Patella dislocation - Revision history

Lenger: /* Background */

2020-12-31T21:07:19Z

Background

← Older revision		Revision as of 21:07, 31 December 2020
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	==Background==		==Background==
	[[File:Knee diagram2.png\|thumb\|Anatomy of anterolateral aspect of right knee.]]		[[File:Knee diagram2.png\|thumb\|Anatomy of anterolateral aspect of right knee.]]
	*Usual mechanism is blow to extended knee with externally rotated ~~foott~~<ref>Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012</ref>		*Usual mechanism is blow to extended knee with externally rotated foot<ref>Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012</ref>
	*May also occur with sudden lateral cut or twisting at the ankle or knee		*May also occur with sudden lateral cut or twisting at the ankle or knee
	*Acute traumatic dislocations more common in males<ref name="epi">Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. AJSM 2004;32:1114-1121</ref>		*Acute traumatic dislocations more common in males<ref name="epi">Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. AJSM 2004;32:1114-1121</ref>

Rossdonaldson1: /* Background */

2020-05-21T21:42:33Z

Background

← Older revision		Revision as of 21:42, 21 May 2020
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	==Background==		==Background==
			[[File:Knee diagram2.png\|thumb\|Anatomy of anterolateral aspect of right knee.]]
	*Usual mechanism is blow to extended knee with externally rotated foott<ref>Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012</ref>		*Usual mechanism is blow to extended knee with externally rotated foott<ref>Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012</ref>
	*May also occur with sudden lateral cut or twisting at the ankle or knee		*May also occur with sudden lateral cut or twisting at the ankle or knee

Spenceemmett: /* Disposition */

2019-12-03T02:32:20Z

Disposition

← Older revision		Revision as of 02:32, 3 December 2019
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	==Disposition==		==Disposition==
	*If unable to reduce or if fracture or loose bodies are seen on post-reduction radiographs, consult orthopedic surgery		*If unable to reduce or if fracture or loose bodies (i.e. osteochondral fracture) are seen on post-reduction radiographs, consult orthopedic surgery
	*If patella successfully reduced, discharge with knee immobilizer and orthopedic follow up within 1 - 2 weeks		*If patella successfully reduced, discharge with knee immobilizer and orthopedic follow up within 1 - 2 weeks

Spenceemmett: /* Techniques for closed reduction */

2019-12-03T02:28:59Z

Techniques for closed reduction

← Older revision		Revision as of 02:28, 3 December 2019
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	*Place patient in knee immobilizer		*Place patient in knee immobilizer
	*Provide NSAIDs		*Provide NSAIDs
	*Obtain radiographs to rule out associated fracture (consider ~~adding~~ sunrise ~~or merchant~~ view)		*Obtain radiographs to rule out associated fracture (consider including sunrise view)
	*Allow weight-bearing as tolerated		*Allow weight-bearing as tolerated

Spenceemmett: /* Techniques for closed reduction */

2019-12-03T02:28:26Z

Techniques for closed reduction

← Older revision		Revision as of 02:28, 3 December 2019
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	*Place patient in knee immobilizer		*Place patient in knee immobilizer
	*Provide NSAIDs		*Provide NSAIDs
	*Obtain radiographs to rule out associated fracture		*Obtain radiographs to rule out associated fracture (consider adding sunrise or merchant view)
	*Allow weight-bearing as tolerated		*Allow weight-bearing as tolerated

SLuckettG: /* Disposition */

2019-05-14T00:24:22Z

Disposition

← Older revision		Revision as of 00:24, 14 May 2019
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	==Disposition==		==Disposition==
	*~~Obtain ortho consult if~~ unable to reduce or fracture/loose bodies seen on post-reduction ~~x-ray~~		*If unable to reduce or if fracture or loose bodies are seen on post-reduction radiographs, consult orthopedic surgery
	*~~Otherwise may be discharged~~ with ~~ortho~~ follow-up in 1-2 weeks		*If patella successfully reduced, discharge with knee immobilizer and orthopedic follow up within 1 - 2 weeks

	==References==		==References==

SLuckettG: /* Clinical Features */

2019-05-14T00:23:17Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	[[File:Patellar dislocation.jpg\|thumb\|patella dislocates laterally]]		[[File:Patellar dislocation.jpg\|thumb\|patella dislocates laterally]]
	*Patella is usually displaced laterally~~; knee is~~ held in flexion		*Patella usually displaced laterally
			*Knee held in flexion
			*Pain

	==Differential Diagnosis==		==Differential Diagnosis==

SLuckettG: /* Management */

2019-05-14T00:22:37Z

Management

← Older revision		Revision as of 00:22, 14 May 2019
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	==Management==		==Management==
	[[File:Patellar Dislocation Relocation.jpg\|thumb\|Relocation with lateral pressure on dislocated patella]]		[[File:Patellar Dislocation Relocation.jpg\|thumb\|Relocation with lateral pressure on dislocated patella]]
	*Reduce; do not need x-rays prior to reduction~~. Rarely need any sedation though a dose of IV pain medication can help relax the patient~~		*Reduce
	**~~Option #1:~~		**Generally do not need x-rays prior to reduction
	***~~Mild flexion~~ of hip ~~(20-30 degrees~~ by raising head of bed~~, not by propping~~ the ~~leg up off the bed) to relax~~ quadriceps		**Sedation rarely required
	***Slowly extend ~~and slightly hyperextend~~ the knee ~~and slide~~ patella back ~~into~~ place.		***Single dose of pain medication may facilitate relaxation
	**Option #2
	~~***~~One provider applies slow downward pressure over ~~the quads.~~ This stretches ~~out~~ the muscle and slowly straightens the leg		===Techniques for closed reduction===
	***At the same time, second provider ~~pulls gentle traction of~~ the patella ~~outward while rotating the patella back over from~~ lateral to anterior
	*~~Knee~~ immobilizer, NSAIDs, weight-bearing as tolerated		*Single operator
			#Place the hip in mild flexion by raising head of bed
			#*This facilitates relaxation of the quadriceps
			#Gently extend the knee with one hand while pushing the patella back in place with the other hand

			*Two operators
			#One provider applies slow downward pressure over quadriceps
			#*This stretches the muscle and slowly straightens the leg
			#Second provider gently rotates the patella lateral to anterior

			*Place patient in knee immobilizer
			*Provide NSAIDs
			*Obtain radiographs to rule out associated fracture
			*Allow weight-bearing as tolerated

			==Complications==
			*Commonly associated fractures:
			**Medial patellar facet
			**Lateral femoral condyle

	==Disposition==		==Disposition==

SLuckettG: /* Background */

2019-05-14T00:18:29Z

Background

← Older revision		Revision as of 00:18, 14 May 2019
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	==Background==		==Background==
	*~~Typically occurs with trauma~~ to an extended knee with externally rotated ~~foot~~<ref>Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012</ref>		*Usual mechanism is blow to extended knee with externally rotated foott<ref>Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012</ref>
	*Acute ~~dislocation occurs with~~ traumatic ~~injury, M=F, may see hemarthrosis~~<ref name="epi">Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. AJSM 2004;32:1114-1121</ref>		*May also occur with sudden lateral cut or twisting at the ankle or knee
			*Acute traumatic dislocations more common in males<ref name="epi">Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. AJSM 2004;32:1114-1121</ref>
	*Chronic dislocation seen more commonly in women/teenage girls, typically little or no swelling<ref name="epi"></ref>		*Chronic dislocation seen more commonly in women/teenage girls, typically little or no swelling<ref name="epi"></ref>
	*~~Common~~ associated ~~fractures~~		**May be associated with hemarthrosis
	**Medial patella facet		*Chronic dislocation more common in females
	**~~Lateral femoral condyle~~		**Typically little or no swelling

	==Clinical Features==		==Clinical Features==

Mholtz at 21:14, 9 May 2017

2017-05-09T21:14:43Z

← Older revision		Revision as of 21:14, 9 May 2017
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	==Background==		==Background==
	*~~Occurs~~ with trauma to an extended knee with externally rotated foot ~~and twisting motion~~<ref>Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012</ref>		*Typically occurs with trauma to an extended knee with externally rotated foot<ref>Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012</ref>
	*Acute~~: in~~ traumatic injury, ~~occurs equally in men/women~~ <ref name="epi">Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. AJSM 2004;32:1114-1121</ref>		*Acute dislocation occurs with traumatic injury, M=F, may see hemarthrosis<ref name="epi">Fithian DC, Paxton EW, Stone ML, Silva P, Davis DK, Elias DA, White LM. Epidemiology and natural history of acute patellar dislocation. AJSM 2004;32:1114-1121</ref>
	*Chronic: women/teenage girls<ref name="epi"></ref>		*Chronic dislocation seen more commonly in women/teenage girls, typically little or no swelling<ref name="epi"></ref>
	*~~Commonly lateral displacement and unable to extend knee~~		*Common associated fractures
			**Medial patella facet
			**Lateral femoral condyle

	==Clinical Features==		==Clinical Features==
	[[File:Patellar dislocation.jpg\|thumb\|patella dislocates laterally]]		[[File:Patellar dislocation.jpg\|thumb\|patella dislocates laterally]]
	*Patella is usually displaced laterally; knee is held in flexion		*Patella is usually displaced laterally; knee is held in flexion
	*Acute: often with large hemarthrosis
	*Chronic: little to no swelling

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	[[File:Patellaluxation ap 001.png\|thumb]]		[[File:Patellaluxation ap 001.png\|thumb]]
	*~~Xray if traumatic mechanism to rule out fracture~~		*Clinical diagnosis
	*Do not need xay prior to reduction if chronic		*May consider pre-reduction x-ray if concern for fracture (not required)
	*~~Post~~-reduction x-ray~~: confirm reduction, eval~~ for ~~fractures and loose bodies~~ (~~avulsions, misalignment, etc~~)~~<ref>Krause E A. et al. Pediatric lateral patellar dislocation: is there a role for plain radiography in the emergency department? J Emerg Med. 2013 Jun;44(6):1126-31</ref>~~
	*Common associated fractures
	**Medial patella facet
	**Lateral femoral condyle

	==Management==		==Management==
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	***Slowly extend and slightly hyperextend the knee and slide patella back into place.		***Slowly extend and slightly hyperextend the knee and slide patella back into place.
	**Option #2		**Option #2
	***One provider applies slow downward pressure over the quads. This stretches out the muscle and slowly ~~straigttens~~ the leg		***One provider applies slow downward pressure over the quads. This stretches out the muscle and slowly straightens the leg
	***At the same time, second pulls gentle traction of the patella outward while rotating the patella back over from lateral to anterior		***At the same time, second provider pulls gentle traction of the patella outward while rotating the patella back over from lateral to anterior
	**Knee immobilizer, NSAIDs, weight-bearing as tolerated		*Knee immobilizer, NSAIDs, weight-bearing as tolerated

	==Disposition==		==Disposition==
	**Orthopedic follow-up within 1-2wks		*Obtain ortho consult if unable to reduce or fracture/loose bodies seen on post-reduction x-ray
	*Unable to reduce or loose bodies~~/fracture~~ on post-reduction ~~imaging~~		*Otherwise may be discharged with ortho follow-up in 1-2 weeks
	**Obtain immediate ortho ~~consult~~

	==References==		==References==