KNEE DISLOCATION, TIBIA-FIBULA
DEFINITION--Injury and displacement of the bones of the lower leg so they no longer touch each other. This is less common than dislocation of the kneecap. It often occurs with fracture of the tibia.
BODY PARTS INVOLVED
Lower leg bones (tibia and fibula) where they join the knee joint.
Soft tissue surrounding the dislocation, including nerves, periosteum (covering of bone), tendons, ligaments, muscles and blood vessels.
SIGNS & SYMPTOMS
A feeling of the knee "giving way."
Excruciating pain at the time of injury.
Locking of the dislocated bones in the abnormal position or spontaneous reposition, leaving no apparent deformity.
Tenderness over the dislocation.
Swelling and discoloration of the knee.
Numbness or paralysis in the lower leg and foot from pressure, pinching or cutting of blood vessels or nerves.
Direct blow to the knee.
End result of a severe sprain caused by a twisting injury.
Powerful muscle contractions related to quick changes of direction while running.
RISK INCREASES WITH
Contact and running sports.
Person with a wide pelvis and "knock-knees".
Previous knee sprains.
Repeated knee injury.
Arthritis of any type (rheumatoid, gout).
Poor muscle conditioning.
Congenital abnormalities of the knee joint.
HOW TO PREVENT
Develop your muscle strength and overall conditioning.
Warm up adequately before physical activity.
After recovery, protect the knee during contact or running sports by wearing wrapped elastic bandages, tape wraps, knee pads or special support stockings.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. This will include manip- ulation of the knee to reposition the bones.
Surgery (usually) to restore the knee to normal function.
Self-care during rehabilitation.
Your own observation of symptoms.
Medical history and exam by a doctor.
X-rays of the knee joint and adjacent bones.
AT THE TIME OF INJURY:
Pressure on or injury to nearby nerves, ligaments, tendons, muscles, blood vessels and connective tissue. This causes numbness, coldness and paleness in the leg or foot.
AFTER TREATMENT OR SURGERY:
Impaired blood supply to the dislocated area.
Infection introduced during surgical treatment.
Excessive internal bleeding around the knee.
Recurrent dislocations, particularly if the previous dislocation has not healed completely.
Loss of muscle strength.
Unstable or arthritic knee following repeated injury.
PROBABLE OUTCOMEAfter the dislocation has been corrected and the knee has been surgically repaired, the knee may require immobilization in a long leg cast for 3 weeks. Complete healing of injured ligaments requires a minimum of 6 weeks. Avoid contact sports if all treatments are unsuccessful in restoring a strong, stable knee.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
Keep the person warm with blankets to decrease the possibility of shock.
Cut away clothing if possible. Don't move the injured area to remove clothing.
Immobilize the knee, hip and ankle joints with padded splints.
Follow instructions for R.I.C.E., the first letters of REST,
ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
The doctor will realign the dislocated bones with surgery or, if possible, without. This should be done as soon as possible after injury. Within 6 hours after the dislocation, bleeding and displacement of body fluids may lead to shock. Also, many tissues lose their elasticity and become difficult to return to a normal position.
CONTINUING CAREAfter removal of the cast:
Use an ice pack 3 or 4 times a day. Wrap ice chips or cubes in a plastic bag, and wrap the bag in a moist towel. Place it over the injured area for 20 minutes at a time.
You may try heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, or heat liniments and ointments.
Take whirlpool treatments, if available.
Massage gently and often to provide comfort and decrease swelling.
MEDICATIONYour doctor may prescribe:
General anesthesia or muscle relaxants to make joint manipulation possible.
Acetaminophen or aspirin to relieve moderate pain.
Narcotic pain relievers for severe pain.
Stool softeners to prevent constipation due to decreased activity.
Antibiotics to fight infection following surgery.
Walk on crutches while the cast is in place.
Resume usual activities gradually after surgery.
Begin weight-bearing and reconditioning of the knee after clearance from your doctor.
Don't drive until healing is complete.
Drink only water before manipulation or surgery to correct the dislocation. Solid food in your stomach makes vomiting while under general anesthesia more hazardous.
During recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Increase fiber and fluid intake to prevent constipation that may result from decreased activity.
Begin daily rehabilitation exercises after clearance from your doctor.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a dislocated knee, even if it repositions itself. Call immediately if the leg becomes numb, pale, or cold. This is an emergency!
Any of the following occur after treatment or surgery:
Nausea or vomiting.
Swelling above or below the cast.
Blue or gray skin color below the cast, particularly under the toenails.
Numbness or complete loss of feeling below the knee.
Increasing pain, swelling or drainage in the surgical area.
Signs of infection (headache, muscle aches, dizziness, or a general ill feeling and fever).
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
Knee dislocations that you can "pop" back into normal position occur repeatedly.