The EM Educator Series: Knee Dislocation Highlights

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case #1:

A 33-year-old female presents after MVC with right leg trauma and deformity. You find what appears to be a knee dislocation, with absence of distal right leg pulses.

Case #2:

A 42-year-old male presents with severe left leg pain after stepping off a curb. He is obese, and to your surprise, left knee x-ray demonstrates dislocation.

Considerations:

• What do you need to know concerning knee anatomy?
• What are mechanisms of injury that you must consider?
  • High vs. low energy mechanisms?
• What complications may occur?
  • Fractures, nerve injuries, vascular injury, compartment syndrome
• What should you consider with procedural sedation and reduction? What is your approach to reduction, and how do you troubleshoot difficulties?
• What are important components in post-reduction management?

Suggested Resources:

• Articles:
  • Orthobullets EM Dislocation
  • emDocs – Knee Dislocation: Pearls and Pitfalls
  • CoreEM – True Knee + Patellar Dislocations
• Podcasts:
  • FOAMCast – Episode 22 – The Knee
  • Emergency Medicine Cases – Episode 21 Occult Knee Injuries Pearls and Pitfalls
  • EM Updates Procedural Sedation