Tag Archive for: Fasciotomy

Pure Obturator Dislocation of the Hip, a Rare Variety of Regular Dislocations, and Long-Term Clinical Outcomes

Vol 8 | Issue 1 | January-June 2022 | page: 19-21 | Walid Bouziane, Machmachi Amine, Soufiane Aharram, Omar Agoumi, Abdelkrim Daoudi

DOI: 10.13107/ti.2022.v08i01.025


Authors: Walid Bouziane [1], Machmachi Amine [2], Soufiane Aharram [1], Omar Agoumi [1], Abdelkrim Daoudi [1]

[1] Department of Orthopaedic Surgery and Traumatology, University Hospital Oujda, Morocco.
[2] Department of Medicine and Pharmacy, Mohammed First Oujda University, Oujda, Morocco.

Address of Correspondence

Dr Walid Bouziane,
Department of Orthopaedic Surgery and Traumatology, University Hospital Oujda, Morocco.
E-mail: walidbouziane93@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] Phillips AM, Konchwalla A. The pathologic features and mechanism of traumatic dislocation of the hip. Clin Orthop 2000;377:7.

[2] Elouakili I, Ouchrif Y, Ouakrim R, Lamrani O, Kharmaz M, Ismael F, Lahlou A, El BardouniA,Mahfoud M, Berrada MS, El Yaacoubi M. Luxation obturatrice de la hanche: un traumatisme rare en pratique sportive. Pan AfricanMedical Journal. 201418 : 138.

[3] Epstein HC, Wiss DA. Traumatic anterior dislocation of the hip. Orthopedics 1985;8:130–2.

[4] Bouya A, et al. Luxation obturatrice de la hanche : survenue rare en milieu sportif. J Traumatol Sport (2017).

[5] Phillips AM, Konchwalla A. The pathologic features and mechanism of traumatic dislocation of the hip. Clin Orthop. 2000;377:7–1.

[6] Catonné Y, Meyer A, Sariali E, Biette G. Pathologie du complexe pelvi-fémoral du sportif. Pathologie du complexe pelvi-fémoral du sportif. 2009:88–99.

[7] Dellanh YY, et al. Luxation obturatrice de la hanche : à propos d’un cas. Pan African Med J 2015;22:195.

[8] Toms AD, Williams S, White SH. Obturator dislocation of the hip. J Bone Joint Surg (Br). 2001; 83(1): 113- 115.

[9] Brav EA. Traumatic anterior dislocation of the hip. J Bone Joint Surgery (Am). 1962; 44(A): 1115-1121.

[10] Polesky RE, Polesky FA. Intrapelvic dislocation of the femoral head following anterior dislocation of the hip: a case report. J Bone Joint Surg (Am). 1972;54(5):1097-8.

[11] Richards BS, Howe DJ. Anterior perineal dislocation of the hip with fracture of the femoral head: a case report. Clin Orthop. 1988;228: 194-201.

[12] Catonné Y, Meyer A, Sariali E, Biette G. Luxation de hanche sans fracture au cours d’activités sportives. In: Pathologie du complexe pelvi-fémoral du sportif; 2009. p. 88–99.

[13] Yang RS, Tsuang YH, Hang YS. Traumatic dislocation of the hip. Clin Orthop 1991;265:218.

[14] Hougaard K. Traumatic posterior dislocation of the hip: prognostic factors influencing the incidence of avascular necrosis of femoral head. Arch Orthop Trauma Surg. 1986;106(1):32–5.


How to Cite this article: Bouziane W, Amine M, Aharram S, Agoumi O, Daoudi A | Pure Obturator Dislocation of the Hip, a Rare Variety of Regular Dislocations, and Long-Term Clinical Outcomes | January-June 2022; 8(1): 19-21.

 


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

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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Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation

Vol 3 | Issue 2 | Sep – Dec 2017 | page: 16-20 | M. Shoaib Qureshi, Mangesh Panat, Pratik Israni


Author: M. Shoaib Qureshi [1], Mangesh Panat [1], Pratik Israni[1].

[1]Department Of Orthopedics, Mgm Hospital & Research Centre, Aurangabad, India

Address of Correspondence
Dr.  Mangesh Panat,
Dept. of orthopedics, mgm medical college and hospital.
Email: mangeshpanat@yahoo.co.in


Learning Points for this Article: This article will focus on successful management of proximal tibia fractures with impending compartment syndrome in two stages supporting the practice of delayed internal fixation until the soft-tissue envelope allows for definitive fixation.


Abstract

Introduction: High energy proximal tibia fractures with soft tissue involvement presenting with dicolored patches over the leg and severe swelling, compound wounds, blisters with tight compartments and absent or feeble dorsalis pedis or posterior tibial arteries warrant to go in for a staged procedure. In patients with multiple injuries, an external fixator can be applied quickly with minimal blood loss for unstable periarticular fractures around the knee. Two-stage procedures involve (1) early joint spanning external fixators with fasciotomy for the medial and posterior compartments, (2) and late definitive fixation with plates or nails and with skin grafting.
Materials and Methods: In our study, we present a short series of 15 proximal tibial fractures with impending compartment syndrome. Patients selected for this study were (1) closed proximal tibia fracture intra- and peri-articular and metaphysis diaphysis junction communited and noncommunited fractures (2) impending compartment syndrome evaluated based on excessive swelling, tight compartments, blisters over skin, feeble or absent dorsalis pedis or posterior tibial pulsations, color Doppler suggestive of severe subcutaneous edema associated with monophasic or absent flow over distal arteries.
Exclusion criteria: (1) Low energy proximal tibia fracture without soft tissue insult and compound wounds over the proximal tibia fractures, (2) associated popliteal artery injuries.
Conclusion: With the initial application of a bridging external fixator followed by delayed internal fixation protocol for pilon fractures has been successful in reducing the historically high rates of wound complications associated with these high-energy injuries. As well this protocol allows the use of minimally invasive plate osteosynthesis technique which is based on a combination of the principles of stability, restoration of anatomy and early motion while eliminating the need for excessive soft tissue dissection.
Keywords: Proximal Tibial fractures, External fixators, Fasciotomy, Definitive fixation.


References

1. Dougherty PJ, Silverton C, Yeni Y, Tashman S, Weir R. Conversion from temporary external fixation to definitive fixation: Shaft fractures. J Am Acad Orthop Surg 2006;14:S124-S127.
2. Chan PS, Klimkiewicz JJ, Luchetti WT, Esterhai JL, Kneeland JB, Dalinka MK, et al. Impact of CT scan on treatment plan and fracture classification of tibial plateau fractures. J Orthop Trauma 1997;11(7):484-489.
3. Weigel DP, Marsh JL. High-energy fractures of the tibial plateau. Knee function after longer follow-up. J Bone Joint Surg Am 2002;84(9):1541-1551.
4. Ricci WM, Rudzki JR, Borrelli J Jr. Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J Orthop Trauma 2004;18(8):521-527.
5. Gosling T, Schandelmaier P, Muller M, Hankemeier S, Wagner M, Krettek C. Single lateral locked screw plating of bicondylar tibial plateau fractures. Clin Orthop Relat Res 2005;439:207-214.
6. Egol KA, Tejwani NC, Capla EL, Wolinsky PL, Koval KJ. Staged management of high-energy proximal tibia fractures (OTA types 41): The results of a prospective, standardized protocol. J Orthop Trauma 2005;19(7):448-455.
7. Watson JT, Moed BR, Karges DE, Cramer KE. Pilon fractures. Treatment protocol based on severity of soft tissue injury. Clin Orthop Relat Res 2000;78-90.
8. Haidukewych GJ, Collinge CA. Conversion of Temporary External Fixation to Formal Internal Fixation for Complex per Articular Injuries of the Lower Extremity: Is there an Infection risk? Presented at the American Academy of Orthopaedic Surgeons Annual Meeting, Dallas, Texas; 2002.


How to Cite this article:  Qureshi MS, Panat M, Israni P. Two-Staged Management of Proximal Tibial Fractures with Impending Compartment Syndrome By Temporary External Stabilization and Fasciotomy and Delayed Definitive Fixation. Trauma International Sep-Dec 2017;3(2):16-20.



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