Knee Injury - Trip And Fall

Le résumé fourni par la source

HISTORY: A 72-year-old male with a history of autoimmune hepatitis s/p transplant and left total knee arthroplasty (TKA) 9 years ago brought in by EMS to the ED shortly after a mechanical trip and fall. While taking out the garbage, he fell and landed on his left leg. He experienced no pain but was unable to stand up after. He denies any other injury or loss of consciousness. PHYSICAL EXAMINATION: Patient was hemodynamically stable. Left knee was immobilized in a splint from EMS and showed significant gross deformity with positive sag sign. Distal pulses and sensation were intact. No drop foot. Pelvis was stable and left ankle had full range of motion and 5/5 strength. DIFFERENTIAL DIAGNOSIS: 1. Dislocated TKA. 2. Popliteal artery injury. 3. Tibial or common fibular nerve injury. 4. Fractured femur, tibia, or fibula. TESTS AND RESULTS: Lateral x-ray of the left knee showed TKA with posterior displacement of the tibial component relative to the femoral component. No gross fractures. Non-specific thin lucency at the bone cement interface of the tibial component that could indicate loosening or infection. FINAL DIAGNOSIS: Dislocated TKA without fracture or neurovascular injury. TREATMENT AND OUTCOME: After 50 mcg Fentanyl x 2, the patient’s knee was reduced with simple traction. Post-reduction physical exam showed intact distal pulses and sensation and knee stable to varus and valgus stress. - Post-reduction left knee x-rays showed reduction of posterior displacement of the tibia. Reaffirmed lucency along tibial tray. - Post-reduction CT angio of aorta with runoff showed widely patent arterial system. Relocated left knee with an associated joint effusion and synovial hypertrophy. - Orthopedics assessed patient, and patient discharged from ED in a bulky Jones dressing and knee immobilizer with crutches, partial weight-bearing. - Two days later, patient had outpatient follow-up with orthopedics. Physical exam showed knee range of motion from 0 to 110 degrees. Patient was switched to a Bledsoe knee brace set at 0 to 90 degrees with full weight-bearing permitted. - Four weeks later, patient was using the Bledsoe brace intermittently. On physical exam, knee range of motion was now 0 to 120 degrees with good stability and no effusion. His knee did not require revision surgery. Future follow up as needed.

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