Firearm Injuries of the Knees without Neurovascular Damage in Police Encounters: Case Series and Review of Literature

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Background: Firearm injuries to the knee, particularly in police encounters, present unique medical, forensic, and legal challenges. While these injuries often spare neurovascular structures, they may result in complex musculoskeletal trauma. Understanding knee anatomy, especially neurovascular relationships with surrounding tissues, is crucial in assessing injury severity, management strategies, and forensic analysis. Case Presentation: This case series examines multiple patients with firearm-related knee injuries sustained during police operations, discussing their presentation, management, rehabilitation, forensic analysis, and legal implications. All three patients presented with firearm injury, soft tissue compromise, and without retained bullet fragments. Radiological investigations confirmed there were no retained firearm products. One had simple 2-part horizontal fracture of patella, second had a stellate fracture of patella, and the third had no bony injury. Patella fracture patients underwent emergency surgical interventions including debridement, open reduction, internal fixation. Post-operative rehabilitation was initiated, though constrained by the custodial setting. Functional outcomes were satisfactory in the short term, with no immediate signs of deep infection or neurovascular complications. Conclusion: A coordinated strategy involving orthopaedics, trauma care, law enforcement, and medico-legal services is necessary for inmate firearm injuries to the knee joint. Fracture stabilization, proper surgical decontamination, early diagnosis, and unambiguous medico-legal documentation are crucial. Within the limitations of custodial care, rehabilitation must be customized with a focus on joint mobility and infection control.

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