7.Knee injury ( Diagnosis???)

1. 7.Knee injury( Diagnosis???)

2. 7.Knee injury • ACL,PCL,MCL injury -common • fracture • Contact sport

3. Knee anatomy 3 bone Patella Tibia femur

4. 1.Ligament 1.Anterior cruciate ligament(ACL) 2.Posterior cruciate ligament(PCL) 3.Medial collateral ligament(MCL) 4.Lateral collateral ligament(LCL)

6. 2.meniscus Medial, lateral meniscus function 1.Transmit load and distribution 2.Increase contact surface area

7. Knee anatomy

8. Mechanisminjury Pivot sport ( soccer , basketball rugby) Decelerate, jumping Hyperextend rotate Pop sound ( ACL torn)

9. Clinical Pain ,cannot walk Swelling hematrosis

10. Knee Exam • Deformity • Swelling , ballotment • Tender - joint line • ROM – Flex,extend • Muscle –quadricep • Special test for ligament

11. 1.Valgus stress test – Medial collateral ligament ( MCL)

12. 2.Varus stress test – lateral collateral ligament ( LCL) • Varus stress test in flex 30,full extend

13. 3.Lachman test for ACL (Anterior cruciate ligament)

14. 3.Anterior drawer test (ADT) for ACL (Anterior cruciate ligament)

15. 4.Posterior drawertest for.Posterior cruciate ligament (PCL)

16. treatment • On – field - RICE ( ligament injury) - splint ( fracture) • Ligament injury - long leg cast (MCL) 4-6week - surgery – 1.Repair - 2.Reconstruction ( 6 week – 6 month)

17. Ligament Reconstruction ACL Reconstruction

18. Post operation -Hinge knee brace -Axillary crutch

19. Meniscus injury

20. Meniscus tear

21. Arthroscopic repair

22. Arthroscopic repair

23. 8.Leg injury • Diagnosis ??

24. Anatomy leg • 2 bone • 1.Tibia ( weight bearing) Tibia plateau – proximal (knee) Tibia plafond – distal (ankle) • 2.Fibula (non weight bearing)

25. 8.Leg injury • Common • Twist , direct injury • Contact sport( soccer,rugby)

26. 8.1Fracturetibia and fibula • Severe pain • Deformity • Shortening • Aware open fracture (Emergency) • Neurovascular

27. treatment • On-field – long splint ,transport - clean wound • Definite - long leg cast 10-12 week - Surgery in displaced fracture ( 3-6 month)

28. Surgery with Intramedullary Nail(tibia)

29. Surgery with External fixator in dirty open fracture tibia

30. Diagnosis ???

31. 8.2 Muscle cramp • Common injury • Calf pain, tender • Cause – electrolyte imbalance - dehydration - muscle contraction imbalance

32. 8.2 Muscle cramp Muscle contraction imbalance

33. treatment • Passive stretching • IV fluid • Check electrolyte

35. 9.Ankle injury • Diagnosis???

36. Ankle anatomy • 3 bone 1.distal tibia,medial malleolus 2.distal fibula,lateral malleolua 3.talus • Ligament 1.medial – deltoid ligament 2.lateral – ATFL,PTFL,CFL

37. Ankle anatomy

38. 9.Ankle injury • Most common • Twist, direct injury • Soccer,basketball • 1.ligament injury -Inversion lateral ankle sprain • 2.Fracture ankle

39. 9.1 Ankle sprain • Mechanism injury • Inversion (common) • Lateral injury ,tear • Pain • Swelling • Cannot walk

40. Ankle sprain

41. Treatment • On field - RICE • Definite treatment depend on grade of injury

42. Grading of ankle sprain • Grade 1 (mild) – pain,tender • Grade 2 (partial tear) - pain ,swelling - marked tender - good stability

43. Treatment in Grade 1,2 • Ankle support • Brace • Elastic bandage • Splint (2-6 week)

44. Grade 3 (complete tear) • Marked pain,swelling • Instability • Cannot walk Treatment • 1.brace, cast • 2.surgery if instability or chronic

45. 9.2 Fracture ankle • Tender,pain,swelling • Deformity • Aware open fracture • Neurovascular – post tibia a,n

46. Fracture ankle

47. treatment • 1.On field - splint • Reduction if marked deformity - Direct traction for prevent neurovascular • 2. Surgery ( 8-12 week)

48. Rehabilitation • ROM • Strength • resist

49. THANK YOU Question ???