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A man with knee injury during football game

HKCEM College Tutorial. A man with knee injury during football game. Author Dr. tw wong Revised by Dr. clarence CHU Kwok Keung Nov 2013. Triage. M 20 Knee injury during football game Swollen knee BP 110/80 P 80/min Temp 37 ° C. Triage category III.

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A man with knee injury during football game

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  1. HKCEM College Tutorial A man with knee injury during football game Author Dr. twwong Revised by Dr. clarence CHU Kwok Keung Nov 2013

  2. Triage • M 20 • Knee injury during football game • Swollen knee • BP 110/80 • P 80/min • Temp 37° C Triage category III

  3. Take a history from the patient ABC => stable

  4. Targeted history • Mechanism of injury • When: time • Where: park, home... • How: fall, sprain • Knee flexed or not • Wt bearing or not • Rotation int vs ext • Strain valgus vs varus • Who: witness • What: regions injured Symptoms • pain, • swelling (gradual?) • locking • functional impairment limping, giving way • PMH • Meds • Allergy

  5. Now, exam the patient

  6. Examination • Look • swelling • deformity • Feel • careful with eliciting tenderness • Fluid wave • Move • Jt stability • Ant/post drawer test • Lachman • Valgus/varus stress • SLR for quad mechanism • Walking • Measure • ROM • Quadricep Remember System Review: Head to Toe

  7. Does this patient need an X-ray? Ottawa Knee Rules Pittsburg Knee Rules

  8. Ottawa Knee Rule X-ray is required if: • Age > 55 • Tenderness over patella • Tenderness over fibula head • Cannot flex knee to 90° • Cannot take 4 steps

  9. Pittsburg Knee Rules Fall/Blunt injury Y N age<12; >50 No Xray Y N X-ray Can take 4 steps N Y No Xray Xray

  10. Next action • Go to case 1 • Go to case 2 • Go to case 3 • Go to summary

  11. Case 1 Your Dx? Your action?

  12. Post CR How to perform CR?

  13. The patient thank you and is ready to go home… Will you discharge him now? What is your plan?

  14. Are you ready to let him go?

  15. Skyline view of patella

  16. If X-ray is negative, what is your plan? Why? Discharge with tubigrip? Discharge with POP? Discharge with knee brace?

  17. Next action • Go to case 1 • Go to case 2 • Go to case 3 • Go to summary

  18. Case 2 What do you see? Dx?

  19. X-ray of knee

  20. Management & Disposal Displaced => Surgery Minimal Displacement => POP

  21. Wiring of patella

  22. Next action • Go to case 1 • Go to case 2 • Go to case 3 • Go to summary

  23. Case 3 Examine This Patient

  24. Physical findings • Look: Swelling gross • Feel: Tenderness medial joint line • Move: • Lachman (ant drawer) • Valgus/varus strain • McMurray (not done, too painful) • Measure: ROM = 10-90° How do you demonstrate joint effusion?

  25. What are your ddx? Torn medial meniscus Torn ACL Fracture… What investigation now?

  26. X-ray: what is your findings? What is your next step?

  27. Knee aspiration

  28. DDx for hemarthrosis with no obvious fracture Torn ACL Peripheral tear of meniscus Dislocation of patella (osteochondral #) Other occult # e.g. tibial spine

  29. Diagnosis?

  30. Diagnosis?

  31. Diagnosis?

  32. Diagnosis?

  33. Next action • Go to case 1 • Go to case 2 • Go to case 3 • Go to summary

  34. Summary We have covered: • Evaluation of knee injuries • Diagnosis and Mx of Patella dislocation • Diagnosis and Mx of Patella fracture • Diagnosis and Mx of Hemarthrosis

  35. The end

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