Knee Pain...

[Eagle5US]

Since we have concluded the Sacamuelas thread...I thought I would start another!
This 24 y/o AD M was playing basketball. On attempting a rebound, he collapsed to the floor in pain.
I dispatched my medics, who brought me THIS on a litter:

[Surgicalcric]

Dislocated ?

JD

[Eagle5US]

Knee hurts way bad with any leg movement...
Leg is temperate, pedal pulses present but deminished, cap refill at 4-5 secs

1. What is the big picture with what is "outta whack"?
2. What internal structures are also now "outta whack"?
3. What would be some good pharmacology to employ?
4. What are some packaging options for this guy?

Here is another view...

[Roguish Lawyer]

Broken femur?

[Eagle5US]

Originally posted by Roguish Lawyer
Broken femur?
Not a femur fracture...GOOD GUESS!
It WAS caused when his sneaker STUCK to the wet gym floor while he attempted to jump for the ball...

Hmmmmm....

[Polar Bear]

Which way are his toes pointed? Dislocated knee cap, torn interior ligs and possible cartilage damage.

[Surgicalcric]

1.) Dislocated Tibia and Patella

2.) Stretched or possibly torn A/PCL and/or MCL/LCL; torn Miniscus with or without femoral epicondyle or tibial condyle tear; partially pinched Femoral Artery and possible femoral vein. If there is any loss of sensation below the knee there could also be Saphenous Nerve involvement.

3.) Demerol for pain, steroid as anti-inflammitory in the hospital or Toradol and kill two birds with one stone. In my bus he gets MS or NO2.

4.) Splint as is. Vacuum splint would be best in this situation. But in absence of that use a pillow under knee for support, strap ankles together with cravat, and use Scoop-stretcher to lift PT onto stretcher.

[Eagle5US]

Originally posted by Surgicalcric
1.) Dislocated Tibia and Patella

2.) Stretched or possibly torn A/PCL and/or MCL/LCL; torn Miniscus with or without femoral epicondyle or tibial condyle tear; partially pinched Femoral Artery and possible femoral vein. If there is any loss of sensation below the knee there could also be Saphenous Nerve involvement.

3.) Demerol for pain, steroid as anti-inflammitory in the hospital or Toradol and kill two birds with one stone. In my bus he gets MS or NO2.

4.) Splint as is. Vacuum splint would be best in this situation. But in absence of that use a pillow under knee for support, strap ankles together with cravat, and use Scoop-stretcher to lift PT onto stretcher.
This young man's sneaker stuck to the floor as he lifted off and rotated in the air, then came crashing down causeing:
A true "dislocated Knee
-Posterior dislocation of the tibia to the femur
-Dislocated Patella
-Ruptred ACL / PCL / MCL...strained LCL
-Torn Patellar tendon
-"Crimped" popaliteal artery
-Bunchen Crunchen of the miniscii

-Was given Valium first, then MS...well padded with pillows and immobilized with a phoenix splint as it lay.
-Transferred via Air Ambulance directly to Ortho team in Tuzla for surgical intervention.

Now for the REST of the Story
-Sent home from Bosnia via MilAir Medevac for more work at Walter Reed.
-Was released after 2nd surgery to be treated as an outpatient.
-While at Walter Reed, was busted for buying Crack Cocaine from an undercover agent.
-Then the night before his court hearing he got a DUI.
-Last I knew was service his sentence at the Ft. Knox Military Corrections Facility.

Well done all...good participation!

The Eagle...

[Surgicalcric]

Well I missed the Patellar Tendon and the Popaliteal Artery somehow.

JD

[Eagle5US]

Originally posted by Surgicalcric
Well I missed the Patellar Tendon and the Popaliteal Artery somehow.

JD
I thought you did GREAT...!!!

The Eagle

[Surgicalcric]

Well...when you have had knee problems...lol...its easier to spot them.

I have to say though, from the pics it appears to be more laterally dislocated than a posteriorly.

Liked that case though Capt.

James D


EDITTED to add:Vacuum splints are great for dislocations such as this BTW. If not vacuum then I would have gone with the pillow splint and scoop.

[Eagle5US]

Originally posted by Surgicalcric
Well...when you have had knee problems...lol...its easier to spot them.

I have to say though, from the pics it appears to be more laterally dislocated than a posteriorly.

Liked that case though Capt.

James D


EDITTED to add:Vacuum splints are great for dislocations such as this BTW. If not vacuum then I would have gone with the pillow splint and scoop.
With the posterior dislocation and rupture of the MCL, the Tibial plateaus then externally rotated about 30 degrees...
Those gnarly bumps are indeed the condyles :(

PA

[Surgicalcric]

Originally posted by Eagle5US
With the posterior dislocation and rupture of the MCL, the Tibial plateaus then externally rotated about 30 degrees...
Those gnarly bumps are indeed the condyles :(

PA

All that trauma to the joint and no Condyle/epicondyle tears. Now that is amazing.

Regardless, looks painful.

'Crip