Archive for December, 2007

KNEE INJURIES

December 11, 2007

FRACTURED PATELLA:   

Symptoms:
Injury caused by direct impact to the patella.
Pain on palpation.
Palpable deformity of the patella.
Can be very swollen and ecchymotic.
A fractured patella can make it difficult to walk, but not impossible.
Once splinted straight, patient can walk a short distance relatively pain-free.

Treatment:
For comfort and long-term care, splint with a posterior knee splint that maintains the knee
at a 20 – 30 degree angle, the position of comfort.
RICE to control swelling if appropriate, but not in a cold environment.

RUPTURED PATELLA TENDON: 

Symptoms:
Injury caused by a direct force to the patella tendon just inferior to the patella.
When the patella tendon ruptures, the patella will retract up the leg.
The patella with the ruptured  tendon will be noticeably more proximal compared to the other knee.
Minimal pain and discomfort.
They can walk with the knee held straight.
They can flex but not extend the knee.

Treatment:
Splint with a posterior knee splint in the position of comfort, usually slightly bent.
Ace wrap to control swelling. Usually minimal bleeding from the rupture.

DISLOCATED PATELLA: 

Symptoms:
A common sports injury.
When the patella dislocates, it moves laterally.
The affected knee will be flexed to about 30 – 45 degrees.
Can be very painful.

Treatment:
The patella can be easily reduced.
Place your hand on the lateral aspect of the knee, with your fingers in the popliteal fossa and thumb against the patella.
As you straighten out the lower leg with your other hand, push your thumb against the patella forcing it back into the patella groove of the femur.
As the leg straightens, the patella will pop back into place.
The sooner this maneuver is performed, the better it works.
Once reduced into proper anatomical position, the knee should be splinted and an Ace wrap applied.
If possible RICE the knee.

Relocation of Patella

LIGAMENTAL KNEE INJURIES:
Anterior and Posterior Cruciate Ligament Injuries
Medial and Lateral Collateral Ligament Injuries

Examination & Evaluation of the Knee:

1.  History/MOI: How were the forces applied to the knee?
Does the knee feel stable when standing and weight bearing?

2.  Drawer test: With the knee at 90 degrees, push and pull.
Instability can indicate a cruciate injury.

3.  Lachman test: With the knee at 30 degrees push and pull.
Instability can indicate a cruciate injury.

4.  Med/lat distraction: With knee slightly bent try to distract med/lat.
Instability can indicate a med. or lat. collateral ligament injury.

Treatment:
The most comfortable splint is a posterior knee splint that maintains the knee at a 20 – 30 degree angle.

DISLOCATED KNEE: 

Symptoms:
A dislocated knee is a very painful and destructive injury.
In order for the knee to dislocate, support ligaments had to be torn.
There is obvious deformity of the knee joint; typically, the tibia is pushed posterior to the femur.
Pressure on the arteries behind the knee can compromise the circulation to the lower leg.
All dislocated knees are surgical knees.

Treatment:

Because the supporting ligaments have been torn, it is usually simple with minimal discomfort to realign and reduce the dislocation.

Gently place knee in proper anatomical postion.

Check and monitor circulation distal to the knee.

Splint in position of comfort with a well-padded, posterior splint in position of comfort, usually bent at about 20 – 30 degrees.
Ace wrap to control swelling.

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LOWER EXTREMITY INJURIES

December 11, 2007

HIP FRACTURES: 

Symptoms:
The leg on the affected side is usually extended and externally rotated.
Pain may be minimal.
Guarding of the hip – they will be unable to weight bear and cannot move the affected leg.
Internal rotation of the leg will increase the hip pain.           
Direct palpation of the hip may not cause pain.
To test a painless hip: Flex, Abduct, and Externally Rotate (FABER).
Pain with the FABER indicates injury to the hip joint or proximal femur. 

Treatment:
Splint with padding/pillow between the legs and tie the legs together, allowing the good leg to support the bad.

DISLOCATED HIP: 

Symptoms:
A dislocated hip presents in the “modesty position.”
The knee and hip are flexed and internally rotated.
A very unusual injury.
Most often caused by high velocity impact or can also occur in someone who has had a total hip replacement.
We would be interested in learning of a mountain rescue (non-ski-related) that involved a dislocated hip. 

Treatment:
Splint in the position found.
This would be a very difficult if not impossible dislocation to reduce in the field. 

MID-SHAFT FRACTURED FEMUR: 

Symptoms:    

A mid-shaft fracture of the femur is very painful and commonly has muscle spasms.

The patient is unable to use the affected leg.

They will have severe pain with palpation or leg movement.

Treatment:
As soon as possible, apply manual traction.
Always place in a traction splint with compression bandage around the femur to control internal bleeding.
Since up to 25% of the blood volume can be lost into the fracture site, wrap the splint and the entire leg with 6” ACE wraps, starting at the ankle and progressing to the hip.
Without traction there is up to a 50% mortality rate due to pulmonary emboli from the fracture.

Traction Splint

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