Surgical outcomes after traumatic open knee dislocation

Abstract

The purpose of this study is to describe the types of injuries and surgical treatments associated with open knee dislocations and to present the functional outcomes of these patients. Between 2001 and 2005, the medical records of patients that sustained traumatic open knee dislocations at our Level 1 Trauma Center were retrospectively reviewed. Initial surgical intervention was performed in all patients including placement of spanning external fixator, repair of vascular injuries if necessary, and irrigation and debridement of the open wounds. Ligamentous reconstruction was delayed until after limb salvage. The Short Form-12 was the primary outcome measure. Seven patients (five male, two female) had a mean age of 31.9 years (range 22-44) at the time of injury (five right, two left). Motorcycle accident was the most common cause (57%). Follow-up was a mean 27.6 months. The PCL was damaged in all patients. Three patients underwent angiography for absent/diminished pulses on initial exam with two requiring operative intervention. Three patients had associated common peroneal nerve injury (one iatrogenic). Ten (10.7) operative procedures were performed per patient (range 5-18) with an average of 6.6 debridements (range 2-11). Infection rate was 43% with one patient undergoing amputation for infection. Good to excellent results were found in 33% of patients. Most patients (86%) report some residual symptomatic or functional deficit. Due to the injury complexity in open traumatic knee dislocations, the surgical treatment is extensive and challenging. While infection rates are high, aggressive, individualized treatment can lead to satisfactory outcome although full return to activity is difficult to achieve using current treatment methods.

The Changing Demographics of Knee Dislocation: A Retrospective Database Review

“…Anterior and posterior dislocations, for example, are associated with a vascular injury rate of approximately 40%, while medial and lateral dislocations have a significantly lower risk of 25% and 3%, respectively [10]. Open dislocations exhibit significantly poorer outcomes than closed dislocations, with an open dislocation infection rate of 43% and an amputation rate of 17% in one series [17]. Despite the heterogeneity and severity of knee dislocations, little is known about their frequency and demographic distribution.…”

“…While knee dislocation incidences of less than 0.001 events per 100 patient-years within the general population and of 0.0125 events per 100 patient-years within orthopaedic injuries are often reported in the literature, knee dislocation incidence has not been evaluated in a large patient population for more than half a century [14,16,22]. In addition, while some recent retrospective studies report the demographic distribution of patients with knee dislocation, these studies are limited by small sample sizes (\ 250 patients) [3,10,17,24]. Knee dislocations often reduce spontaneously, and so the diagnosis of knee dislocation depends largely on clinical suspicion and is often missed at initial presentation [15].…”

Initial Assessment of the Acute and Chronic Multiple-Ligament Injured (Dislocated) Knee

“…They have been reported to occur in 19% to 35% of all KDs. 45,46 The open injury is generally not subtle with Gustilo Type IIIB injuries being the most common reported by King et al 45 Vascular injures are more common in open KDs (26% to 29%) as are neurological injuries (37%). 47 A preliminary ligamentous examination should be performed in the emergency department.…”

Radiologic Review of Knee Dislocation: From Diagnosis to Repair

“…An external fixator is recommended in circumstances of gross instability when joint reduction cannot be maintained with a brace, often in association with intraarticular and periarticular fractures [1, 2,24,28,29]. An external fixator is also suggested for open knee dislocations to facilitate soft-tissue care of open wounds [29,30]. Ideally, this should be done using MRI-compatible equipment with consideration of pin placement to keep pins in an extraarticular position and well clear of potential graft tunnel sites required for future reconstruction.…”