Handbook of Fractures by Egol MD Kenneth

Author:Egol MD, Kenneth [Egol MD, Kenneth]
Language: eng
Format: epub
Publisher: Lippincot (Wolters Kluwer Health)
Published: 2012-03-30T00:00:00+00:00

A knee dislocation is a potentially limb-threatening condition. Because of the high incidence of neurovascular compromise, immediate reduction is recommended before radiographic evaluation. Following reduction, anteroposterior (AP) and lateral views of the knee should be obtained to assess the reduction and evaluate associated injuries. Widened knee joint spaces may indicate soft tissue interposition and the need for open reduction.

Plain radiographs

AP and lateral

45-degree oblique and/or plateau views if an associated fracture is suspected.

Findings

Obvious dislocation

Irregular/asymmetric joint space

Lateral capsular sign (Segund)

Avulsions

Osteochondral defects

The use of angiography in every case of knee dislocation is controversial. Vascular compromise is an indication for operative intervention. Identifying intimal tears in a neurovascularly intact limb may be unnecessary because most do not result in thrombosis and vascular occlusion. Some authors advocate selective arteriography only if the ankle brachial index is (ABI) <0.9. Regardless, the patient should be closely observed for evidence of vascular insufficiency.

MRI

Valuable diagnostic tool

Preoperative planning

Identification of ligament avulsions

MCL: injury location (femur, tibia, midsubstance)

Lateral structures: popliteus, LCL, biceps

Meniscal pathology

Displaced in notch an indication for early surgery Limited arthroscopy secondary to extravasation

Articular cartilage lesions

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