common in sports |
Exclude gross instability and posterolateral corner injury (PLCI). Associations: haemarthrosis, capsular tear, meniscal tear or tibial spine #. X-Rays often normal |
Often too painful to assess clinically at presentation. Crutches and analgesia Must document distal N/V status |
ED physio appointment at 5-7 days or referral to local physio via patient’s own GP Immediate referral to ortho if gross instability. Refer associated injuries as indicated e.g PLCI |
Posterolateral corner injury (PLCI) |
Sport/RTC/Fall. Hyperextension or anteromedial trauma |
Often missed. Can be associated with knee ligament and nerve injury |
Dial Test: Patient prone, External rotation of tibia with knee at 30° and 90°. +ve if > 10° difference |
Immediate referral to ortho |
Knee dislocation |
Falls. RTA |
Neurovascular injury: Consider CT angiogram |
Must document neurovascular exam. |
Immediate referral to ortho. Consider concurrent vascular referral |
Meniscus |
Twisting injury. True locking. Bucket handle tear = springy block to full extension. |
Often settles over 2-3 weeks but prone to recurrent locking or giving way |
Crutches and analgesia |
Fracture clinic If locked knee despite maximal analgesia – Immediate referral to ortho |