Difference between revisions of "Patella dislocation"

Revision as of 16:42, 9 May 2017

Occurs with trauma to an extended knee with externally rotated foot and twisting motion^[1]
Acute: in traumatic injury, occurs equally in men/women ^[2]
Chronic: women/teenage girls^[2]
Commonly lateral displacement and unable to extend knee

patella dislocates laterally

Xray if traumatic mechanism to rule out fracture
Do not need xay prior to reduction if chronic
Post-reduction x-ray: confirm reduction, eval for fractures and loose bodies (avulsions, misalignment, etc)^[3]
Common associated fractures
- Medial patella facet
- Lateral femoral condyle

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
- Option #1:
  - Mild flexion of hip (20-30 degrees by raising head of bed, not by propping the leg up off the bed) to relax quadriceps
  - Slowly extend and slightly hyperextend the knee and slide patella back into place.
- Option #2
  - One provider applies slow downward pressure over the quads. This stretches out the muscle and slowly straigtens the leg
  - At the same time, second pulls gentle traction of the patella outward while rotating the patella back over from lateral to anterior
- Knee immobilizer, NSAIDs, weight-bearing as tolerated
- Orthopedic follow-up within 1-2wks
Unable to reduce or loose bodies/fracture on post-reduction imaging
- Obtain immediate ortho consult

↑ 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
↑ ^2.0 ^2.1 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
↑ 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

@@ Line 25: / Line 25: @@
 ==Management==
 [[File:Patellar Dislocation Relocation.jpg|thumb|Relocation with lateral pressure on dislocated patella]]
-*Reduce; do not need x-rays prior to reduction
+*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
-**Mild flexion of hip (20-30 degrees) to relax quadriceps
+**Option #1:
-**Extend and slightly hyperextend the knee and slide patella back into place
+***Mild flexion of hip (20-30 degrees by raising head of bed, not by propping the leg up off the bed) to relax quadriceps
-**Knee immobilizer, NSAIDs, partial weight-bearing
+***Slowly extend and slightly hyperextend the knee and slide patella back into place.
+**Option #2
+***One provider applies slow downward pressure over the quads.  This stretches out the muscle and slowly straigtens the leg
+***At the same time, second pulls gentle traction of the patella outward while rotating the patella back over from lateral to anterior
+**Knee immobilizer, NSAIDs, weight-bearing as tolerated
 **Orthopedic follow-up within 1-2wks
 *Unable to reduce or loose bodies/fracture on post-reduction imaging