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Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report

June 10, 2022/in January-June 2022 | Volume 8 | Issue 1

Vol 8 | Issue 1 | January-June 2022 | page: 15-18 | Ajay Kurahatti, Hariprasad S, Satyarup D DOI: 10.13107/ti.2022.v08i01.024 Authors: Ajay Kurahatti [1], Hariprasad S [1], Satyarup D [1] [1] Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Address of Correspondence Dr. Ajay Kurahatti, Assistant Professor, Department of Orthopaedics, Sri Devaraj […]

Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report

June 10, 2022/in January-June 2022 | Volume 8 | Issue 1

Vol 8 | Issue 1 | January-June 2022 | page: 11-14 | Steven Gonzales Farrell, Munif Hatem, Hal David Martin DOI: 10.13107/ti.2022.v08i01.023 Authors: Steven Gonzales Farrell [1], Munif Hatem [2], Hal David Martin [2] [1] Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States. [2] Department of Orthopaedic Surgery, Baylor University Medical Center, […]

Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report

June 10, 2022/in January-June 2022 | Volume 8 | Issue 1

Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report

June 10, 2022/in January-June 2022 | Volume 8 | Issue 1

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Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report

June 10, 2022/in January-June 2022 | Volume 8 | Issue 1

Vol 8 | Issue 1 | January-June 2022 | page: 15-18 | Ajay Kurahatti, Hariprasad S, Satyarup D

DOI: 10.13107/ti.2022.v08i01.024

Authors: Ajay Kurahatti [1], Hariprasad S [1], Satyarup D [1]

[1] Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.

Address of Correspondence

Dr. Ajay Kurahatti,
Assistant Professor, Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.
E-mail: ajaykurahatti@gmail.com

Abstract

Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction.
History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent.
Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint.
Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed.
Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution.
Keywords: Dislocation, Posterior tibial artery, Fasciotomy

References

1. Jacodzinski M, Petri M. (2014). Knee dislocations and soft tissue injuries. Skeletal Trauma: Basic Science, Management and reconstruction, Philadelphia, Saunders, 1907-36.

2. Whelan AB, Levy BA. Knee dislocations. Rockwood and Green’s Fractures in Adults, Lippincott Williams & Wilkins, 2369-414.

3. Miller HH, Welch CS. (1949) Quantitative studies on the time factor in arterial injuries. Ann Surg, 130, 428-30.

4. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977; 59(2): 236-9.

5. Merrill KD. Knee dislocations with vascular injuries. Orthop Clin North Am 1994; 25(4): 707-13.

6. Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: an evidence-based approach to the management of the multiligament injured knee. Injury 2011; 42(11): 1198-204.

7. Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004; 56(6): 1261-5.

8. Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985(198): 94- 101.

9. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86-A(2): 262-73.

How to Cite this article: Kurahatti A, S Hariprasad, D Satyarup | Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report | January-June 2022; 8(1): 15-18.

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Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report

June 10, 2022/in January-June 2022 | Volume 8 | Issue 1

Vol 8 | Issue 1 | January-June 2022 | page: 11-14 | Steven Gonzales Farrell, Munif Hatem, Hal David Martin

DOI: 10.13107/ti.2022.v08i01.023

Authors: Steven Gonzales Farrell [1], Munif Hatem [2], Hal David Martin [2]

[1] Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States.
[2] Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, TX.

Address of Correspondence

Dr Steven Gonzales,
Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States.
E-mail: stevefarrell125@gmail.com

Abstract

Introduction: Ischiofemoral impingement is a cause of posterior hip pain and limitation in hip extension. The compensatory motion at the lumbar spine associated with limitation in hip mobility has been associated with low-back pain, and an increase of 30% in the load at L3-L4 and L4-L5 lumbar facet joint is reported in a cadaveric study involving simulated ischiofemoral impingement.

Case Presentation: A 66-year-old female developed low back pain associated with bilateral hip pain over a period of 12 years. The symptoms persisted despite 5 surgical interventions in the lumbar spine and sacroiliac joints. Impingement between the lesser trochanter and ischium, with limitation of hip extension, was identified on the physical examination and imaging studies. The patient underwent endoscopic partial resection of the lesser trochanter bilaterally. The Oswestry lumbar disability index improved from 56% before surgery to 14% at the 17-month follow-up. Impingement between the lesser trochanter and ischium should be considered in the differential diagnosis of low back pain.

Conclusion: Ischiofemoral impingement should be considered as a differential diagnosis for patients with unsuccessful lumbar spine surgery.

Keywords: Ischiofemoral impingement, Low back pain, Hip pain

References

1. Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am. 1977;59(2):268-269.

2. Truong WH, Murnaghan L, Hopyan S, Kelley SP. Ischioplasty for Femoroischial Impingement. J Bone Joint Surg Am. 2012;2(3):2-6.

3. Torriani M, Souto SCL, Thomas BJ, Ouellette H, Bredella M a. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;193(1):186-190.

4. Hatem MA, Palmer IJ, Martin HD. Diagnosis and 2-year outcomes of endoscopic treatment for ischiofemoral impingement. Arthroscopy. 2015;31(2):239-246.

5. Patti JW, Ouellette H, Bredella MA, Torriani M. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skeletal Radiol. 2008;37(10):939-941. doi:10.1007/s00256-008-0551-3

6. Tosun O, Algin O, Yalcin N, Cay N, Ocakoglu G, Karaoglanoglu M. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skeletal radiology. 2012;41(5):575-587. doi:10.1007/s00256-011-1257-5.

7. Hatem M, Martin HD. Low Back Pain Improves After Surgery for Lesser Trochanteric–Ischial Impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021; 37 (5): 1503-1509. doi: 10.1016/j.arthro.2021.01.006.

8. Tosun O, Cay N, Bozkurt M, Arslan H. Ischio femoral impingement in an 11-year-old girl. Diagn Interv Radiol. Published online 2012. doi:10.4261/1305-3825.DIR.5728-12.1

9. Gómez-Hoyos J, Khoury A, Schröder R, Johnson E, Palmer IJ, Martin HD. The Hip-Spine Effect: A Biomechanical Study of Ischiofemoral Impingement Effect on Lumbar Facet Joints. Arthroscopy. 2017;33(1):101-107.

10. Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25(22):2940-2953.

11. Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Maak TG, Anderson AE. In Vivo Measurements of the Ischiofemoral Space in Recreationally Active Participants During Dynamic Activities: A High-Speed Dual Fluoroscopy Study. The American journal of sports medicine. 2017;45(12):2901-2910.

12. DiSciullo AA, Stelzer JW, Martin SD. Dynamic Ischiofemoral Impingement: Case-Based Evidence of Progressive Pathophysiology from Hip Abductor Insufficiency: A Report of Two Cases. JBJS case connector. 2018;8(4):e107.

13. Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus hip with high antetorsion causes pain through posterior extraarticular FAI. Clinical orthopaedics and related research. 2013;471(12):3774-3780.

14. Morris WZ, Fowers CA, Weinberg DS, Millis MB, Tu LA, Liu RW. Hip morphology predicts posterior hip impingement in a cadaveric model. HIP International. 2019;29(3):322-327.

How to Cite this article: Farrell SG, Hatem M, Martin HD | Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report | January-June 2022; 8(1): 11-14.

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Half Sized Blog Element (Multi Author Style)

Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report

Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report

Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report

Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report

Full Sized Blog Element (Big Preview Pic)

Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report

Authors: Ajay Kurahatti [1], Hariprasad S [1], Satyarup D [1]

Abstract

References

(Abstract Text HTML) (Download PDF)

Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report

Authors: Steven Gonzales Farrell [1], Munif Hatem [2], Hal David Martin [2]

Abstract

References

(Abstract Text HTML) (Download PDF)

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