KNEE DISLOCATION, TIBIA-FEMUR |
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General Information
DEFINITION--Injury to the knee joint in which the upper and lower leg bones are displaced and no longer touch each other. Knee dislocations often include torn or ruptured ligaments in the knee.
BODY PARTS INVOLVED
Tibia (large lower leg bone), femur (thigh bone) and patella (kneecap).
Ligaments of the knee joint.
Meniscus (cartilage) of the knee joint.
Soft tissue surrounding the dislocated knee, including periosteum (covering to bone), nerves, tendons, blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Severe knee pain at the time of injury.
Loss of function of the knee, and severe pain when attempting to move it.
Visible deformity if the dislocated bones have locked in the dislocated position. Bones may spontaneously reposition themselves and leave no deformity, but damage is the same.
Tenderness over the dislocation.
Swelling and bruising around the knee.
Numbness or paralysis below the dislocation.
CAUSES
Overextension of the knee.
Direct blow to the tibia.
Direct blow to the thigh, driving the knee to either side.
End result of a severe knee sprain.
Congenital knee abnormality, such as shallow or malformed joint surfaces.
RISK INCREASES WITH
Contact sports, especially football or hockey.
Previous knee sprain or dislocation.
Repeated knee injury of any sort.
Poor muscle conditioning.
HOW TO PREVENT
Build your strength with a conditioning program appropriate for your sport.
Warm up adequately before physical activity.
After healing, wear protective equipment such as special knee pads and knee braces during participation in contact sports.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment.
Surgery (usually) to restore the knee to its normal position and repair torn ligaments and tendons. Acute or recurring dislocations may re-
quire reconstruction or replacement of the joint.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the knee, hip and ankle.
POSSIBLE COMPLICATIONS
AT THE TIME OF INJURY:
Shock.
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels and connective tissue.
AFTER TREATMENT OR SURGERY:
Excessive internal bleeding around the knee.
Impaired blood supply to the knee.
Death of bone cells from interruption of the blood supply.
Infection introduced during surgical treatment.
Recurrent dislocations with progressively less serious provocation.
Prolonged healing if activity is resumed too soon.
Unstable or arthritic knee joint following repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected, the knee may require immobilization with a cast or splint for 6 to 8 weeks. Complete healing of injured ligaments requires a minimum of 6 weeks. Avoid contact sports if all treatments are unsuccessful in restoring a strong, stable knee.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
This is a medical emergency. Get help as soon as possible.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
Cut away clothing if possible. Don't move the injured leg to do so.
Immobilize the knee, hip and ankle joints with padded splints.
The doctor will repair torn ligaments and tendons and manipulate the dislocated knee to return it to its normal position. Manipulation should be done within 6 hours after injury, or bleeding and displacement of body fluids may lead to shock. Also, many tissues lose elasticity and become difficult to return to a normal position. Manipulation may require spinal or general anesthesia. If blood vessels or nerves have major damage, surgery is mandatory.
CONTINUING CAREAfter removal of the cast or splint:
Use an ice pack 3 or 4 times a day. Place ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
Apply heat instead of ice, if it feels better. Use heat lamps, hot soaks, hot showers, heating pads or whirlpool treatments.
Wrap the injured knee with an elasticized bandage between treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia, spinal anesthesia or muscle relaxants prior to joint manipulation.
Acetaminophen to relieve moderate pain.
Narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to decreased activity.
Antibiotics to fight infection if surgery is necessary.
ACTIVITY
Walk with crutches while the cast is in place. See Appendix 3 (Safe Use of Crutches). Begin weight-bearing and reconditioning of the knee after clearance from your doctor.
If surgery is necessary, resume activity gradually. Don't drive until healing is complete.
DIET
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
REHABILITATION
Begin daily rehabilitation exercises after clearance from your doctor.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly in a circle over the injured area.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a dislocated knee, even if the knee goes back into position. Call immediately if the leg becomes numb, pale, or cold. This is an emergency!
Any of the following occur after treatment:
Nausea or vomiting.
Swelling above or below the cast.
Blue or gray skin color below the cast, particularly under the toenails.
Loss of feeling below the knee.
Constipation.
Any of the following occur after surgery:
Increasing pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Knee dislocations that you can "pop" back into normal position occur repeatedly.
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