Staged protocol for initial management of the dislocated knee

Levy, Bruce A.; Krych, Aaron J.; Shah, Jay P.; Morgan, Joseph A.; Stuart, Michael J.

doi:10.1007/s00167-010-1209-y

Cited by 58 publications

(50 citation statements)

References 42 publications

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“…If vascular repair is required, subsequent surgical priority must be given to stabilising the knee to protect the vascular repair. This can either be in a standard above knee plaster cast or external fixator while awaiting definitive surgery [34]. …”

Section: Surgical Decision Makingmentioning

confidence: 99%

Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?

McKee¹,

Ibrahim²,

Lawrence³

et al. 2014

TOORTHJ

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Traumatic knee dislocation is a serious and potentially limb threatening injury that can be easily missed if meticulous history and examination have not been employed. Neurovascular injuries are common in this condition, and due diligence should be given to their thorough evaluation at time of secondary survey so as to avoid complications such as ischaemia, compartment syndrome and eventual amputation. There is growing evidence in the literature that morbid obesity is associated with low energy knee dislocation, therefore this should be considered when assessing this cohort of patients presenting with an acute knee injury. Early operative intervention especially with multi ligaments involvement is the preferable strategy in the management of this acute injury. Controversy exists whether to reconstruct or repair damaged structures, and whether to adopt a one stage or two stage reconstruction of the cruciate ligaments. Early rehabilitation is important and essential to achieve satisfactory outcomes. This article is an evidence-based overview of this rare but devastating injury.

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Section: Surgical Decision Makingmentioning

confidence: 99%

Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?

McKee¹,

Ibrahim²,

Lawrence³

et al. 2014

TOORTHJ

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“…Reconstruction of the multiligament-injured knee often combines arthroscopic and open techniques [13,15,26], involves extended surgical and tourniquet use times, and is often performed in patients who have sustained concomitant fractures as well as vascular and/or neurologic injuries from the initial trauma [14,25,30,33,49]. As such, these patients are at risk of developing venous thromboembolism (VTE).…”

Section: Introductionmentioning

confidence: 99%

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Born¹,

Engasser

King

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Reconstruction of the multiligament-injured knee often involves extended surgical and tourniquet use times and often is performed in patients who have sustained concomitant fractures as well as vascular injuries, all of which would appear to predispose the patient to the potentially serious complications of deep vein thrombosis and perhaps pulmonary embolism, yet little is known about the frequency of venous thromboembolic (VTE) events after multiligamentous knee reconstruction. Questions/purposes The purposes of this study were to (1) determine the frequency of symptomatic VTE after multiligamentous knee reconstruction at a single institution; and (2) to determine associated risk factors for VTE in these patients. Methods The records of 134 (63% of the 213 consented individuals in our longitudinal database) patients who underwent primary (129 [96%]) or revision (five [4%]) multiligamentous knee reconstruction at a single institution between 1992 and 2013 were retrospectively reviewed. With two patients undergoing procedures bilaterally, this resulted in a total of 136 multiligamentous knee reconstructions. VTE for which clinical symptoms were evident and confirmed by imaging within 3 months after the reconstructive procedure was noted. Pre-and perioperative data were collected with respect to demographics, associated injuries, medical history, smoking status, and surgical data. Standard rehabilitation and thromboprophylaxis protocols were used in all patients. Results Three cases of symptomatic VTE (three deep vein thromboses) occurred after the 136 reconstructions (2%; 95% confidence interval, 0.53%-7.3%). Two of the three patients were obese and the remaining patient smoked and abused alcohol. However, as a result of a low frequency of VTE, no risk factors could be identified in this series. Conclusions Symptomatic VTE occurred in 2% of multiligamentous knee reconstructions at our institution while receiving thromboprophylaxis. This is similar to rates documented after anterior cruciate ligament reconstruction without thromboprophylaxis. Further multicenter research is required to identify the true frequency of and risk factors for developing VTE in patients undergoing multiligamentous knee reconstruction after knee dislocation. Level of Evidence Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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“…9 In another study, none of 9 patients developed DVT after knee dislocation surgery; LMWH was used as pharmacological prophylaxis, but the screening method for DVT was not described. 4 Of 19 patients who underwent temporal external fixation for femoral shaft fractures, 0% and 5.3% developed PE and DVT, respectively, but methods of VTE prophylaxis and screening were not described. 3 The use of LMWH decreases the risk of VTE.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6][7] Complex lower-limb fractures and immobilisation are risk factors for deep vein thrombosis (DVT). 8 The rate of DVT after temporary joint-spanning external fixation for complex lower-limb fractures was 2.1% when low-molecular-weight heparin (LMWH) prophylaxis was used.…”

mentioning

confidence: 99%

Rate of Venous Thromboembolism after Complex Lower-Limb Fracture Surgery without Pharmacological Prophylaxis

Niikura

Sakai

Lee

et al. 2015

J Orthop Surg (Hong Kong)

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Purpose. To evaluate the rate of venous thromboembolism (VTE) after complex lowerlimb fracture surgery without pharmacological prophylaxis. Methods. Between July 2005 and April 2009, 11 men and 6 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 3 femoral and 20 tibial fractures. Patients were screened for VTE using contrastenhanced computed tomography (CT) when the D-dimer value was beyond normal range. Between May 2009 and December 2012, 18 men and 4 women (mean age, 45 years) underwent temporary external fixation followed by internal fixation for a total of 8 femoral and 20 tibial fractures. Patients were routinely screened for deep vein thrombosis (DVT) using ultrasonography and for pulmonary embolism (PE) using contrast-enhanced CT (in high-risk patients with multiple injuries or pelvic and acetabular fractures). In both groups, pharmacological prophylaxis was not Rate of venous thromboembolism after complex lower-limb fracture surgery without pharmacological prophylaxis used; only mechanical prophylaxis was used.Results. The 2 groups were comparable in terms of age, sex, and proportion of bilateral external fixation, open fracture, and associated injury, except that the duration of external fixation was longer in the early group (29.8±28.0 vs. 11.6±4.0 days, p=0.001). Of the 17 patients in the early group, 5 developed VTEs (3 DVTs and 2 PEs) at a mean of 13.6 (range, 6-20) days after injury; 2 of whom developed VTE during the external fixation period. Of the 22 patients in the later period, 10 developed VTEs (10 DVTs and 4 PEs) at a mean of 13 (range, 5-33) days after injury; 7 of whom developed VTE during the external fixation period. Conclusion. The rate of VTE was high in patients undergoing complex lower-limb fracture surgery without pharmacological prophylaxis.

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Staged protocol for initial management of the dislocated knee

Cited by 58 publications

References 42 publications

Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?

Current Concepts in Acute Knee Dislocation: The Missed Diagnosis?

Low Frequency of Symptomatic Venous Thromboembolism After Multiligamentous Knee Reconstruction With Thromboprophylaxis

Rate of Venous Thromboembolism after Complex Lower-Limb Fracture Surgery without Pharmacological Prophylaxis

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