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Acute Knee Injury

Acute Knee Injury. LTC Fred H. Brennan, Jr., DO, FAOASM, FAAFP Director, Tri-Service Primary Care Sports Medicine Fellowship Assistant Professor Uniformed Services University of the Health Sciences Bethesda, MD. Case Study.

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Acute Knee Injury

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  1. Acute Knee Injury LTC Fred H. Brennan, Jr., DO, FAOASM, FAAFP Director, Tri-Service Primary Care Sports Medicine Fellowship Assistant Professor Uniformed Services University of the Health Sciences Bethesda, MD

  2. Case Study • 21 year old All American football player “entangled” in broken play injuring left knee • Intense pain • Difficult to bear weight • Iced, crutches, your office in morning

  3. Exam • WB with crutches • Swollen knee • Unable to get an accurate exam • Neurovascular intact • What is your differential diagnosis?

  4. Possibilities • ACL tear • Peripheral meniscal tear • Pre-patellar bursitis • Patellar subluxation/dislocation • Osteochondral fracture

  5. Do You Want an X-ray?

  6. X-ray Segond fracture Femoral condyar fracture

  7. Aspirate the Knee? • Indications post trauma • Pain • Improve motion • Diagnosis: Hemarthrosis Fat globules Contraindications - Overlying infection - Inexperience

  8. Put it Together • Hemarthrosis • Fat globules • X-ray findings • History • What is your diagnosis?

  9. Case Study • Intra-articular fracture • Probable ACL tear • How do we acutely manage this?

  10. Management • NWB on crutches • PRICE-M • Education • Refer to Ortho within 72 hours

  11. Take Home Points • 5 causes of acute knee swelling • X-ray preferable before exam but sometimes not practical • Timing and amount of swelling is helpful • Inability to weight bear is concerning • Consider aspiration for diagnosis and therapeutic relief of pain

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