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There is no role for the Ex-Fix: Understanding Knee Dislocations & How I stabilize

There is no role for the Ex-Fix: Understanding Knee Dislocations & How I stabilize. JD Adams, MD Greenville Health System Greenville, SC. Learning Points. Ex-fix is not needed 90-95% of the time When to acutely Repair/Reconstruct Limited and temporary role for static exfix.

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There is no role for the Ex-Fix: Understanding Knee Dislocations & How I stabilize

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  1. There is no role for the Ex-Fix: Understanding Knee Dislocations & How I stabilize JD Adams, MD Greenville Health System Greenville, SC

  2. Learning Points • Ex-fix is not needed 90-95% of the time • When to acutely Repair/Reconstruct • Limited and temporary role for static exfix

  3. Do we Ex-fix other joint dislocations? Elbow??? RARELY Hip??? Shoulder???

  4. Why don’t we ex-fix other joints? • Stiffness • Does not lead to a functional extremity in most cases • Does not eliminate the need for other surgery

  5. Don’t Use a Static Ex-fix • Concentric reduction usually obtained after reduction (90% of patients) If not concentric…they need a ”real” operation • Significant capsular injury • Avulsions that can be repaired

  6. Knee Dislocation- management 90-95% of dislocations Hinged knee brace, MRI, and motion Reconstruction in 3-4 weeks Yes Concentric reduction? Reduce dislocation No MRI (Consider temporary ex-fix if grossly mal-aligned) Acute Repair/Reconstruction of collaterals/capsule 5-10% of dislocations Arthroscopic Reconstruction 3-4 weeks

  7. Case Example- 29 yo Motorcycle After Reduction Not concentric

  8. What next?? NOT A STATIC EX-FIX Real Operation: Lateral Capsular Repair PLC reconstruction Compass Hinge

  9. NO STATIC EX-FIX Lateral Capsular Repair PLC reconstruction Compass Hinge

  10. Do I ever use a static ex-fix?? • Open dislocations needing soft tissue coverage • Fracture-dislocations • Dislocations that require vascular repair- BEFORE vascular repair • How long? • 3-4 weeks

  11. Take Home Points • Vast majority of knee dislocations do not need an exfix • Concentric reduction is key • Most can be treated in hinged knee brace until reconstruction in 3-4 weeks • If not concentric- patient needs a ”real” surgery • Repair capsule • Repair/Reconstruct Capsule • Consider Compass Hinge

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