膝关节的评估及处理

ASSESSMENT AND MANAGEMENT OF THE KNEE AND LOWER LIMB,Overview,HistoryExaminationX-raysFractures and Dislocations.Soft Tissue InjuriesOther Knee/Lower limb Problems,Anatomy of the Knee,Meniscus,Quads insertion,Ligamentum patellae,Patella,Femur,Tibia,Medial Collateral Ligt,Fibula,ACL,PCL,HISTORY,Mechanism of injury is vitally important.Flexed/TwistingForced flexion/HyperextensionFalls/Direct BlowSwelling Rapid/GradualPrevious Knee ProblemsNo Injury or Previous Problems?,KNEE EXAMINATION,LookWasting,swelling,deformity,redness,scarsFeelTemp,Effusion,crepitusMovePassive,ActiveResting position,SLR,Extension,flexion,collateral ligaments, cruciates menisci,X-RAYS,Ottawa Knee Rules,Xrays are only required if the following are present.Isolated bony tenderness of the patella.Bony tenderness of the fibula head.Patient cannot flex knee to 90Patient cannot weight bear (4 steps) after injury or in A&EExceptions,Knee,Tibia Plateau fractureFall extended leg,compression # proximal tibia.Valgus stress, # lateral tibia plateauVarus stress, # medial tibia plateauProximal tibia examination reveals tenderness.Swelling, haemarthrosis, ligament damage.X-ray,Fracture of lateral tibial plateau,Patella Facture,Patella,Patella FractureDirect blow, Fall, Violent flexion, Quadriceps contraction.Pain/Swelling, Crepitus, Pain on extensionStraight leg raise.HaemarthrosisX-rayTreatmentVerticalTransverse,High Patella,Patella,DislocationMedial stress Lateral dislocationKnee in flexion. Dislocation usually obvious.EntonoxMedial reduction with knee extension.Obtain X-rays, cylinder POP, Analgesia, and orthopaedic follow up.,Dislocation of the Knee,DislocationSerious ligamentous and soft tissue damage.Assess above and below knee.Vascular and Nerve damage.ReductionAdequate analgesiaTraction/Reduction of deformityCheck Pulses and SensationPOP backslabAdmission,Knee,Tibia Plateau FractureTreatmentLong POP backslabOrthopaedic referralElevationORIF/Bone grafting,Haemarthrosis,Acute haemarthrosisOnset of swelling following injuryWarm, tense, painfulCausesCruciate ligament damage, tibial avulsions, fracturesOrthopaedic opinion,Cruciate Ligament Rupture,ExaminationAnteriorLook for medial collateral and menicus damageAnterior drawAvulsion of anterior tibial spine.Posterior“Sagging” of tibiaAvulsed posterior tibial spine.Both require referral,ACL Rupture,PCL Rupture (tibial sag),Avulsion fracture of ACL insertion,Meniscal Injury,Usually twisting” injuryHistory crucialMcMurrays Test,Collateral Ligament Injury,ExaminationTenderness, stress testingGradingGrade I Local tenderness+slight or no laxityGrade II Local tenderness+laxity with endpoint. Orthopaedic follow upComplete rupture No endpoint. POP cylinder. Analgesia, Crutches. Orthopaedic referral,Soft Tissue Injuries,Ruptured QuadricepsUnable to straight leg raisePossible palpable defect.Surgical repairRuptured Patellar TendonUnable to straight leg raisePossible palpable defect. Displaced patellaAvulsion of tibial tuberositySurgical repair.,Soft Tissue Injury,“Locked” KneeFull extension blocked. Degree of which can vary.Possible meniscal injury.X-ray for loose body.Requires arthroscopy.,Bursitis,Typically from kneelingPrepatellar In front of patellaInfrapatellar Below patellaTreatment Rest, NSAIDS, stop kneeling Pyrexia and/or Cellulitis Fluid aspiration. Cultures. Antibiotics.,Prepetellar and Infrapatellar Bursitis,Knee problems not to be missed,Bakers CystOsteoarthritisSeptic ArthritisOsteomyelitisReferred painNB other lower limb problemsDVTCompartment Syndrome,Summary,When a patient complains of a painful kn