Cutting edge Orthopedics

Knee Dislocations • 49  39 months. In this study the patients who had supplemental placement of a hinged external knee brace had a higher failure rate compared to those who had supplemental treatment with a hinged external fixator (29% vs. 15%) [40]. Another factor that can influence outcome is the severity and type of injury. A recent study by Vallier and associates on 119 dislocations found that open knee dislocations had a significantly higher rate of amputation (26% vs 1.3%, p < 0.001). Vascular injury, more specifically popliteal artery injury was associated with a higher rate of amputation (31% vs. 3.2%, p < 0.001), infection (37% vs 8%, p = 0.002), and DVT (32% vs. 8.8%, p = 0.014). Patients with wound infection were more likely to develop heterotopic ossification (36% vs. 9.4%, p = 0.017) and less knee motion (77.5° vs. 117°, p = 0.049). Finally this study found that an ISS greater than 19 was associated with less knee motion (97 vs. 121, p = 0.029) [41]. References 1. O’Shea KJ, Murphy KP, Heekin RD, et al. The diagnostic accuracy of history, physical examination, and radiographs in the evaluation of traumatic knee disorders. Am J Sports Med. 1996;24:164–7. 2. Twaddle BC, Hunter JC, Chapman JR, et al. MRI in acute knee dislocation. A prospective study of clinical, MRI, and surgical findings. J Bone Joint Surg (Br). 1996;78:573–9. 3. Silverberg DA, Acus R. Irreducible posterolateral knee dislocation associated with interposition of the vastus medialis. Am J Sports Med. 2004;32:1313–6. 4. Walker DM, Kennedy JC. Occult knee ligament injuries associated with femoral shaft fractures. Am J Sports Med. 1980;8:172–4. 5. Wascher DC, Dvirnak PC, DeCoster TA. Knee dislocation: initial assessment and implications for treatment. J Orthop Trauma. 1997;11:525–9. 6. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am. 1977;59:236–9. 7. Patterson BM, Agel J, Swiontkowski MF, et al. Knee dislocations with vascular injury: outcomes in the Lower Extremity Assessment Project (LEAP) Study. J Trauma. 2007;63:855–8. 8. Stannard JP, Sheils TM, Lopez-Ben RR, et al. Vascular injuries in knee dislocations: the role of physical examination in determining the need for arteriography. J Bone Joint Surg Am. 2004;86-A:910–5. 9. 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;56:1261–5. 10. Busquets AR, Acosta JA, Colon E, et al. Helical computed tomographic angiography for the diagnosis of traumatic arterial injuries of the extremities. J Trauma. 2004;56:625–8. 11. Niall DM, Nutton RW, Keating JF. Palsy of the common peroneal nerve after traumatic dislocation of the knee. J Bone Joint Surg (Br). 2005;87:664–7. 12. Levy BA, Krych AJ, Shah JP, et al. Staged protocol for initial management of the dislocated knee. Knee Surg Sports Traumatol Arthrosc. 2010;18:1630–7. 13. Dedmond BT, Almekinders LC. Operative versus nonoperative treatment of knee dislocations: a meta-analysis. Am J Knee Surg. 2001;14:33–8. 14. Richter M, Bosch U, Wippermann B, et al. Comparison of surgical repair or reconstruction of the cruciate ligaments versus nonsurgical treatment in patients with traumatic knee dislocations. Am J Sports Med. 2002;30:718–27. 15. Harner CD, Waltrip RL, Bennett CH, et al. Surgical management of knee dislocations. J Bone Joint Surg Am. 2004;86-A:262–73. 16. Liow RY, McNicholas MJ, Keating JF, et al. Ligament repair and reconstruction in traumatic dislocation of the knee. J Bone Joint Surg (Br). 2003;85:845–51. 17. Owens BD, Neault M, Benson E, et al. Primary repair of knee dislocations: results in 25 patients (28 knees) at a mean follow-up of four years. J Orthop Trauma. 2007;21:92–6. 18. Mariani PP, Santoriello P, Iannone S, et al. Comparison of surgical treatments for knee dislocation. Am J Knee Surg. 1999;12:214–21. 19. Stannard JP, Brown SL, Farris RC, et al. The posterolateral corner of the knee: repair versus reconstruction. Am J Sports Med. 2005;33:881–8.