knee joint mishaps

Question 1

Femoral shaft fractures.

Answer 1

• high energy injuries.
• site could be proximal, mid-shaft or supracondylar.
• causes extreme blood loss which could lead to hypovolaemic shock.
• traction splint or surgical fixation.

Question 2

tibial plateau fractures.

Answer 2

• high energy fracture due to axial loading and angulation.
• could cause articular cartilage damage, instability and reduction in joint surface.
• fix articular segment to shaft, post traumatic OA.

Question 3

patella fractures.

Answer 3

• direct/ indirect force.
• is extensor mechanism intact : straight leg test.
• displaced : reduce and fix.
• undisplaced : splint and protect.

Question 4

patella dislocation.

Answer 4

• lateral direction or twisting or falling in slight flexion.
• predispositions : long patella ligament, previous dislocations, shallow trochlear groove.
• reduce and immobilise, soft tissue reconstruction.

Question 5

meniscal injuries.

Answer 5

• twisting injury in high flexion leading to localised pain and swelling. mechanically jamming and locking.
• traumatic : meniscectomy/ meniscal repair.
• degenerative : leave alone & rehabilitation.

Question 6

collateral ligament injuries.

Answer 6

• due to contact/ direct blow causing pain, instability.
• medial collateral : valgus strain.
• lateral collateral : varus strain.
• associates injuries are ‘unhappy or terrible triad’
• brace and rehab.

Question 7

unhappy triad

Answer 7

occurs due to a lateral blow to the knee causing a rupture in the anterior cruciate ligament, medial collateral ligament, and meniscus.
- lateral (from the outside) force impacts the knee while the foot is fixed on the ground.

Question 8

cruciate ligament injuries.

Answer 8

• ACL : non contact landing or directional change.
• recurrent instability.
• rehab and surgical reconstruction.
• PCL : contact fall onto knee or hyperextension.
• brace and rehab.

Question 9

knee joint dislocation.

Answer 9

• high energy trauma, 3/4 ligaments ruptured.
• vascular injury (popliteal artery, angiography)
• late stiffness & instability.
• reduce and stabilise.

Question 10

knee swellings.

Answer 10

• bony.
• soft tissue localised/ generalised.
• fluid inside or outside joint.
• knee effusion : haemarthrosis, lipo-haemarthrosis.

Question 11

bursitis.

Answer 11

• inflammation and fibrosis of a bursa.
• pre-patellar bursitis (housemaids)
• infra-patellar bursitis (clergymans)
• supra-patellar bursitis ( knee joint effusion)
• semimembranosus bursitis (popliteal/ bakers cyst)

Question 12

knee arthritis.

Answer 12

• osteoarthritis.
• inflammatory arthritis.
• joint surface / chondral damage.
• synovitis.
• may cause pain, stiffness, loss of function, deformity.

Question 13

knee osteoarthritis.

Answer 13

• prevalence.
• provoked by activity, relieved by rest.
• predispositions include age, sex, weight, post-trauma, genetics.
• strengthening exercises, analgesia, weight loss, activity modification, surgery.

Question 14

septic arthritis.

Answer 14

• medical/ surgical emergency : clinically unwell, pain, swell, red, warm, splinted.
• recent surgery? knee effusion secondary bacterial infection.
• articular cartilage damage.
• aspirate to confirm diagnosis and antibiotics and surgical washout.