[Hereditary, congenital knee joint luxation].
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Wilderness trauma consists of common injuries diagnosed and treated in the least desirable environment. Improvisation is a key factor in wilderness medicine. The article discusses management of fractures; dislocations; and trauma to the head, neck, spine, abdomen, and chest. The physician accompanying an expedition should plan in advance for the management of acute traumatic injuries.
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In describing a case of congenital dislocation of the knee which was brought to the authors' attention, the paper highlights the three most important types of anatomofunctional difference associated to this malformation.
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Bone marrow contusions are frequently identified at magnetic resonance imaging after an injury to the musculoskeletal system. These osseous injuries may result from a direct blow to the bone, from compressive forces of adjacent bones impacting one another, or from traction forces that occur during an avulsion injury. The distribution of bone marrow edema is like a footprint left behind at injury, providing valuable clues to the associated soft-tissue injuries. Five contusion patterns with associated soft-tissue injuries occur in the knee: pivot shift injury, dashboard injury, hyperextension injury, clip injury, and lateral patellar dislocation. The classic bone marrow edema pattern seen following the pivot shift injury involves the posterolateral tibial plateau and the midportion of the lateral femoral condyle. Edema occurs in the anterior aspect of the proximal tibia following the dashboard injury. Hyperextension results in the "kissing" contusion pattern involving the anterior aspect of the proximal tibia and distal femur. The clip injury results in a prominent area of edema involving the lateral femoral condyle and a smaller area of edema involving the medial femoral condyle. Finally, lateral patellar dislocation results in edema involving the inferomedial patella and anterior aspect of the lateral femoral condyle. In many instances, the mechanism of injury can be determined by studying the distribution of bone marrow edema, which then enables one to predict with accuracy the specific soft-tissue abnormalities that are likely to be present.
In a group of 87 total knee joint prostheses with posterior stabilization, 18 femoro patellar complications happened. Fractures, loosening, dislocations and subluxations are relatively rare. The persistence of residual patellar pain was more frequent with a high proportion of femoro-patellar derangement syndrome (FPDS). This last complication was specific of posterior stabilization model (MK II) and its origin is related to the formation of a synovial pannus in front of intercondylar region. In one case, it was surgically removed. The existence of this "FPDS" is statistically correlated with lowering of the patella, posterior position of tibial tuberosity and excessive thickness of the patellar implant complex.
For a mean period of 7.8 years, the morphology of knee deformity and its annual changes in 8 patients (16 knees; mean age at the initial examination, 8.4 years) with multiple hereditary exostoses were evaluated radiographically. Knee deformity developed during the growth spurt period. Genu valgum with a femorotibial angle that decreased more than 2 standard deviations from the mean of age-matched normal children was observed in 6 of the 16 knees. In 3 of these 6 knees, recurrent dislocation of the patella was observed. Angulation of the femur varied among the knees, but the tibia showed valgus angulation in the proximal metaphysis in all knees. Thus, knee deformity in patients with multiple hereditary exostoses was primarily genu valgum caused by valgus angulation of the tibia.
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Bilateral posterior shoulder dislocations and vertebral fractures are well described complications of convulsive activity. A 72-year-old woman with osteoarthritis of both hips and knees centrally dislocated both hips during a tonic-clonic seizure. Bilateral central fracture dislocation of the hip, although rare, must be suspected in the postictal patient who complains of hip and knee pain.
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