Jonny Utah (
) presents to your ED clutching his knee, grimacing, and firing his weapon unnecessarily into the ceiling. After he puts his weapon down, you assess the leg. He has a deformity to the knee, cannot bear weight, and is NV intact at the foot.
Does he need X-Rays?
Immediate plan?
Pain control, call ortho/vascular, and the soonest possible attempt at reduction.
Hard indications for OR with this injury?
Depends a bit on what you read, but definitely pulse deficit or distal ischemia. Some sources also add in an ankle brachial index (ABI) less than 0.8, active hemorrhage, or an expanding/pulsatile hematoma.
After a successful reduction and no hard signs, what is the appropriate plan?
CTA!!! These patients are at very high risk for popliteal injuries. Per uptodate – CTA if ABI < 0.9 or asymmetrical pulse. If ABI>0.9 with good pulses, can admit for serial vascular exams. Also, pre-op labs/ECG.
By Dr. Andrew Grock and Dr. Sally Bogoch
References
Tintinalli’s
Perron AD, Brady WJ, Sing RF. Orthopedic pitfalls in the ED: Vascular injury associated with knee dislocation. Am J Emerg Med 2001;19(7):583–588.
Emergency Orthopedics
uptodate.com
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