Acute Management of Traumatic Knee Dislocations for the Generalist
Acute knee dislocations are an uncommon injury that can result in profound consequences if not recognized and managed appropriately on presentation. Patients presenting with knee pain in the setting of high- or low-energy trauma may have sustained a knee dislocation that spontaneously reduced. Promp...
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| Veröffentlicht in: | Journal of the American Academy of Orthopaedic Surgeons 2015-12, Vol.23 (12), p.761-768 |
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| container_title | Journal of the American Academy of Orthopaedic Surgeons |
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| creator | Boyce, Robert H Singh, Keerat Obremskey, William T |
| description | Acute knee dislocations are an uncommon injury that can result in profound consequences if not recognized and managed appropriately on presentation. Patients presenting with knee pain in the setting of high- or low-energy trauma may have sustained a knee dislocation that spontaneously reduced. Prompt reduction of the dislocated knee and serial neurovascular examinations are paramount. Damage to the popliteal artery is a common associated injury that can be diagnosed on physical examination using ankle brachial indices (ABIs), CT angiography, or standard angiography. After reduction, patients with a normal pulse examination and an ABI ≥0.9 may be observed, with serial examination performed to document vascular status and monitor for compartment syndrome. Patients with asymmetric pulses or an ABI |
| doi_str_mv | 10.5435/JAAOS-D-14-00349 |
| format | Article |
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Patients presenting with knee pain in the setting of high- or low-energy trauma may have sustained a knee dislocation that spontaneously reduced. Prompt reduction of the dislocated knee and serial neurovascular examinations are paramount. Damage to the popliteal artery is a common associated injury that can be diagnosed on physical examination using ankle brachial indices (ABIs), CT angiography, or standard angiography. After reduction, patients with a normal pulse examination and an ABI ≥0.9 may be observed, with serial examination performed to document vascular status and monitor for compartment syndrome. Patients with asymmetric pulses or an ABI <0.9 in the presence of pulses may be treated urgently depending on the results of additional vascular imaging, and patients with absent pulses and clear signs of vascular compromise should be treated emergently. Some knee dislocations are not reducible and should be taken emergently to the operating room for an open reduction. Persistent joint subluxation or severe soft-tissue injuries after reduction require temporary external fixation before definitive repair or reconstruction of ligaments is performed.</description><identifier>ISSN: 1067-151X</identifier><identifier>EISSN: 1940-5480</identifier><identifier>DOI: 10.5435/JAAOS-D-14-00349</identifier><identifier>PMID: 26493970</identifier><language>eng</language><publisher>United States: by Lippincott Williams & Wilkins, Inc</publisher><subject>Care and treatment ; Compartment Syndromes - diagnosis ; Compartment Syndromes - etiology ; Compartment Syndromes - surgery ; Diagnosis ; Dislocations ; Humans ; Injuries ; Knee ; Knee Dislocation - complications ; Knee Dislocation - diagnosis ; Knee Dislocation - therapy ; Peripheral Nerve Injuries - diagnosis ; Peripheral Nerve Injuries - etiology ; Peroneal Nerve - injuries ; Popliteal Artery - injuries ; Practice guidelines (Medicine) ; Vascular System Injuries - diagnosis ; Vascular System Injuries - etiology</subject><ispartof>Journal of the American Academy of Orthopaedic Surgeons, 2015-12, Vol.23 (12), p.761-768</ispartof><rights>2015 by Lippincott Williams & Wilkins, Inc.</rights><rights>Copyright 2015 by the American Academy of Orthopaedic Surgeons.</rights><rights>COPYRIGHT 2015 American Academy of Orthopaedic Surgeons</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4199-f99be16b3db573c88f48cc16333bac79a13fd4bee94adca221357f13855eeaa83</citedby><cites>FETCH-LOGICAL-c4199-f99be16b3db573c88f48cc16333bac79a13fd4bee94adca221357f13855eeaa83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26493970$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Boyce, Robert H</creatorcontrib><creatorcontrib>Singh, Keerat</creatorcontrib><creatorcontrib>Obremskey, William T</creatorcontrib><title>Acute Management of Traumatic Knee Dislocations for the Generalist</title><title>Journal of the American Academy of Orthopaedic Surgeons</title><addtitle>J Am Acad Orthop Surg</addtitle><description>Acute knee dislocations are an uncommon injury that can result in profound consequences if not recognized and managed appropriately on presentation. Patients presenting with knee pain in the setting of high- or low-energy trauma may have sustained a knee dislocation that spontaneously reduced. Prompt reduction of the dislocated knee and serial neurovascular examinations are paramount. Damage to the popliteal artery is a common associated injury that can be diagnosed on physical examination using ankle brachial indices (ABIs), CT angiography, or standard angiography. After reduction, patients with a normal pulse examination and an ABI ≥0.9 may be observed, with serial examination performed to document vascular status and monitor for compartment syndrome. Patients with asymmetric pulses or an ABI <0.9 in the presence of pulses may be treated urgently depending on the results of additional vascular imaging, and patients with absent pulses and clear signs of vascular compromise should be treated emergently. Some knee dislocations are not reducible and should be taken emergently to the operating room for an open reduction. Persistent joint subluxation or severe soft-tissue injuries after reduction require temporary external fixation before definitive repair or reconstruction of ligaments is performed.</description><subject>Care and treatment</subject><subject>Compartment Syndromes - diagnosis</subject><subject>Compartment Syndromes - etiology</subject><subject>Compartment Syndromes - surgery</subject><subject>Diagnosis</subject><subject>Dislocations</subject><subject>Humans</subject><subject>Injuries</subject><subject>Knee</subject><subject>Knee Dislocation - complications</subject><subject>Knee Dislocation - diagnosis</subject><subject>Knee Dislocation - therapy</subject><subject>Peripheral Nerve Injuries - diagnosis</subject><subject>Peripheral Nerve Injuries - etiology</subject><subject>Peroneal Nerve - injuries</subject><subject>Popliteal Artery - injuries</subject><subject>Practice guidelines (Medicine)</subject><subject>Vascular System Injuries - diagnosis</subject><subject>Vascular System Injuries - etiology</subject><issn>1067-151X</issn><issn>1940-5480</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkU1P3DAQhq2qCCjl3lMVqRcuAc_aieNjyvJRPsShVOrNmnjHbFonBtsR4t83sLQqp5mRnnc0eoaxT8APKymqo4u2vfleLkuQJedC6ndsF7TkZSUb_n7uea1KqODnDvuQ0i_OoZa13mY7i1pqoRXfZV9bO2UqrnHEOxpozEVwxW3EacDc2-JyJCqWffLBznMYU-FCLPKaijMaKaLvU_7Ithz6RPuvdY_9OD25PT4vr27Ovh23V6WVoHXptO4I6k6sukoJ2zRONtZCLYTo0CqNINxKdkRa4sriYgGiUg5EU1VEiI3YYwebvfcxPEyUshn6ZMl7HClMyYASSqqm0WpGv2zQO_Rk-tGFHNE-46aVQi8USOAzxTeUjSGlSM7cx37A-GSAm2e_5sWvWRqQ5sXvHPn8esPUDbT6F_grdAbkBngMPlNMv_30SNGsCX1ev93739_EH6lphWI</recordid><startdate>201512</startdate><enddate>201512</enddate><creator>Boyce, Robert H</creator><creator>Singh, Keerat</creator><creator>Obremskey, William T</creator><general>by Lippincott Williams & Wilkins, Inc</general><general>American Academy of Orthopaedic Surgeons</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201512</creationdate><title>Acute Management of Traumatic Knee Dislocations for the Generalist</title><author>Boyce, Robert H ; Singh, Keerat ; Obremskey, William T</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4199-f99be16b3db573c88f48cc16333bac79a13fd4bee94adca221357f13855eeaa83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Care and treatment</topic><topic>Compartment Syndromes - diagnosis</topic><topic>Compartment Syndromes - etiology</topic><topic>Compartment Syndromes - surgery</topic><topic>Diagnosis</topic><topic>Dislocations</topic><topic>Humans</topic><topic>Injuries</topic><topic>Knee</topic><topic>Knee Dislocation - complications</topic><topic>Knee Dislocation - diagnosis</topic><topic>Knee Dislocation - therapy</topic><topic>Peripheral Nerve Injuries - diagnosis</topic><topic>Peripheral Nerve Injuries - etiology</topic><topic>Peroneal Nerve - injuries</topic><topic>Popliteal Artery - injuries</topic><topic>Practice guidelines (Medicine)</topic><topic>Vascular System Injuries - diagnosis</topic><topic>Vascular System Injuries - etiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Boyce, Robert H</creatorcontrib><creatorcontrib>Singh, Keerat</creatorcontrib><creatorcontrib>Obremskey, William T</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American Academy of Orthopaedic Surgeons</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Boyce, Robert H</au><au>Singh, Keerat</au><au>Obremskey, William T</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Acute Management of Traumatic Knee Dislocations for the Generalist</atitle><jtitle>Journal of the American Academy of Orthopaedic Surgeons</jtitle><addtitle>J Am Acad Orthop Surg</addtitle><date>2015-12</date><risdate>2015</risdate><volume>23</volume><issue>12</issue><spage>761</spage><epage>768</epage><pages>761-768</pages><issn>1067-151X</issn><eissn>1940-5480</eissn><abstract>Acute knee dislocations are an uncommon injury that can result in profound consequences if not recognized and managed appropriately on presentation. Patients presenting with knee pain in the setting of high- or low-energy trauma may have sustained a knee dislocation that spontaneously reduced. Prompt reduction of the dislocated knee and serial neurovascular examinations are paramount. Damage to the popliteal artery is a common associated injury that can be diagnosed on physical examination using ankle brachial indices (ABIs), CT angiography, or standard angiography. After reduction, patients with a normal pulse examination and an ABI ≥0.9 may be observed, with serial examination performed to document vascular status and monitor for compartment syndrome. Patients with asymmetric pulses or an ABI <0.9 in the presence of pulses may be treated urgently depending on the results of additional vascular imaging, and patients with absent pulses and clear signs of vascular compromise should be treated emergently. Some knee dislocations are not reducible and should be taken emergently to the operating room for an open reduction. Persistent joint subluxation or severe soft-tissue injuries after reduction require temporary external fixation before definitive repair or reconstruction of ligaments is performed.</abstract><cop>United States</cop><pub>by Lippincott Williams & Wilkins, Inc</pub><pmid>26493970</pmid><doi>10.5435/JAAOS-D-14-00349</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 1067-151X |
| ispartof | Journal of the American Academy of Orthopaedic Surgeons, 2015-12, Vol.23 (12), p.761-768 |
| issn | 1067-151X 1940-5480 |
| language | eng |
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| source | Journals@Ovid Ovid Autoload; MEDLINE |
| subjects | Care and treatment Compartment Syndromes - diagnosis Compartment Syndromes - etiology Compartment Syndromes - surgery Diagnosis Dislocations Humans Injuries Knee Knee Dislocation - complications Knee Dislocation - diagnosis Knee Dislocation - therapy Peripheral Nerve Injuries - diagnosis Peripheral Nerve Injuries - etiology Peroneal Nerve - injuries Popliteal Artery - injuries Practice guidelines (Medicine) Vascular System Injuries - diagnosis Vascular System Injuries - etiology |
| title | Acute Management of Traumatic Knee Dislocations for the Generalist |
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