dislocation

What is a Dislocation?

Knee Dislocations occur when the bones that form the knee joint (the femur, tibia, and patella) are forced out of their normal alignment. This is a severe injury often caused by high-impact trauma and can involve significant damage to ligaments, blood vessels, and nerves.

Mechanism of Injury:

Knee dislocations are usually caused by severe trauma or high-impact forces such as:

High-Impact Trauma: Motor vehicle accidents, falls from a height, or sports-related injuries involving direct blows to the knee.
Twisting or Hyperextension: Forceful twisting or hyperextension of the knee, such as during contact sports or extreme activities.
Non-Traumatic Causes: In rare cases, severe muscular contractions or sudden changes in direction can lead to dislocation, particularly in individuals with hypermobile joints.

Symptoms

Severe Pain: Intense pain immediately following the dislocation, usually around the knee joint.
Visible Deformity: The knee may appear visibly out of place, with the bones misaligned or the kneecap displaced.
Swelling and Bruising: Rapid swelling and bruising around the knee.
Inability to Move the Knee: The knee is typically immobile, and the leg may appear bent or twisted.
Numbness or Tingling: If nerves are involved, there may be numbness, tingling, or a lack of sensation in the lower leg or foot.
Instability: The knee may feel extremely unstable or unable to bear weight.
Pale or Cool Skin: If blood vessels are damaged, the lower leg or foot may appear pale, cool, or lose its pulse, indicating a possible emergency.

Treatment

Pre-Hospital Treatment:

Do Not Attempt to Realign: Do not attempt to move or realign the knee. Immobilise the leg in the position it was found.
Immobilisation: Use a splint or any available material to keep the knee as still as possible.
Control Bleeding: If there is an open wound, apply sterile dressings and pressure to control bleeding, avoiding the joint itself if possible.
Monitor Circulation: Check for a pulse below the injury, and observe the colour and temperature of the foot to ensure blood flow.
Avoid Eating or Drinking: The patient may need surgery, so avoid food or drink.
Emergency Services: Call for emergency medical help immediately. This injury is a medical emergency due to the risk of vascular or nerve damage.

Assessment: Immediate medical evaluation, including imaging (X-rays, MRI) to determine the extent of the dislocation and any associated damage to ligaments, blood vessels, and nerves.
Reduction: A healthcare professional will typically perform a closed reduction (manually realigning the bones) under sedation or anesthesia. Surgery may be required if closed reduction is not possible or if there is extensive damage.
Surgical Intervention: Often necessary to repair damaged ligaments, blood vessels, or nerves, and to stabilize the knee joint. Surgery may involve reconstructive procedures depending on the severity of the injury.
Immobilisation: After reduction, the knee may be immobilised in a splint or brace to allow healing. The duration depends on the severity of the injury and the structures involved.
Pain Management: Medication for pain relief, which may include anti-inflammatory drugs and analgesics.
Physical Therapy: Once healing allows, a comprehensive rehabilitation program focusing on restoring range of motion, strengthening the muscles around the knee, and gradually returning to weight-bearing activities.
Rehabilitation Plan: Includes progressive exercises to restore knee stability, flexibility, and strength. The rehab process is typically long and requires close supervision.
Dry Needling and Massage: Utilised during rehabilitation to reduce muscle tension and pain, improve circulation, and promote healing.
Ultrasound Therapy: Applied to reduce inflammation and aid in tissue repair, particularly after surgery.
Hot Stones and Cupping: May be used during rehabilitation for muscle relaxation and pain relief, helping to facilitate recovery.