Patellar Dislocation Knee Dislocation & Tibial Shaft Fracture

Patellar Dislocation, Knee Dislocation & Tibial Shaft Fracture

Dr. Wahby Ghalib CABMS, FJMC, MRCS

Patellar Dislocation

Usually : lateral dislocation

Stabilizers

Medial patellofemoral ligament Intercondylar groove Extensor retinacula Vastus medialis obliquus

Mechanism

Direct trauma Sudden contraction of quadriceps

Predisposing factors

Genu valgum External tibial torsion High patella Shallow intercondylar groove Ligamentous laxity Muscle weakness



CF
Haemarthrosis : if fat droplets : osteochondral # (5%)


XR
AP Lateral skyline


Rx
CR : usually successful Cast immobilization 2-3 w

Cx
Recurrent dislocation : 20%

Knee dislocation

Usually anterior

Mechanism

Severe trauma e.g. RTA



At least one cruciate + both collateral ligaments or both cruciate ligaments torn


Rx
CR + slabMCL may be torn & lodged in the joint  OR


Cx
Vascular injury : 30% Nerve injury Ligamentous injury : repair or reconstruction Recurrence stiffness

Tibial Shaft #

It is the commonest diaphyseal #

Mechanism

Twisting : spiral #s at different levels Direct : transverse or short oblique at same level


Accepted alignment

Rx

Undisplaced #

Cast : 3 m NWB 1 m PWB 1 m

Displaced #

CR & cast

Irreducible or unstable #

ORIF : plate or IMN

Open #

According to Gustilo classification


Cx
Vascular injury Compartment s. Malunion nonunion

Objectives :

Stressing the significance of knee dislocation as a serious limb threatening condition. Developing the students skills to early identify this type of injury and the way of providing the early supportive measures. Clarification of the general lines of management.

Onbjectives :

Stressing the significance of patellar dislocation as a common traumatic condition that is frequently complicated by recurrence. Clarification of the general outlines of management and their indications according to the type of the injury. The importance of physiotherapy.

Objectives :

Understanding the general outlines of management of tibial shaft fractures including identification and treatment of open fractures.