References
Acute multiligament injured or dislocated knee: field assessment and management
Abstract
Knee dislocation is a serious but uncommon injury that can result in significant trauma to the ligaments, nerves, and blood vessels of the leg. With a high rate of spontaneous reduction and signs of injury that are often subtle in the acute stage, knee dislocation can be missed if not specifically sought through meticulous and thorough history-taking and physical examination. Targeted visual inspection, neurologic and vascular examination, and palpation of the limb are all instrumental in the identification of a potential multiligament knee injury or dislocated knee. The association of significant vascular injury with knee dislocation puts the injury victim at risk of limb loss if the injury is not identified and treated in a timely fashion. By identifying the injury, reducing and splinting as appropriate, and communicating awareness of the injury to hospital-based caregivers, the paramedic has a unique opportunity to direct the course of treatment that the patient receives.
There are few instances within the realm of musculoskeletal trauma where paramedics can have such a profound impact on the care of their patients as in the case of the acutely dislocated knee. Although uncommon, the multiligament injured knee or dislocated knee has the potential to become a very serious limb threatening injury. These injuries are often subtle and require a meticulous and targeted history-taking and examination to detect. Failure to identify and appropriately treat these injuries in a timely fashion can have catastrophic results. In seeking pathology rather than assuming wellness, an occult, limb-threatening injury can be detected, and in the process, a limb saved.
Knee dislocation is a descriptive term that belies the complexity of the injured state that it represents. It is better understood as a complete disruption of the articulation of the tibia and the femur, significant enough to potentially injure the nervous, vascular, and ligamentous structures of the lower limb. Early classification schema for knee dislocations were based on the position of the tibia relative to the femur in the dislocated state (Kennedy, 1963). This system was not useful because a spontaneous reduction of the dislocation occurs in 50% of cases, thereby masking the true severity of the injury (Wascher et al, 1997).
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