Skeletal Trauma - PowerPoint PPT Presentation

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Skeletal Trauma

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  1. Skeletal Trauma Soft tissue injury / Knee Dislocations

  2. > 2 ligament injuries • Always suspect knee dislocation • This level of injury should warrant further studies + eval • Pulses, ABI, ? Angio • Neuro exam

  3. Describe how knee ligament injuries are graded

  4. Describe how knee ligament injuries are graded • Grade I = min laxity / <5mm displacement • Grade II= 5-10mm displacement / *End point • Grade III= >10mm / ** No End Point

  5. Patient with knee dislocation • No pulses in ER. Next step ?

  6. Patient with knee dislocation • No pulses in ER. Next step ? • Pulses return post reduction * • Next step ?

  7. Patient with knee dislocation • No pulses in ER. Next step ? • Pulses return post reduction * • Next step ? • ABI = 0.7 , next step ? • (what if initial exam + pulses ) , post red ABI=0.9 , next step ? , need to admit ?

  8. Patient has arterial repair of popliteal artery tear. What must be done now ? • How common are peroneal nerve injuries s/p knee dislocations ? And prognosis ?

  9. Patient has arterial repair of popliteal artery tear. What must be done now ? • *** Fasciotomy= all 4 compartments • How common are peroneal nerve injuries s/p knee dislocations ? And prognosis ? • ** up to 40% and most have poor prognosis

  10. Treatment of Knee Dislocations

  11. Tx of Knee Dislocations ? • For patient young healthy and no associated injuries ? • Patient with severe head injury, intubated in ICU with increased ICP + unstable ???

  12. Tx of Knee Dislocations ? • For patient young healthy and no associated injuries ? • ** Knee reconstruction • Patient with severe head injury, intubated in ICU with increased ICP + unstable ??? ** EXFIX***

  13. ACL + Peripheral Meniscal injury • Tx options and rehab protocol ??

  14. ACL + Peripheral Meniscal injury • Tx options and rehab protocol ?? • Reconstruction of ACL + repair of meniscal tear • Book chapter recommends allowing ROM

  15. MCL • What location are MCL tears more common ? • What are the Tx recommendations for both Grade III proximal and distal MCL tears ?

  16. MCL • What location are MCL tears more common ? • Proximal • What are the Tx recommendations for both Grade III proximal and distal MCL tears ? • Proximal = nonop (excellent blood supply, min retraction) • Distal= surgical due to retraction + poorer blood supply

  17. PCL • Can grade III PCL midsubstance tears heal ? • What grade III PCL injury pattern warrants surgical treatment ?

  18. PCL • Can grade III PCL midsubstance tears heal ? • YES ( Shelbourne) • What grade III PCL injury pattern warrants surgical treatment ? • Distal avulsion

  19. Lateral Ligament Injuries • What is the timing for lateral knee ligament injury ?

  20. Lateral Ligament Injuries • What is the timing for lateral knee ligament injury ? • Repair early < 3wks • Reconstruction >3wks , or if repair of tissues early is not