knee dislocations what s my role do i put on the ex fix
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Knee Dislocations: Whats My role? Do I put on the Ex Fix? William - PowerPoint PPT Presentation

Knee Dislocations: Whats My role? Do I put on the Ex Fix? William T Obremskey MD MPH Vanderbilt University Orthopedic Trauma Disclosures Board SEFC OTA EBQVS Chair No Industry Conflicts Whats My role? Role


  1. Knee Dislocations: What’s My role? Do I put on the Ex Fix? William T Obremskey MD MPH Vanderbilt University Orthopedic Trauma

  2. Disclosures • Board SEFC • OTA EBQVS Chair • No Industry Conflicts

  3. What’s My role? • Role – Reduce Joint – Assess Neuro/Vacular – Assist Vascular if needed – Release Compartments if needed – Stabilize - ?

  4. Do I put on the Ex Fix? • It depends

  5. OBJECTIVES • What knee injuries are likely to result in vascular injury? • What is appropriate evaluation? • When Ex Fix? • Irreducible KD?

  6. JAAOS December 2015

  7. Schenck Classification KD I Multiligamentous injury with involvement of ACL or PCL KD II Injury to ACL and PCL only (2 ligaments) KD III Injury to ACL, PCL, and PMC or PLC (3 ligaments) KD IV Injury to ACL, PCL, PMC, and PLC (4 ligaments) KD V Multiligamentous injury with periarticular fracture

  8. What Injuries? What knee injuries are likely to result in vascular compromise? • Fractures - distal femur and proximal tibia • Dislocations

  9. INJURY KNEE DISLOCATIONS 10% - 60% rate of associated vascular injury (5% - 15% requiring surgery)

  10. High vs Low energy KNEE DISLOCATION DeCoster JOT 1997 22 knee dislocations vs 28 “reduced” bicruciate ligament injuries • 14% popliteal artery disruptions in each • Equal risk of vascular injury

  11. VASCULAR INJURY TIMING Miller Arch Surg 1949 Extremity salvage repair 90% at 6 hours 50% at 12-18 hours 20% at > 24 hours

  12. DIAGNOSIS NONINVASIVE VASCULAR EXAM Lynch, Johansen Ann Surg 1991 ABI < 0.9 95% sensitivity 97% specificity

  13. When to Ex Fix?

  14. When to Ex Fix? • Vascular injury – To manage CPS release

  15. When to Ex Fix? • Obese – unable to hold reduced

  16. When to Ex Fix? • Severe Soft Tissue injury

  17. Nerve Injury Peroneal most common 14% - 35% One third will recover One half will remain as complete palsy

  18. Peroneal Nerve Contusion

  19. Nerve Avulsion

  20. Indications for immediate operative treatment Open dislocation Irreducible dislocation Popliteal artery disruption Compartment syndrome

  21. Open Dislocation

  22. Open Dislocation Ex Fix or Splint

  23. Posterolateral - irreducible

  24. Irreducible Pucker Sign

  25. Evaluation: Radiographic Exam AP/lat/oblique MRI helpful in defining torn structures Adds to both sensitivity and specificity (can still miss LCL and PLC) Aids preop planning by defining the location of tears

  26. Take Home Knee dislocation is challenging Not always obvious When obvious, not always reducible closed On table or formal Angiogram only for hard signs/ ABI < 0.9X Initial stabilization, then MRI prior to repair or reconstruction

  27. THANK YOU

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